Research
Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study
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* Corresponding author: Dejan Zurovac dzurovac@nairobi.kemri-wellcome.org
1 Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI/Wellcome Trust Collaborative Programme, P.O. Box 43640, 00100 GPO, Nairobi, Kenya
2 Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
3 Chainama Hills College Hospital of Health Sciences, P.O. Box 33991, Lusaka, Zambia
4 National Malaria Control Centre, Ministry of Health, P.O. Box 32509, Lusaka, Zambia
5 Center for International Health and Development, Boston University School of Public Health, 85 East Concord Street, 5th Floor, Boston, MA 02118, USA
6 Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
Malaria Journal 2007, 6:31 doi:10.1186/1475-2875-6-31
Published: 16 March 2007Abstract
Background
Zambia was the first African country to change national antimalarial treatment policy to artemisinin-based combination therapy – artemether-lumefantrine. An evaluation during the early implementation phase revealed low readiness of health facilities and health workers to deliver artemether-lumefantrine, and worryingly suboptimal treatment practices. Improvements in the case-management of uncomplicated malaria two years after the initial evaluation and three years after the change of policy in Zambia are reported.
Methods
Data collected during the health facility surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission facilities in four Zambian districts were analysed. The surveys were cross-sectional, using a range of quality of care assessment methods. The main outcome measures were changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five years of age presenting with uncomplicated malaria as defined by national guidelines.
Results
In 2004, 94 health facilities, 103 health workers and 944 consultations for children with uncomplicated malaria were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were evaluated using the same criteria of selection. Health facility and health worker readiness improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60% (62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75% (78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of in-service training from 25% (26/103) to 41% (55/135). The proportions of children with uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006: from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to 42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22% (441/2020) of children with uncomplicated malaria were not prescribed any antimalarial drug.
Conclusion
Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment provided at the point of care is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.