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Malaria Case Management in Children at a Lower-Level Health Facility in Uganda: A Mixed-Methods Study

Harriet Ajilong

Background: Malaria is often diagnosed and treated clinically despite negative test results in low-resource settings. This has resulted in substantial overuse of antimalarial drugs and delays in the diagnosis of other febrile illnesses thereby increasing mortality and morbidity. This study aimed to describe the malaria diagnosis and treatment practices for uncomplicated malaria among children aged 2-59 months with fever at a health center in Kampala district.

Methods: This was a cross-sectional study using both qualitative and quantitative methods. The study was carried out at Kisenyi health center IV between January and February 2014. A total of 420 children aged 2-59 months with fever were consecutively enrolled. Information regarding malaria diagnosis and treatment practices were extracted from medical records as caretakers exited from the health facility. Key informant interviews were conducted with selected health workers at the facility. Quantitative data was analyzed using Statistics and Data (STATA) version 10 into proportions, means and medians where appropriate while qualitative data was analyzed using the content thematic approach.

Results: Out of the 420 children with fever enrolled, 162(38.6%) were prescribed antimalarial drugs without laboratory evaluation. Out of the 206 patients who were tested for malaria, all the confirmed positive cases and 72(35%) who tested negative were prescribed antimalarial drugs. Majority of the patients (81%) received artemether-lumefantrine, the recommended first line treatment for uncomplicated malaria while a small proportion (15%) was prescribed non recommended antimalarial therapies. From logistic regression, history of antimalarial drug use was found to be significantly associated with laboratory diagnosis of malaria (p-value 0.02).

Conclusion: Appropriate malaria case diagnosis and treatment is still a challenge in lower-level health facilities. A large proportion of febrile illnesses is clinically diagnosed and treated as malaria and many patients are prescribed antimalarial drugs despite negative test results. This has led to continued misuse of antimalarial drugs and under diagnosis of other causes of fever in children thereby increasing mortality and morbidity. To achieve the universal “test and treat” strategy for malaria case management and control, stakeholders should ensure regular supply of laboratory diagnostic equipment. Regular refresher training is needed so that health workers adhere to the recommended national malaria treatment guidelines. Emphasis should be put on proper examination and treatment of alternative causes of children in fever.