Makumbe Bargley, Tshuma Cremence, Shambira Gerald, Mungati More, Gombe Notion Tafara, Bangure Donewell, Juru Tsitsi Patience, Tshimanga Mufuta
Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
Ministries of Health and Child Care, Provincial Medical Directorate Mashonaland Central, Bindura, Zimbabwe.
Pan Afr Med J. 2017 May 11;27:33. doi: 10.11604/pamj.2017.27.33.11081. eCollection 2017.
Malaria is a preventable and curable disease. Mazowe district had been experiencing a lower malaria transmission rate in comparison to other districts in the Mashonaland Central province but it experienced a huge outbreak in the 2013-2014 rainy seasons with a case fatality rate (CFR) of 0.21%. This CFR was the highest in the province and it was twice as much as the national CFR (0.12%) for the same period. We evaluated severe malaria case management in Mazowe district to determine if practice is as per standard treatment guidelines.
A descriptive cross sectional study was conducted in Mazowe district using the Logical Framework approach. District Health Executives (DHE) members, nurses and severe malaria case notes were purposively and conveniently selected into the study. Key informant Interviews and review of case notes were carried out. All data were analysed using Epi Info 3.5.1.to calculate means and frequencies. Permission to conduct the study was obtained from the Mashonaland Central Provincial Medical Directorate (PMD) Institutional Ethical Review Board (IRB).
The median age in years of the cases was 16 (Q1=7.3; Q3=30.8) and up to 58.1% of the cases were female. Inputs including staff, medicines and medical and laboratory equipment for severe case management were inadequate in the district. Only 60% of severe cases were diagnosed using blood slides and up to 95.6% of cases presented with one or more of the clinical signs of severe malaria. All severe cases were treated using correct anti-malarial and analgesic doses. Patient monitoring was not done as per prerequisite intervals and up to 5% of cases died. The health workers had above average knowledge on severe malaria.
Severe malaria case management inputs were inadequate in the district. For many cases, the district did not follow complicated malaria treatment guidelines for diagnosis, treatment and monitoring. Untrained staff needs training in Severe Malaria Case Management and monitoring of commodity stocks needs to be strengthened.
疟疾是一种可预防和可治愈的疾病。与马绍纳兰中部省的其他地区相比，马佐韦区的疟疾传播率一直较低，但在2013 - 2014年雨季经历了一次大规模疫情，病死率为0.21%。这一病死率是该省最高的，是同期全国病死率（0.12%）的两倍。我们评估了马佐韦区的重症疟疾病例管理情况，以确定实际做法是否符合标准治疗指南。
采用逻辑框架法在马佐韦区进行了一项描述性横断面研究。有目的地且方便地选取了区卫生行政人员（DHE）成员、护士和重症疟疾病例记录纳入研究。进行了关键 informant 访谈并审查了病例记录。所有数据均使用 Epi Info 3.5.1 进行分析，以计算均值和频率。该研究获得了马绍纳兰中部省医务主任办公室（PMD）机构伦理审查委员会（IRB）的许可。
病例的年龄中位数为16岁（第一四分位数 = 7.3；第三四分位数 = 30.8），高达58.1%的病例为女性。该地区用于重症病例管理的人员、药品以及医疗和实验室设备等投入不足。只有60%的重症病例通过血涂片进行诊断，高达95.6%的病例出现了一种或多种重症疟疾的临床症状。所有重症病例均使用了正确的抗疟药和镇痛药剂量。未按照规定的间隔时间对患者进行监测，高达5%的病例死亡。卫生工作者对重症疟疾的了解高于平均水平。
该地区重症疟疾病例管理的投入不足。在许多病例中，该地区未遵循复杂疟疾治疗指南进行诊断、治疗和监测。未受过培训的工作人员需要接受重症疟疾病例管理培训，并且需要加强对商品库存的监测。
