Quality of malaria services offered in public health facilities in three provinces of Mozambique: a cross-sectional study

• Published in: Malaria journal Vol. 18; no. 1; p. 162
• Main Authors: Candrinho, Baltazar, Plucinski, Mateusz M, Colborn, James M, da Silva, Mariana, Mathe, Guidion, Dimene, Mercia, Chico, Ana Rita, Castel-Branco, Ana Christina, Brito, Frederico, Andela, Marcel, Ponce de Leon, Gabriel, Saifodine, Abuchahama, Zulliger, Rose
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.05.2019; BioMed Central; BMC
• Subjects: Adolescent; Adult; Ambulatory Care; Ambulatory care facilities; Analysis; Antimalarials - therapeutic use; Bioavailability; Care and treatment; Case management; Child; Child, Preschool; Commodities; Cross-Sectional Studies; Data collection; Disease Management; Disease transmission; Dosage; Ebola virus; Epidemiology; Female; Fever; Fever - drug therapy; Health care; Health care industry; Health counseling; Health facilities; Health Facilities - statistics & numerical data; Health facility survey; Health Personnel - standards; Health Personnel - statistics & numerical data; Human diseases; Humans; Infant; Malaria; Malaria - drug therapy; Malaria - epidemiology; Malaria case management; Male; Medical care quality; Microscopy; Mozambique; Mozambique - epidemiology; Patient Acceptance of Health Care; Patients; Provinces; Public health; Public Health - statistics & numerical data; Quality; Quality of care; Quality of Health Care; Testing; Training; Vector-borne diseases; Workers; Young Adult; Mozambique; Mozambique; Malaria case management; Health facility survey; Quality of care
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-019-2796-9

Fever associated with malaria is the leading cause of health care-seeking in Mozambique, yet there is limited evidence on the quality of malaria case management. This study evaluated the quality of malaria service provision offered in public health facilities in Mozambique. A cross-sectional assessment was conducted in April-May 2018 in three provinces of Mozambique: Maputo Province (low malaria burden), Cabo Delgado (high), and Zambézia (high). The study included all secondary and tertiary facilities and a random sample of primary facilities in each province. Data collection included exit interviews and re-examinations of 20 randomly selected outpatient service patients, interviews with up to five health care providers and the health facility director, a stockroom inventory and routine data abstraction. A total of 319 health care providers and 1840 patients from 117 health facilities were included. Of these, 1325 patients (72%) had suspected malaria (fever/history of fever) and 550 (30%) had febrile, confirmed malaria with the highest burden in Cabo Delgado (43%), followed by Zambézia (34%) and Maputo Province (2%). Appropriate management of malaria cases, defined as testing malaria suspects and treating confirmed cases with the correct dose of anti-malarial, was highest in Zambézia and Cabo Delgado where 52% (95% CI 42-62) and 49% (42-57) of febrile malaria cases were appropriately managed, respectively. Only 14% (5-34) of febrile cases in Maputo Province were appropriately managed. The biggest gap in the malaria case management pathway was failure to test febrile patients, with only 46% of patients with this indication tested for malaria in Maputo Province. Additionally, anti-malarial treatment of patients with a negative malaria test result was common, ranging from 8% (2-23) in Maputo Province to 22% (14-32) of patients with a negative test in Zambézia. Only 58-62% of patients prescribed an anti-malarial correctly recited dosing instructions. Provider training and malaria knowledge was low outside of Zambézia and supervision rates were low in all provinces. Factors associated with correct case management varied by province and included patient age, facility type, treatment and testing availability, supervision, and training. These findings underscore the need to strengthen provider testing of all patients with fever, provider adherence to negative test results, and effective counselling of patients across epidemiological settings in Mozambique.