Evaluation of severe malaria case management in Mazowe District, Zimbabwe, 2014

Abstract

Introduction: Malaria is a preventable and curable disease. Mazowe district had been experiencing a lower malaria transmission rate in comparison to other districts in the Mashonaland Central province but it experienced a huge outbreak in the 2013-2014 rainy seasons with a case fatality rate (CFR) of 0.21%. This CFR was the highest in the province and it was twice as much as the national CFR (0.12%) for the same period. We evaluated severe malaria case management in Mazowe district to determine if practice is as per standard treatment guidelines.

Methods: A descriptive cross sectional study was conducted in Mazowe district using the Logical Framework approach. District Health Executives (DHE) members, nurses and severe malaria case notes were purposively and conveniently selected into the study. Key informant Interviews and review of case notes were carried out. All data were analysed using Epi Info 3.5.1.to calculate means and frequencies. Permission to conduct the study was obtained from the Mashonaland Central Provincial Medical Directorate (PMD) Institutional Ethical Review Board (IRB).

Results: The median age in years of the cases was 16 (Q1=7.3; Q3=30.8) and up to 58.1% of the cases were female. Inputs including staff, medicines and medical and laboratory equipment for severe case management were inadequate in the district. Only 60% of severe cases were diagnosed using blood slides and up to 95.6% of cases presented with one or more of the clinical signs of severe malaria. All severe cases were treated using correct anti-malarial and analgesic doses. Patient monitoring was not done as per prerequisite intervals and up to 5% of cases died. The health workers had above average knowledge on severe malaria.

Conclusion: Severe malaria case management inputs were inadequate in the district. For many cases, the district did not follow complicated malaria treatment guidelines for diagnosis, treatment and monitoring. Untrained staff needs training in Severe Malaria Case Management and monitoring of commodity stocks needs to be strengthened.

Keywords: Severe malaria; case management; patient monitoring.