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Open Access Case management of malaria in Swaziland, 2011–2015: on track for elimination?

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Objective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015.

Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed.

Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03).

Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs.
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Keywords: SORT IT; Swaziland; malaria case management; malaria elimination

Document Type: Research Article

Affiliations: 1: Faculty of Health Sciences, University of Swaziland, Mbabane, Swaziland 2: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya 3: National Malaria Control Programme, Ministry of Health, Mbabane, Swaziland 4: World Health Organization (WHO), Swaziland Country Office, Mbabane, Swaziland 5: National Institute for Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Beijing, China 6: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya 7: National Tuberculosis Control Programme, Ministry of Health, Mbabane, Swaziland 8: WHO, African Regional Office and Inter-Country Support Team, Asmara, Eritrea 9: Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, Luxembourg City, Luxembourg

Publication date: April 25, 2018

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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