Clinicians’ Adherence to Implementation of Test, Treat and Track Strategy for Malaria Control among Children Under-five Years in Ho Municipality, Volta Region, Ghana

Abstract

Background: The World Health Organization emphasized testing and confirming every suspected malaria case with either Rapid Diagnostic Tests (RDTs) or microscopy before treatment with anti-malarial drugs. Over 80% of cases in endemic countries of Africa are still treated without diagnostic test. This study presented an assessment of the adherence of clinicians to implementation of the Test, Treat and Track (T3) strategy for malaria control among children under-five years in Ho municipality of the Volta region of Ghana. Methods: A cross-sectional study was carried out in 10 facilities comprising 7 public and 3 private in 2015. The survey was to determine the number of fever cases that were tested before Artemisinin-based Combination Therapy (ACT) was prescribed, if tracking of patients was done by clinicians, and the challenges to implementation of the T3 strategy among children under-five years. Data was collected using a structured questionnaire, and analysed using SPSS version 20, at the level 0.05. Results: Of the 300 children under-five years, 82% reported to the health facilities with fever. Only 58.5% of these fever cases was tested, out of which 52.8% was confirmed malaria positive, whilst 43.8% tested negative for malaria. All confirmed and unconfirmed cases were treated with ACT. About 61.5% of the cases treated were not asked to return for review. Majority (80%) of the clinicians cited frequent RDT stock-out as the major challenge to their adherence to the T3 policy. Conclusions: Adherence to the test of fever cases by clinicians was poor. Also, a substantial proportion of the untested fever cases were presumptively treated with ACT as malaria. Adherence to the use of ACT for the treatment of all malaria cases was overwhelming. The Ministry of Health/Ghana Health Service should ensure adequate and sustained supply of RDTs and ACTs to both public and private health facilities. Clinicians should be sensitized on the T3 policy.