ArticleMalaria journal2017
Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi.
Article in Malaria journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 34 citations in OpenAlex.
- Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda.PloS one · 2019Trial
- Drug stock-outs in HIV, tuberculosis, and malaria programs: a systematic review.EClinicalMedicine · 2026Review
- Barriers to accessing malaria treatment amongst school-age children in rural Malawi.Malaria journal · 2023Article
- How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries.Infectious diseases of poverty · 2023Article
- Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda.International journal of environmental research and public health · 2021Article
- Bayesian network models with decision tree analysis for management of childhood malaria in Malawi.BMC medical informatics and decision making · 2021Article
- Leveraging phone-based mobile technology to improve data quality at health facilities in rural Malawi: a best practice project.Malaria journal · 2021Article
- Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda.PloS one · 2021Article
- Article
- Prevalence and determinants of malaria infection among children of local farmers in Central Malawi.Malaria journal · 2020Article
- Article
- Challenges affecting prompt access to adequate uncomplicated malaria case management in children in rural primary health facilities in Chikhwawa Malawi.BMC health services research · 2019Article
- The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi.BMC health services research · 2019Article
- Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004-2010.Emerging infectious diseases · 2019Article
- Community-based malaria control in southern Malawi: a description of experimental interventions of community workshops, house improvement and larval source management.Malaria journal · 2018Article
- Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study.Malaria journal · 2018Article
- Fine-scale spatial and temporal variation of clinical malaria incidence and associated factors in children in rural Malawi: a longitudinal study.Parasites & vectors · 2018Article
- Malaria control in rural Malawi: implementing peer health education for behaviour change.Globalization and health · 2017Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children.
methodsA cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted.
resultsHealth workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63-84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96-100%) RDT negative children, respectively. However, 24% (95% CI 13-37%) of children receiving artemisinin-lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51-69%) of children presented within 24 h of onset of child's symptoms.
conclusionThe survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.
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