Providers’ knowledge, preference and practice in treating patients with suspected malaria in Cameroon and Nigeria

Doctoral thesis English OPEN
Jefferies, LJM

Working as agents for their patients, health care providers often make treatment decisions\ud on the patient’s behalf. By establishing common standards, clinical guidelines are central\ud to efforts to improve patient care and can expedite the introduction of new technologies.\ud Each year considerable resources are used to disseminate clinical guidelines, though\ud conventional public health interventions often have a limited effect in changing providers’\ud practice.\ud Using economic theory and methods, research was undertaken to design and evaluate\ud interventions to support the roll-out of malaria rapid diagnostic testing. This thesis\ud contains five research papers on providers’ knowledge, preference and practice in treating\ud patients with malaria symptoms in Cameroon and Nigeria. In this setting, uncomplicated\ud malaria is routinely diagnosed and treated by health workers in outpatient departments\ud and primary health centres, or self-treated using antimalarials purchased at pharmacies\ud and drug stores.\ud Major problems with malaria diagnosis and treatment were identified. Relatively few\ud febrile patients were tested for malaria, many did not receive the recommended\ud antimalarial, and when patients were tested for malaria the test result was often ignored\ud when treatment was prescribed. Moreover, there was no significant relationship between\ud providers’ knowledge and their practice, and preferences over alternative antimalarials\ud were similar among providers working in the same facility or locality.\ud The results of a cluster randomized trial in Cameroon demonstrated that introducing rapid\ud diagnostic tests with enhanced training, which targeted providers’ practice, was more\ud cost-effective than introducing rapid diagnostic tests with basic training, when each was compared to current practice. Since the trial concluded, the Ministry of Health has\ud incorporated the enhanced training in the nationwide roll-out of rapid diagnostic testing.\ud The findings are also relevant for policy makers elsewhere, and highlight the value in\ud developing strategies to improve providers’ adherence to malaria treatment guidelines\ud when expanding access to malaria testing
  • References (8)

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    14 Onwujekwe O, Uzochukwu B, Dike N, Uguru Nm Nwobi E, Shu E. Malaria treatment perceptions, practices and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria. Malar J 2009; 8: 246.

    15 Chandler CIR, Mwangi R, Mbakilwa H, Olomi R, Whitty CJM, Reyburn H. Malaria overdiagnosis: is patient pressure the problem? Health Policy Plann 2008; 23: 170-78.

    16 Odaga J, Sinclair D, Lokong JA, Donegan S, Hopkins H, Garner P. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings. Cochrane Database Syst Rev 2014; 4: CD008998.

    17 Smith LA, Jones C, Meek S, Webster J. Review: provider practice and user behavior interventions to improve prompt and effective treatment of malaria: do we know what works? Am J Top Med Hyg 2009; 80: 326-35.

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