MAPD Project, US President's Malaria Initiative, Kampala, Uganda.
Malaria Branch, Centers for Disease Control and Prevention, US President's Malaria Initiative, Atlanta, GA, 30329, USA.
Malar J. 2021 Dec 4;20(1):456. doi: 10.1186/s12936-021-03992-9.
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.
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.
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).
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.
世界卫生组织（WHO）建议通过显微镜检查或疟疾快速诊断检测（RDT）进行快速疟疾诊断，并使用有效的抗疟药物进行治疗，这是控制疟疾的关键干预措施。然而，在撒哈拉以南非洲，疟疾诊断仍然常常受到临床症状的影响，患者和护理人员通常将所有发热都视为疟疾。乌干达卫生部将疑似疟疾病例定义为发热患者。《2014-2020 年国家减少疟疾战略计划》规定，目标是对至少 75%的疑似疟疾患者进行检测。
本研究使用美国总统疟疾倡议（PMI）支持的 52 个区在 2017 年 3/4 月进行的横断面卫生机构调查中收集的数据，调查了乌干达卫生机构进行疟疾检测的影响因素。该研究评估了卫生机构提供优质疟疾护理和治疗的能力。数据来自 52 个区的 1085 家公立和私立卫生机构。评估的因素包括支持性监督、疟疾管理指南的可用性、实验室基础设施以及培训卫生工作者使用疟疾快速诊断检测（RDT）。使用多变量逻辑回归检查将至少 75%的疑似疟疾患者进行检测与几个因素之间的关联。
主要疟疾商品广泛供应；92%和 85%的卫生机构分别报告了 RDT 和青蒿素-本芴醇的供应情况。总体而言，933 家（86%）卫生机构对疑似疟疾患者进行了超过 75%的检测。达到检测目标的预测因素是：在过去 6 个月内接受监督（比值比：1.72，95%置信区间：1.04-2.85）和卫生机构至少有一名接受过 RDT 使用培训的卫生工作者（比值比：1.62，95%置信区间：1.04-2.55）。
研究结果强调了疟疾控制规划向卫生机构提供定期支持性监督和培训卫生工作者使用 RDT 的必要性。
