Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon.


Mangham, LJ; Cundill, B; Achonduh, OA; Ambebila, JN; Lele, AK; Metoh, TN; Ndive, SN; Ndong, IC; Nguela, RL; Nji, AM; Orang-Ojong, B; Wiseman, V; Pamen-Ngako, J; Mbacham, WF; (2012) Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon. Tropical medicine & international health, 17 (3). pp. 330-42. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2011.02918.x

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Abstract

OBJECTIVE: To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated.<br/> METHODS: A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers.<br/> RESULTS: Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial.<br/> CONCLUSIONS: Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: ACT Consortium
Malaria Centre
Tropical Epidemiology Group
PubMed ID: 22098135
Web of Science ID: 300686600010
URI: http://researchonline.lshtm.ac.uk/id/eprint/20261

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