International Health Sciences University, Kampala, Uganda.
PACE Uganda, PSI, Kampala, Uganda.
Malar J. 2018 Nov 19;17(1):432. doi: 10.1186/s12936-018-2577-x.
Uganda adopted the Integrated Management of Malaria (IMM) guidelines, which require testing all suspected cases of malaria prior to treatment and which have been implemented throughout the country. However, adherence to IMM guidelines has not been explicitly investigated, especially in lakeshore areas such as Buyende and Kaliro, two districts that remain highly burdened by malaria. This study assesses the level of adherence to IMM guidelines and pinpoints factors that influence IMM adherence by health providers in Buyende and Kaliro. A cross-sectional study among 197 patients and 26 healthcare providers was conducted. The algorithm for adherence to IMM guidelines was constructed to include physical examination, medical history, laboratory diagnosis, and anti-malarial drug prescription. Adherence was measured as a binary variable, and binary regression was used to identify factors associated with adherence to IMM guidelines.
Only 16 (8.1%) of the 197 patients had their medical history and physical examinations taken, while the majority (65.5%) of the patients were recommended for malaria (laboratory) testing. Regarding adherence to prescription guidelines, 127 (64.5%) of the patients received artemisinin combination therapy (ACT) drug prescription. On the other hand, 18.6% of those who tested negative received an ACT drug/prescription and 10.1% tested positive but did not receive an ACT drug or prescription. Overall adherence to IMM guidelines was only 3.1%. The only factor that significantly influenced adherence to IMM guidelines was training; healthcare providers who had attended recent training on these guidelines were almost three times more likely to adhere to the IMM guidelines compared to those who had not attended recent training (OR = 2.858, 95% CI 1.754-4.659).
The findings indicate very low levels of adherence to IMM guidelines among healthcare workers in the lakeshore areas of Kaliro and Buyende districts. Since adherence was independently influenced, majorly by training healthcare workers on these guidelines, recommendations include facilitating training on IMM guidelines throughout Uganda.
乌干达采用了综合疟疾管理 (IMM) 指南，该指南要求在治疗前对所有疑似疟疾病例进行检测，并在全国范围内实施。然而，IMM 指南的遵循情况并未被明确调查，特别是在像 Buyende 和 Kaliro 这样的湖滨地区，这些地区仍然受到疟疾的高度影响。本研究评估了 Buyende 和 Kaliro 地区卫生工作者对 IMM 指南的遵循程度，并确定了影响他们遵循 IMM 指南的因素。对 197 名患者和 26 名医疗保健提供者进行了横断面研究。构建了 IMM 指南的依从性算法，包括体格检查、病史、实验室诊断和抗疟药物处方。依从性被测量为二项变量，并使用二项回归来确定与 IMM 指南依从性相关的因素。
只有 197 名患者中的 16 名（8.1%）接受了病史和体格检查，而大多数（65.5%）患者被推荐进行疟疾（实验室）检测。关于处方指南的依从性，127 名患者（64.5%）接受了青蒿素联合疗法（ACT）药物处方。另一方面，18.6%检测结果为阴性的患者接受了 ACT 药物/处方，10.1%检测结果为阳性但未接受 ACT 药物或处方。总体上，IMM 指南的依从性仅为 3.1%。唯一显著影响 IMM 指南依从性的因素是培训；最近参加过这些指南培训的医疗保健提供者遵循 IMM 指南的可能性几乎是没有参加过培训的三倍（OR=2.858，95%CI 1.754-4.659）。
研究结果表明，Kaliro 和 Buyende 地区湖滨地区的医疗保健工作者对 IMM 指南的遵循程度非常低。由于依从性主要受到培训的独立影响，因此建议在乌干达各地为医疗保健工作者提供有关 IMM 指南的培训。
