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Observational Study
. 2014 Dec 10:19:367.
doi: 10.11604/pamj.2014.19.367.4719. eCollection 2014.

Direct observation of outpatient management of malaria in a rural Ghanaian district

Donne Kofi Ameme  1 , Edwin Andrews Afari  1 , Kofi Mensah Nyarko  2 , Keziah Laurencia Malm  3 , Samuel Sackey  1 , Fred Wurapa  1
Affiliations
Observational Study

Direct observation of outpatient management of malaria in a rural Ghanaian district

Donne Kofi Ameme et al. Pan Afr Med J. .

Abstract

Introduction: In Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines.

Methods: We conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median.

Results: Of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message.

Conclusion: Conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement.

Keywords: Ghana; Malaria; case-management; observation.

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Figures

Figure 1
Figure 1
Map of Eastern Region of Ghana showing the 26 districts including Kwahu South District. The insert depicts the location of the Eastern Region in Ghana
Figure 2
Figure 2
Proportion of suspected malaria cases tested (microscopy or RDT) and appropriately prescribed ACTs by health facility, Kwahu South District, 2013
Figure 3
Figure 3
Health workers’ reasons for prescribing other anti-malarials other than AA, Kwahu South District, 2013
See this image and copyright information in PMC

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