Quality of malaria case management at outpatient health facilities in Angola

摘要: Angola's malaria case-management policy recommends treatment with artemether-lumefantrine (AL). In 2006, AL implementation began in Huambo Province, which involved training health workers (HWs), supervision, delivering to facilities, and improving testing microscopy rapid diagnostic tests (RDTs). Implementation was complicated by a that sometimes ambiguous. Fourteen months after began, cross-sectional survey conducted 33 outpatient facilities Province assess their readiness manage the quality of for patients all ages. Consultations were observed, interviewed re-examined, HWs interviewed. Ninety-three 177 consultations evaluated, although many sampled missed. All had in-stock at least one HW trained use RDTs. However, anti-malarial stock-outs previous three common, clinical supervision infrequent, important knowledge gaps. Except fever history, assessments often incomplete. Although recommended suspected malaria, only 30.7% such tested. Correct significantly associated caseloads < 25 patients/day (odds ratio: 18.4; p 0.0001) elevated patient temperature 2.5 per 1°C increase; = 0.007). Testing more common among AL-trained HWs, but association borderline significant (p 0.072). When test negative, diagnosed (57.8%) prescribed anti-malarials (60.0%). Sixty-six percent malaria-related diagnoses correct, 20.1% minor errors, 13.9% major (potentially life-threatening) errors. Only 49.0% treatments 5.4% 45.6% almost always dosed correctly gave accurate dosing instructions patients; however, other aspects counseling needed improvement. By late-2007, substantial progress been made implement setting weak infrastructure. ambiguities, under-use testing, distrust negative results led incorrect treatments. 2009, Angola published clarified issues. As problems identified this are not unique Angola, better strategies performance urgently needed.