‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

摘要: Abstract In response to widespread overuse of antimalarial drugs, the World Health Organisation changed guidelines in 2010 restrict use antimalarials parasitologically confirmed malaria cases. Malaria rapid diagnostic tests (RDTs) have been presented as a means realize new guidelines, and National Control Programmes, including that Cameroon, are developing plans introduce replace microscopy or clinical diagnosis at public health facilities across country. We aimed understand how drugs currently used part social interactions between workers patients mission Yaounde Bamenda surrounding districts Northwest region Cameroon. May June 2010, we held 17 focus group discussions with 146 involved care from 49 facilities. Clinicians enacted ‘juggling’ exercise, involving attention pathophysiology patient well their desires medical reputations, utilising medicines for therapeutic effects symbols process care. Parasites were rarely mentioned describing decisions. These enactments contrast evidence-based emanating WHO, which assume parasite is central driver practice. If RDTs be taken up practice, practitioners need pay careful values priorities if they work them improve treatment febrile illnesses.