School of Health and Social Care, University of Essex, Colchester, UK.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Malar J. 2024 Oct 15;23(1):307. doi: 10.1186/s12936-024-05136-1.
Healthcare providers (HCPs) practice and correct management of suspected malaria (CMSM) are central components of malaria elimination and prevention of re-establishment (POR) in countries in the elimination phase. However, knowledge of malaria surveillance systems and HCPs practices often wanes in countries aiming to eliminate malaria due to the low numbers of cases. The study aimed to implement a valid Simulated Malaria Online Tool (SMOT) for assessment HCP performance in CMSM and POR in a malaria-free area.
HCPs were evaluated using SMOT tool based on four criteria including presenting a suspected malaria case for detection of HCPs' failures in recognition (a), diagnosis (b), appropriate treatment (c), and urgent reporting (d); and compared with simulated patients (SP). Multiple logistic regression analysis was carried out to estimate adjusted odds ratios (ORs) for the risk of HCPs failures.
The overall failure proportion was 237 (83%), and the majority of failures were in recognition (a). There was no significant difference between the SMOT and SP based on all failure criteria (P > 0.05). The private clinic (93%) and the public specialized clinic (70%) had the highest and lowest failure proportions. After passing the recognition stage (a), the overall failure proportions decreased to 47.8% and 25.0% for total HCPs and infectious disease specialists, respectively. In the final analysis, private sector (AOR = 4.36: 1.25-15.2), not-specialist providers (AOR = 2.84: 1.29-6.25) and HCPs with ≥ 5 years' experience (AOR = 2.03: 1.01-6.25) increased the risk of failure.
Findings confirmed the implementation of SMOT tool in settings where malaria transmission is low or interrupted. The tool is able to identify sub-groups of providers needing strengthening, and contributes to the prevention of malaria re-establishment.
医疗保健提供者(HCPs)对疑似疟疾的实践和正确管理是疟疾消除和预防重新出现(POR)的核心组成部分,在消除阶段的国家。然而,由于病例数量较少,在旨在消除疟疾的国家中,疟疾监测系统和 HCPs 实践的知识往往会减少。该研究旨在为疟疾零传播地区实施有效的模拟疟疾在线工具(SMOT),以评估 HCP 在 CMSM 和 POR 中的表现。
根据四项标准,使用 SMOT 工具评估 HCP,包括提出疑似疟疾病例以检测 HCP 在识别(a)、诊断(b)、适当治疗(c)和紧急报告(d)方面的失败;并与模拟患者(SP)进行比较。进行多项逻辑回归分析,以估计 HCP 失败风险的调整比值比(OR)。
总失败率为 237(83%),大多数失败发生在识别(a)阶段。基于所有失败标准,SMOT 和 SP 之间没有显著差异(P > 0.05)。私营诊所(93%)和公共专科诊所(70%)的失败比例最高和最低。通过识别阶段(a)后,总失败比例分别下降至 47.8%和 25.0%,分别为所有 HCP 和传染病专家。在最终分析中,私营部门(AOR = 4.36: 1.25-15.2)、非专科提供者(AOR = 2.84: 1.29-6.25)和经验超过 5 年的 HCP(AOR = 2.03: 1.01-6.25)增加了失败的风险。
研究结果证实,SMOT 工具在疟疾传播率低或中断的情况下得到了实施。该工具能够识别需要加强的提供者亚组,并有助于预防疟疾的重新出现。