Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study
Date
2007
DOI
Authors
Zurovac, Dejan
Ndhlovu, Mickey
Sipilanyambe, Nawa
Chanda, Pascalina
Hamer, Davidson
Simon, Jon
Snow, Robert
Version
OA Version
Citation
2007. "Paediatric malaria case-management with artemether-lumefantrine
in Zambia: a repeat cross-sectional study," Malaria Journal. vol. 6 issue. 1 .
Abstract
BACKGROUND:Zambia was the first African country to change national
antimalarial treatment policy to artemisinin-based combination therapy -
artemether-lumefantrine. An evaluation during the early implementation phase revealed low
readiness of health facilities and health workers to deliver artemether-lumefantrine, and
worryingly suboptimal treatment practices. Improvements in the case-management of
uncomplicated malaria two years after the initial evaluation and three years after the
change of policy in Zambia are reported.METHODS:Data collected during the health facility
surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission
facilities in four Zambian districts were analysed. The surveys were cross-sectional, using
a range of quality of care assessment methods. The main outcome measures were changes in
health facility and health worker readiness to deliver artemether-lumefantrine, and changes
in case-management practices for children below five years of age presenting with
uncomplicated malaria as defined by national guidelines.RESULTS:In 2004, 94 health
facilities, 103 health workers and 944 consultations for children with uncomplicated malaria
were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were
evaluated using the same criteria of selection. Health facility and health worker readiness
improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60%
(62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75%
(78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of
in-service training from 25% (26/103) to 41% (55/135). The proportions of children with
uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006:
from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to
42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22%
(441/2020) of children with uncomplicated malaria were not prescribed any antimalarial
drug.CONCLUSION:Although significant improvements in malaria case-management have occurred
over two years in Zambia, the quality of treatment provided at the point of care is not yet
optimal. Strengthening weak health systems and improving the delivery of effective
interventions should remain high priority in all countries implementing new treatment
policies for malaria.