Introduction
Malaria, a life-threatening disease transmitted through the bite of an infected Anopheles mosquito, remains a significant public health challenge globally. Mozambique, located in Southeast Africa, is one of the countries hardest hit by this disease, with fever associated with malaria leading as the primary reason for health care-seeking behavior. In light of this ongoing battle, a recent study conducted by Candrinho Baltazar and colleagues, and published in the “Malaria Journal,” provides important insights into the quality of malaria services provided at public health facilities across three Mozambican provinces. This article aims to dissect the study’s findings, explore the implications for malaria management in the region, and suggest recommendations for future improvements in line with the global fight against malaria.
Study Background and Methodology
The cross-sectional study, which took place in April-May 2018, targeted public health facilities in the provinces of Maputo, Cabo Delgado, and Zambézia. These provinces were selected based on their differing malaria burdens—low in Maputo Province and high in both Cabo Delgado and Zambézia. The study’s dataset comprised exit interviews and re-examinations of randomly-selected patients, interviews with health care providers and facility directors, stockroom inventories, and an abstraction of routine data. A total of 319 health care providers and 1,840 patients across 117 health facilities participated in the study (DOI: 10.1186/s12936-019-2796-9).
Findings of the Study
The study revealed that 72% of the surveyed patients exhibited suspected malaria symptoms (fever/history of fever). Notably, the accurate management of malaria—defined as appropriately testing and treating confirmed cases—was less than optimal. Zambézia and Cabo Delgado managed febrile malaria cases appropriately in only 52% and 49% of instances, respectively. Maputo Province trailed significantly with a mere 14% management rate.
Key Challenges Identified
One of the most critical issues noted was the failure to test feverish patients for malaria—a gap most prominent in Maputo Province, where only 46% of patients with a suspected case were tested. Incorrect treatment of patients with a negative malaria test result also emerged as a problem, with rates ranging from 8% in Maputo Province to 22% in Zambézia. Furthermore, there was a discrepancy between the prescription and the patient’s understanding of the dosing instructions, as only 58-62% could accurately recount the dosage prescribed.
Providers’ Training and Knowledge
The study underscored that provider training and knowledge of malaria were below par in most provinces except Zambézia. However, across all provinces, supervision rates were low, indicating a potentially broader systemic issue within the health care system.
Divergent Factors Affecting Case Management
The study acknowledged that factors influencing correct malaria case management varied by province. These included the patient’s age, the type of facility, the availability of treatment and testing material, supervision levels, and provider training.
Implications for Public Health
These findings are critical for Mozambique’s national malaria control strategies and have broad implications for future training, resource allocation, and management practices. The evidence points to a considerable need to improve testing for all patients with fever symptoms and for providers to adhere to treatment protocols, especially in the wake of a negative test result.
Proposed Solutions
Training and supervision of healthcare providers must be enhanced to ensure adherence to national malaria management protocols. Moreover, patient education on medication usage and dosage could likely improve treatment outcomes.
Conclusion and Future Directions
The findings presented in Candrinho Baltazar’s et al.’s study highlight crucial gaps in the quality of malaria services in Mozambique. There is a pressing need to strengthen malaria case management and to harmonize practices with national guidelines to combat this pervasive disease effectively.
Keywords
1. Malaria management Mozambique
2. Public health facilities malaria
3. Malaria case management
4. Mozambique healthcare providers training
5. Malaria treatment protocols adherence
References
1. Candrinho B, et al. (2019). Quality of malaria services offered in public health facilities in three provinces of Mozambique: a cross-sectional study. Malaria Journal, 18(1), 162. https://doi.org/10.1186/s12936-019-2796-9
2. MISAU, INE. (2016). Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA) 2015: Relatório de Indicadores Básicos. Maputo.
3. Plucinski MM, et al. (2017). Evaluating malaria case management at public health facilities in two provinces in Angola. Malar J, 16, 186. https://doi.org/10.1186/s12936-017-1843-7
4. Steinhardt LC, et al. (2014). Quality of malaria case management in Malawi: results from a nationally representative health facility survey. PLoS ONE, 9, e89050. https://doi.org/10.1371/journal.pone.0089050
5. Namuyinga RJ, et al. (2017). Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J, 16, 40. https://doi.org/10.1186/s12936-017-1693-3