Assessing malaria case management among children under five years of age attending health facilities in Urambo district

Abstract

Background Malaria is still a major public health problem in Tanzania. Due to this, the Ministry of Health and Social Welfare has developed guidelines for malaria case management. The main goal of the guidelines in the country is to attain uniformity and rational use of Antimalarials in malaria case management. The current guidelines specifically emphasize the use of parasitological confirmatory test using mRDTs or microscopy before taking the recommended ACTs. Objective This study aimed to assess malaria case management practices among children under five years of age attending health facilities in Urambo District, as per the National Guidelines for malaria case management of Tanzania. Materials and Methods A descriptive and analytical cross sectional survey was conducted at the Out Patient Clinic of randomly selected health facilities in Urambo District from April to mid May 2013. The routine diagnosis and treatment practices were assessed for all children under five years during exit interviews. Results The study involved 380 children under five and 87 health care workers. The prevalence of malaria by mRDTs was 40% and by blood slide read at Urambo was 19.5% and when quality controlled at MUHAS it was 20.5%. Out of 380 children, 260 (68.4%) had fever. vi Medications prescribed to children were as follows: Antipyretics (97.6%), Antimalarials (82.1%), Antibiotics (60%), Haematinics (3.7%) and Antihelminthic (1.8%). Antimalarials were prescribed for 312 (82.1%) children and ALu was the commonest antimalarial prescribed (81.1%). The others were Quinine injection (17%), Quinine tabs (0.6%) and SP (0.3%). Among the children prescribed Antimalarials, 186 (59.6%) had negative mRDTs results. Only 49 (56.3%) health care workers were trained on the guidelines for malaria case management. Guidelines were available in 33 (37.9%) health facilities, availability of diagnostics both mRDTs and microscopes were 100% and 86.2% respectively and ALu availability was 100%. Conclusions and Recommendations In this study there was irrational use of Antimalarials. Physical examination was not properly done. This indicates that the National guideline for malaria case management is not strictly followed in Urambo District. Therefore better strategies for improving health care workers adherence to guidelines