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Quality of malaria care in 25 low-income and middle-income countries

Macarayan, Erlyn K., Papanicolas, Irene ORCID: 0000-0002-8000-3185 and Jha, Ashish K. (2019) Quality of malaria care in 25 low-income and middle-income countries. BMJ Global Health. ISSN 2059-7908 (In Press)

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Introduction. Even with accessible and effective diagnostic tests and treatment, malaria remains a leading cause of death among children under-five. Malaria case management requires prompt diagnosis and correct treatment but the degree to which this happens in low-income and middleincome countries (LMICs) remains largely unknown. Methods. Cross-sectional study of 132,566 children under five, of which 25% reported fever in the last two weeks from 2006 to 2017 using the latest Malaria Indicators Survey (MIS) data across 25 malaria-endemic countries. We calculated the percent of patient encounters of febrile children under five that received poor quality of care (no blood testing, less or more than two antimalarial drugs, and delayed treatment provision) across each treatment cascade and region. Results. Across the study countries, 48,316 (58%) of patient encounters of febrile children under five received poor quality of care for suspected malaria. When comparing by treatment cascade, 62% of cases were not blood tested despite reporting fever in the last two weeks, 82% did not receive any antimalarial drug, 17% received one drug, and 72% received treatment more than 24 hours after onset of fever. Of the four countries where we had more detailed malaria testing data, we found that 35% of patients were incorrectly managed (26% were undertreated, while 9% were overtreated). Poor malaria care quality varies widely within and between countries. Conclusion. Quality of malaria care remains poor and varies widely in endemic LMICs. Treatments are often prescribed regardless of malaria test results, suggesting that presumptive diagnosis is still commonly practiced amongst cases of suspected malaria, rather than the WHO recommendation of “test and treat”. To reach the 2030 global malaria goal of reducing mortality rates by at least 90%, focusing on improving the quality of malaria care is needed.

Item Type: Article
Official URL:
Divisions: Health Policy
Date Deposited: 03 Dec 2019 14:12
Last Modified: 22 Jan 2020 00:27

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