Factors associated with malaria case management practices at health facilities in Guinea during the 2014 Ebola epidemic Open Access

Hennessee, Ian Patrick (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/gm80hv88f?locale=en


Malaria is a critical public health problem in Guinea and is the primary cause of outpatient hospital visits. Malaria case management in the context of the Ebola Virus Disease (EVD) epidemic is complicated by similar clinical presentation of the two diseases, and malaria case management practices that require close patient contact and blood testing may place health workers at elevated risk of EVD infection. Information on malaria case management practices and determinants of those practices is needed to inform policy and training efforts aimed at reducing EVD transmission risk among health workers and reducing excess morbidity and mortality from incorrect malaria case management.

A retrospective register abstraction was performed at 120 health facilities in Guinea, and questionnaires were administered to health workers at each facility. Outcomes included malaria diagnostic testing for febrile patients, presumptive malaria treatment, and antimalarial treatment after diagnostic confirmation. Associations between each outcome and possible determinants were calculated using multivariate logistic regression models, controlling for expected confounders.

Among febrile patients, 61.9% received a malaria diagnostic test and 85.9% of patients with positive tests received antimalarial drugs, whereas 15.8% of all patients were presumptively treated without diagnostic confirmation. Report of EVD case(s) at health facilities was associated with lower odds of rapid diagnostic testing (aOR= 0.01, 95%CI: 0.001, 0.10) and higher odds of presumptive treatment (aOR= 30.7, 95%CI: 2.12, 444) compared to facilities that did not report EVD case(s). Complete PPE was only available at 6.2% of health facilities, and 21.8% of febrile patients received neither a malaria diagnostic test nor presumptive antimalarial treatment.

Malaria case management practices were highly associated with EVD case report at health facilities, and inadequate case management of febrile illness was common. As the EVD epidemic continues, training efforts may emphasize the importance of presumptive malaria treatment for reducing EVD transmission risk among health workers, especially at facilities that have not yet reported EVD cases(s). At facilities where adequate PPE is not available, presumptive malaria treatment should also be encouraged in order to reduce excess morbidity and mortality among febrile patients who do not receive malaria diagnostic tests.

Table of Contents

Chapter 1: Background & Literature Review.. 1

Background.. 2

Literature Review.. 2

Malaria in Guinea. 2

The 2014-2015 EVD epidemic in Guinea. 4

EVD and malaria case management in Guinea. 6

Factors associated with malaria case management practices. 8

Chapter II: Manuscript. 10

Title. 11

Abstract. 12

Introduction.. 14

Methods:. 18

Data Source:. 18

Study Site and Sampling:. 18

Data Collection:. 19

Outcome and Variable Definitions. 20

Analysis. 22

Ethics:. 23

Results. 23

Discussion.. 28

Conclusion.. 33

References. 35

Tables & Figures. 38

Tables. 38

Figures. 43

Chapter III: Summary, Public Health Implications, Possible Future Directions. 47

Summary. 47

Public Health Implications. 48

Possible Future Directions. 50

Appendices. 51

Appendix I: Register Abstraction Tools for Nov 2013 and Nov 2014.. 51

Appendix II: Aggregate Register Abstraction Form... 54

Appendix III: Health Worker Questionnaire. 56

Appendix IV: Verbal consent form for health worker questionnaires. 63

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