GUIDELINES FOR SUPPORT OF HEWS IN MALARIA TREATMENT PRACTICE IN ETHIOPIA

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Malaria diagnosis

Appropriate diagnosis of health problems such as malaria is one of essential elements of rational drug use cycle (MSH & WHO 1997:423). With regard to diagnosis, there are two main methods of malaria diagnosis: diagnosis of malaria according to clinical signs and symptoms, and detection of parasites in the blood (laboratory testing). Laboratory testing using light microscopy or RDT to confirm presence of malaria parasite in blood is the preferred method of diagnosis, and is strongly recommended by the WHO, especially in areas of low to moderate malaria transmission (WHO 2010a:11).

Malaria treatment

Immediate treatment with efficacious antimalarial medicines at an early stage of malaria infections creates rapid full recovery. Access to effective antimalarial medicines and prompt treatment also minimises the chance of severe malaria and death. Ineffective medicine and delayed treatment particularly in Plasmodium falciparum creates a chance to increase parasite load in the patient’s blood and increases the probability of development of severe malaria (WHO 2010a:4). Hence, appropriate treatment (adequate dose, duration and counselling) with effective medication against malaria parasites, minimises the development of severe malaria and death (WHO, 2010a:5). According to the WHO treatment guideline (WHO 2010a:49): Chloroquine 25 mg base/kg body weight divided over 3 days is the drug of choice for chloroquine sensitive infections. Chloroquine also combined with Premaquine 0.25 mg base/kg body weight once daily for 14 days to treat systemic infection of Plasmodium vivax malaria.

Compliance to malaria diagnosis

The appropriate treatment of malaria with effective drugs is a “fundamental pillar of the malaria control strategy” (Eriksen et al 2007:52). Health workers’ adherence to diagnostic and treatment guidelines is one of the critical aspects determining effective implementation of malaria case management policies (Whitty, Chandler, Ansah, Leslie & Staedke 2008). For appropriate treatment to take place, making the malaria diagnosis according to treatment guidelines and adequately assessing malaria cases is vital, and helps to ensure correct treatment. Inadequate clinical assessment could cause incorrect diagnosis and inappropriate treatment of malaria episodes and other conditions (Eriksen et al 2007:53).

Compliance to prescribing and dispensing

In addition to problems in diagnosis, another challenge is the quality of prescription by the health workers for those patients who attend health facilities. Studies indicate that prescribed treatment is often incorrect in dosage and duration and that unnecessary drugs are prescribed to patients (Eriksen et al 2007). But the WHO (2010a:24) strongly recommends that whilst prescribing and dispensing, all patients ought to get appropriate 54 drugs, adequate information about the drugs prescribed as well as become informed about the disease in order to fully promote adherence.

Factors affecting compliance to treatment guidelines

According to Wassuna et al (2008), the factors affecting health workers’ compliance to antimalarial drug prescription include: “health workers perception, health workers concern about the cost of drug, health workers fear of drug stock outs, excess stock of non-recommended drugs, ambiguous training messages, severity of illness, and patient pressure”. The quality of prescribing drugs also affected by the availability of diagnostic facility, the type of health facility, patient expectation, the level of training of health workers, availability of medical supplies, and drugs (Boonstra et al 2002).

Table of Contents :

• CHAPTER 1 Overview of the study
  • 1.1 INTRODUCTION
  • 1.2 BACKGROUND TO THE PROBLEM
    • 1.2.1 Malaria control
    • 1.2.2 Health extension program
    • 1.2.3 Adherence to medications
    • 1.2.4 Antimalarial drug use
  • 1.3 GUIDELINES FOR DIAGNOSIS AND TREATMENT OF MALARIA
    • 1.3.1 Malaria diagnosis
    • 1.3.2 Malaria treatment
  • 1.4 PROBLEM STATEMENT
  • 1.5 RESEARCH QUESTIONS
  • 1.6 PURPOSE AND OBJECTIVES OF THE STUDY
  • 1.7 DEFINITIONS OF KEY CONCEPTS
  • 1.8 PARADIGMATIC PERSPECTIVE OF RESEARCH
    • 1.8.1 Ontological assumptions
    • 1.8.2 Epistemological assumptions
    • 1.8.3 Methodological assumptions
  • 1.9 RESEARCH DESIGN AND METHODOLOGY
    • 1.9.1 Research design
    • 1.9.2 Research setting
    • 1.9.3 Population of the study
    • 1.9.4 Sample size and sampling techniques
    • 1.9.5 Data collection
    • 1.9.6 Data analysis
  • 1.10 TRUSTWORTHINESS
  • 1.11 ETHICAL CONSIDERATIONS
  • 1.12 DEVELOPMENT OF THE GUIDELINES
  • 1.13 SCOPE OF THE STUDY
  • 1.14 OUTLINE OF THE STUDY
  • 1.15 CONCLUSION
• CHAPTER 2 LITERATURE REVIEW
  • 2.1 INTRODUCTION
  • 2.2 MALARIA A MAJOR PUBLIC HEALTH PROBLEM
    • 2.2.1 The World and Sub-Saharan situation
    • 2.2.2 Ethiopia’s situation
  • 2.3 CAUSES, TYPES AND MANAGEMENT OF MALARIA
    • 2.3.1 Causes and types of malaria
    • 2.3.2 Management of malaria
      • 2.3.2.1 Early diagnosis and treatment
      • 2.3.2.1.1 Diagnosis of malaria
      • 2.3.2.1.2 Treatment of malaria
• 2.4 PATIENT ADHERENCE
• 2.4 PATIENT ADHERENCE
  • 2.4.1 Definitions of adherence
  • 2.4.2 Adherence to antimalarial drugs
  • 2.4.3 Consequences of non-adherence
  • 2.4.4 Types of non-adherence
  • 2.4.5 Factors affecting patient adherence
    • 2.4.5.1 Health care provider’s factor
    • 2.4.5.2 Patient-related factors
    • 2.4.5.3 Health care system factor
    • 2.4.5.4 The disease related factors
    • 2.4.5.5 Medication related factors
  • 2.4.6 Measurement for adherence
  • 2.4.7 Interventions to improve patient adherence
• 2.5 HEALTH WORKERS COMPLIANCE TO MALARIA TREATMENT GUIDELINES
• CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
  • 3.1 INTRODUCTION
  • 3.2 RESEARCH DESIGN
    • 3.2.1 Qualitative aspect of design
    • 3.2.2 Explorative aspect of design
    • 3.2.3 Descriptive aspect of design
    • 3.2.3 Contextual aspect of design
  • 3.3 REASONING STRATEGIES
    • 3.3.1 Inductive reasoning
    • 3.3.2 Deductive reasoning
    • 3.3.3 Analysis
    • 3.3.4 Synthesis
  • 3.4 RESEARCH METHODS
• CHAPTER 4 FINDINGS AND DISCUSSIONS
• CHAPTER 5 GUIDELINES FOR SUPPORT OF HEWS IN MALARIA TREATMENT PRACTICE IN ETHIOPIA
• CHAPTER 6 CONCLUSION, LIMITATIONS AND RECOMMENDATIONS

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EVALUATION OF ANTIMALARIAL DRUG USE PRACTICES OF HEALTH EXTENSION WORKERS AND PATIENT ADHERENCE IN SOUTHERN ETHIOPIA/WOLYTA ZONE