improving malaria case management by health care providers in antenatal clinics in akwa ibom state...

7/27/2019 Improving Malaria Case Management by Health Care Providers in Antenatal Clinics in Akwa Ibom State of Nigeria Powerpoint

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Improving Malaria Case Management by

Health Care Providers in Antenatal Clinics in

Akwa Ibom State of Nigeria

Bright Orji, William Brieger,

Emmanuel Otolorin and John Orok


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MIS 2011 Revealed Very Poor Indices

Large Problem:Approximately 11% ofmaternal deaths arecaused by malaria inpregnancy (MIP)

Poor Response: Malariatreatment is largely bypresumptive diagnosis

Ideally parasitologicaldiagnosis followed byACT if positive

2

66.2

19.516.9

0

10

20

30

40

50

60

70

ANC attendance at

least once with

SBA

Pregnant women

with 2 or more

doses of IPTp-SP

Pregnant women

who slept inside

ITN the previous

night

Percentag

e

MICS, 2011 (FMoH, NBS, Abuja)


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Promoting Integrated Management

of Malaria and Fever in Pregnancy

Use of long-lasting insecticide-treated nets

(LLINs),

Intermittent preventive treatment (IPTp), and

Prompt and effective case management of

febrile illness:

With early and proper diagnosis of malaria using

rapid diagnostic tests (RDTs) and microscopy

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Study Aims

This study sought to

learn whether the

introduction of RDTs

into government-ownedantenatal care (ANC)

clinics would influence

the pattern of fever and

malaria management inAkwa Ibom State,

Nigeria

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Methods

At baseline, 597 client cards were reviewed

at 6 government-owned ANC clinics in Onna

and Ibeno Local Government Areas

Staff were then trained in RDT use

At endline, 472 cards were reviewed

The ANC client cards were drawn from firstnon-follow-up visits where a complaint of

fever was recorded

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Time Frame

Data extraction was

conducted between

February 2010 and

March 2011 by trainednurses/midwives

The State Ministry of

Health approved the

study: confidentiality,

non-use of identifiers

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Patients Records and Clinical

Assessments

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63.6

56.8

84.7

0 0 0

36.4

61.4

23.5

76.5

19.6

80.4

0

10

20

30

40

50

60

70

80

90

Temp was taken Temp taken and

recorded

Presumptive

diagnosis

conducted

RDT conducted RDT positive RDT negative

Percentage

Baseline

Endline


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Pattern of Prescription for

Anti-Malarial Medicines

10

27 2624

12 11

64

6

15

68

0

10

20

30

40

50

60

70

ACTs Quinine SP Quinine

Injection

CQ

Percentage

Baseline

Endline


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Record Quality Issues

The percentage of time

that clients

temperature was takenand recorded improved

from 56.7% at baseline

to 61.4%; difference

between the two wasstatistically significant

(p-value=0.00)

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Pattern of Prescription for

Anti-Malarial Medicines after RDT

Anti-Malarial medicines Baseline Endline

Drug base (No RDTs at

Baseline)

RDT

Positive

Result

RDT

Negative

Result

ACTs 138(27) 45(64) 52(64)

Quinine 132(26) 4(6) 4(5)

Sulfadoxine-

pyrimethamine

122(24) 11(15) 9(11)

Quinine injection 58(12) 5(7) 3(4)

Chloroquine 56(11) 6(8) 13(16)

Total 506 71 81

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Implications for Intervention

The review of records did show that nursing andmidwifery staff at government clinics could in arelatively short time period adopt the use of RDTs

They did improve their prescribing of appropriateanti-malarial medicines

Gaps exist in history taking and malaria diagnosis,with inappropriate dispensing of anti-malarialmedicines and antibiotics

Continued follow-up and supervision will be neededto ensure that correct malaria diagnostic andtreatment guidelines are fully practiced

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improving malaria case management by health care providers in antenatal clinics in akwa ibom state...

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