scholarly journals Management of Uncomplicated Malaria in Underfives in Private and Public Health Facilities in South-Eastern Nigeria: A Clinical Audit of Current Practices

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Ekong Udoh ◽  
Angela Oyo-ita ◽  
Friday Odey ◽  
Emmanuel Effa ◽  
Ekpereonne Esu ◽  
...  
Keyword(s):  
Case Management ◽  
Uncomplicated Malaria ◽  
Clinical Audit ◽  
Data Extraction ◽  
Artemisinin Combination Therapy ◽  
Medical Personnel ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross River State

Malaria remains a leading cause of underfive morbidity and mortality in sub-Saharan Africa. Effective case management is a strategy recommended by the World Health Organization for its control. A clinical audit of case management of uncomplicated malaria in underfives in health facilities in Cross River State, Nigeria, was conducted from January to March 2012. Data was extracted from patients’ case records by trained medical personnel using pretested data extraction forms. Of the 463 case records reviewed, age, gender, and weight were reported in 98.1%, 97.3%, and 49.7% of the children, respectively. A history of fever was obtained in 89.6% and a record of temperature in 74.1% of the children. General examination was performed in 203 (43.8%) children. Malaria parasite test was requested in 132 (28.5%) while Packed cell volume or haemoglobin was requested in 107 (23.1%) children. Appropriate dose of Artemisinin Combination Therapy (ACT) was instituted in 300 (64.8%), wrong dose in 109 (23.5%), and inappropriate treatment in 41 (8.9%). The utilization of ACTs for treating uncomplicated malaria in the State has improved but clinical assessment of patients and laboratory confirmation of diagnosis are suboptimum.

Quality of Antenatal, Labour and Delivery Services in Selected Districts in Malawi, Zambia and Zimbabwe: A Descriptive Cross-Sectional Study

2021 ◽  
pp. 1-9
Author(s):  
Clara Opha Haruzivishe
Keyword(s):  
Perinatal Care ◽  
Neonatal Morbidity ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
World Health ◽  
Performance Standard ◽  
Cross Sectional ◽  
Care Services

Background: High Maternal and Neonatal Mortality Ratios persist in Sub-Saharan Africa despite increasing perinatal care coverage. This suggests that coverage alone is not adequate to reduce maternal and neonatal morbidity and mortality. Quality of care should be the emphasis of maternal and child care services. Materials and Methods: A descriptive cross-sectional multicentre study was conducted in selected health facilities in Zambia, Malawi and Zimbabwe using purposive sampling. A World Health Organization-WHO 2016 Quality of Maternal and New-born assessment Framework and the WHO (2015) Service Availability and Readiness Assessment tool were used for data collection. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. Results: Less than 43% of the health facilities satisfied at least three of the five Performance Standards of availability and adequacy of Antenatal infrastructure and supplies. Regarding Antenatal processes/care, an observation was the most common performance standard satisfied by 70.6% of all health facilities assessed while less than 30% fulfilled all other standards. Only 57.1% of the health facilities satisfied 5 of the 11 standards for labour and delivery infrastructure, while only 55.6% of the Health facilities satisfied only two of the 13 standards of Labour and delivery care. Conclusion: To achieve a significant and sustainable reduction in maternal and neonatal morbidity and mortality, there is a need for investment and improvement in maternity care services infrastructure and processes as opposed to focusing on mere attendance of Antenatal, and deliveries by trained birth attendants.

scholarly journals Management of uncomplicated malaria among children under five years at public and private sector facilities in Mali

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Seydou Fomba ◽  
Diakalia Koné ◽  
Bakary Doumbia ◽  
Diadier Diallo ◽  
Thomas Druetz ◽  
...  
Keyword(s):  
Case Management ◽  
Severe Malaria ◽  
Uncomplicated Malaria ◽  
Artemisinin Combination Therapy ◽  
Diagnostic Testing ◽  
Public And Private ◽  
Confirmatory Testing ◽  
Children Under Five ◽  
Under Five ◽  
Multiple Drugs

Abstract Background Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1–59 months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali. Methods Data were collected at sites in Sikasso Region and Bamako. Health workers recorded key information from the consultation including malaria diagnostic testing and result, their final diagnosis, and all drugs prescribed. Children with signs of severe diseases were ineligible. Consultations were not independently observed. Appropriate case management was defined as both 1) tested for malaria using rapid diagnostic test or microscopy, and 2) receiving artemisinin combination therapy (ACT) and no other antimalarials if test-positive, or receiving no antimalarials if test-negative. Results Of 1602 participating children, 23.7% were appropriately managed, ranging from 5.3% at public rural facilities to 48.4% at community health worker sites. The most common reason for ‘inappropriate’ management was lack of malaria diagnostic testing (50.4% of children). Among children with confirmed malaria, 50.8% received a non-ACT antimalarial (commonly artesunate injection or artemether), either alone or in combination with ACT. Of 215 test-negative children, 44.2% received an antimalarial drug, most commonly ACT. Prescription of multiple drugs was common: 21.7% of all children received more than one type of antimalarial, while 51.9% received an antibiotic and antimalarial. Inappropriate case management increased in children with increasing axillary temperatures and those seeking care over weekends. Conclusions Multiple limitations in management of febrile children under five were identified, including inconsistent use of confirmatory testing and apparent use of severe malaria drugs for uncomplicated malaria. While we cannot confirm the reasons for these shortcomings, there is a need to address the high use of non-ACT antimalarials in this context; to minimize potential for drug resistance, reduce unnecessary expense, and preserve life-saving treatment for severe malaria cases. These findings highlight the challenge of managing febrile illness in young children in a high transmission setting.

scholarly journals Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e047205
Author(s):  
Fisaha Haile Tesfay ◽  
Sara Javanparast ◽  
Hailay Gesesew ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nutritional Recovery ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Nutritional Outcomes

ObjectivesAlthough some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.DesignSystematic review.Data sourcesWe searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.Eligibility criteriaStudies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.Data extraction and synthesisData were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.ResultsSixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.Conclusions and recommendationsNutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.PROSPERO registration numberCRD42020196827.

scholarly journals Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study

2013 ◽  
Vol 1 (1) ◽  
pp. 9
Author(s):  
Frank Felix Mosha ◽  
Mwita Wambura ◽  
Joseph R. Mwanga ◽  
Jacklin F. Mosha ◽  
Gerry Mshana ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Infection Prevention ◽  
Demand Forecasting ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
World Health ◽  
Health Practitioners ◽  
Minor Surgery ◽  
Safe Male Circumcision ◽  
Sterilization Equipment

Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59%) of the facilities visited provided circumcision services and only 46/203 (24%) of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority – 190/203 (95%) – of the health practitioners require additional training prior to providing circumcision services. Most facilities – 63/69 (91%) – had all basic supplies (gloves, basin, chlorine and waste disposal) necessary for infection prevention, 44/69 (65%) provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90%) had the capability to perform at least minor surgery. However, only 25/69 (36%) and 15/69 (22%) of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting. Sterilization equipment for infection prevention and resuscitation equipment should also be made available.

scholarly journals Determinants of malaria testing at health facilities: the case of Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ruth N. Kigozi ◽  
JohnBaptist Bwanika ◽  
Emily Goodwin ◽  
Peter Thomas ◽  
Patrick Bukoma ◽  
...  
Keyword(s):  
Health Facility ◽  
Health Workers ◽  
Clinical Symptoms ◽  
Malaria Diagnosis ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
World Health ◽  
Supportive Supervision ◽  
Care Providers ◽  
Cross Sectional Survey

Abstract Background The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75% of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014–2020. Methods This study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President’s Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75% of suspect malaria cases with several factors were examined using multivariate logistic regression. Results Key malaria commodities were widely available; 92% and 85% of the health facilities reported availability of RDTs and artemether–lumefantrine, respectively. Overall, 933 (86%) of the facilities tested over 75% of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95% CI 1.04–2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95% CI 1.04–2.55). Conclusion The study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs.

scholarly journals The Gendered Implications of Energy Gaps in Health Care: A Comparative Analysis of Haiti, Senegal, and the Democratic Republic of Congo

2021 ◽  
Author(s):  
Vivek Shastry ◽  
Sophie M Morse
Keyword(s):  
Health Services ◽  
Health Systems ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Health And Safety ◽  
Clean Energy ◽  
Medical Personnel ◽  
Sub Saharan Africa ◽  
World Health ◽  
Energy Access

The World Health Organization recently articulated a number of challenges faced by health systems due to unreliable access to energy services. Reliable energy availability at rural health facilities is understood to be an enabler of access to quality healthcare, owing to its potential impacts on medical services, health and safety, disease prevention and treatment, staff recruitment and retention, and administration and logistics. However, little is known empirically about the intersections of energy and healthcare, often due to the lack of availability of facility level data. Moreover, the gender implications of energy access (or lack thereof) for women as providers and seekers of primary healthcare have not been investigated. In this study, using a gender lens, we explore the linkages between energy and healthcare in three Francophone countries in the Caribbean and sub-Saharan Africa: Democratic Republic of the Congo (DRC), Haiti and Senegal. All three countries have faced serious challenges to the provision of quality health services, including infrastructure problems and specifically unreliable access to electricity. We use Demographic Health Survey data from all three countries to present detailed descriptions of the association between (a) the availability and reliability of electricity sources, and (b) availability of health services, equipment and medical personnel at different levels of the respective health systems. We find that the unavailability and unreliability of electricity is associated with lower availability of medical equipment and basic health services, especially among facilities at the primary care level in DRC and Haiti. Our findings highlight the opportunity to create more dependable and sustainable health systems by integrating decentralized clean energy technologies into health infrastructure, which can facilitate providers in female-dominated cadres such as nursing the ability to provide the care they are tasked with.

scholarly journals Safety of Artemisinin Derivatives in the First Trimester of Pregnancy: A Controversial Story

Molecules ◽  
2020 ◽  
Vol 25 (15) ◽  
pp. 3505 ◽  
Author(s):  
Sarah D’Alessandro ◽  
Elena Menegola ◽  
Silvia Parapini ◽  
Donatella Taramelli ◽  
Nicoletta Basilico
Keyword(s):  
Congenital Malformation ◽  
Uncomplicated Malaria ◽  
Time Window ◽  
Artemisinin Combination Therapy ◽  
First Trimester ◽  
Experimental Models ◽  
World Health ◽  
Artemisinin Derivatives ◽  
Increased Risk ◽  
First Trimester Of Pregnancy

Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that artemisinin derivatives can cause foetal death and congenital malformation within a narrow time window in early embryogenesis. During this period, artemisinin derivatives induce defective embryonic erythropoiesis and vasculogenesis/angiogenesis in experimental models. However, clinical data on the safety profile of ACT in pregnant women have not shown an increased risk of miscarriage, stillbirth, or congenital malformation, nor low birth weight, associated with exposure to artemisinins in the first trimester. Although further studies are needed, the evidence collected up to now is prompting the WHO towards a change in the guidelines for the treatment of uncomplicated malaria, allowing the use of ACT also in the first trimester of pregnancy.

scholarly journals Malaria Case-Management in Urban Area: Various Challenges in Public and Private Health Facilities in Benin, West Africa

2018 ◽  
Vol 11 (1) ◽  
pp. 54-61
Author(s):  
Badirou Aguemon ◽  
Barikissou Georgia Damien ◽  
Antoine Vickey Hinson ◽  
Géraud Padonou ◽  
Abévi Fleury Bruno Agbessinou ◽  
...  
Keyword(s):  
Public Health ◽  
Case Management ◽  
Health Care Providers ◽  
Malaria Case ◽  
Uncomplicated Malaria ◽  
Health Facilities ◽  
Malaria Case Management ◽  
Care Providers ◽  
Public And Private ◽  
The Public

Background:In Benin, malaria remains endemic and perennial throughout the year in most areas. During the last decade, a substantial increase was noticed in the procurement of Artemisinin-based combination therapies and malaria RDT. This study aimed to evaluate the quality of uncomplicated malaria cases-management in public and private health facilities.Methods:A cross-sectional survey was carried out in public and private health facilities in the municipality of Abomey-Calavi in southern Benin from August to September 2016. The study focused on two targets: (i) patients with uncomplicated malaria who sought care in a health facility in Abomey-Calavi during the study period; and (ii) the health care providers in public and private health facilities authorized by the Ministry of Health.Results:In 27 health facilities investigated, 15 in the public sector and 12 in the private sector, a total of 313 patients and 93 health care providers were included. Forty-four percent (44%) had no education. Among the patients, 60% were identified in the public health facilities. About 87% of uncomplicated malaria patients were tested in public facilities while 63% were tested in private facilities. In the same way, 54% of patients were treated in accordance with National Malaria Control Program (NMCP) guidelines.Conclusions:The present study showed a poor performance in uncomplicated malaria case-management in private health facilities compared to public health facilities. Strategy to improve access and utilization of malaria case-management supplies needs to be reviewed in both public and private health facilities.

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