Adherence to malaria treatment guidelines among health care workers in private health facilities in Kampala's informal settlements, Uganda

Douglas Bulafu; Bridget Nagawa Tamale; Lesley Rose Ninsiima; James Natweta Baguma; Lydia Nabawanuka Namakula; Filimin Niyongabo; Grace Biyinzika Lubega; Dickson Aruhomukama; Rawlance Ndejjo; David Musoke

doi:10.1371/journal.pgph.0002220

Adherence to malaria treatment guidelines among health care workers in private health facilities in Kampala's informal settlements, Uganda

PLOS Glob Public Health. 2023 Sep 5;3(9):e0002220. doi: 10.1371/journal.pgph.0002220. eCollection 2023.

Affiliations

¹ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
² Department of Immunology and Molecular Biology, College of Health Sciences, School of Biomedical Sciences, Makerere University, Kampala, Uganda.

Abstract

Poor adherence to malaria treatment guidelines among healthcare workers (HCWs) is a major contribution to diagnostic challenges, treatment failure, and non-rational use of antimalarial medicines. However, there is limited information about adherence to malaria treatment guidelines among HCWs in private health facilities in informal settlements in Uganda. This study therefore assessed the level of adherence to malaria treatment guidelines and associated factors among HCWs in private health facilities in Kampala's informal settlements. A cross-sectional study was conducted among 339 HCWs from private health facilities in slums of 4 selected divisions in Kampala, Uganda. Quantitative data was collected using a semi-structured questionnaire, cleaned in MS Excel 2016 and analyzed using STATA 15.0 statistical software. Bivariate and multivariate analysis were conducted using a generalized linear model of modified Poisson regression to obtain factors associated with adherence to malaria treatment guidelines. The study revealed that majority of respondents 71.1%(241/339) were aged 30 years and below, and 50.1%(170/339) of the were female. Almost all of the respondents 98.8%(335/339) reported that they had malaria diagnostic equipment (microscopy or rapid diagnostic tests) at their facilities, 47.5%(161/339) had non-recommended anti-malarial drugs present in stock and 36.0% reported that they did not refer severely ill patients to higher health facilities in the previous 3 months. Although 92.6%(314/339) of the respondents had heard about the national malaria treatment guidelines, 63.1%(214/339) of them adhered to these guidelines. Having a bachelors degree (APR 1.54, (CI: 1.13-2.10)P 0.006), and having high levels of knowledge (APR 1.44, (CI: 1.13-1.60)P 0.001) were positively associated with high adherence to malaria treatment guidelines. In conclusion, adherence to malaria treatment guidelines was suboptimal and less than the national target of 90%. Enforcement, supervision, trainings, and continuous medical education should be enhanced in private healthcare facilities to improve adherence to malaria treatment guidelines in informal settlements.

Copyright: © 2023 Bulafu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by the Royal Society of Tropical Medicine and Hygiene (RSTMH) under the RSTMH Early Career Researchers Award – 2021 to DB. The views expressed herein are those of the authors and not necessarily those of RSTMH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No author received salary from the funders.