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BMC Public Health. 2012; 12: 695.
Published online Aug 24, 2012. doi:  10.1186/1471-2458-12-695
PMCID: PMC3490993
Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?
Daniel J Kyabayinze,corresponding author1,2 Jane Achan,3 Damalie Nakanjako,3 Betty Mpeka,1 Henry Mawejje,1 Rukaaka Mugizi,1 Joan N Kalyango,3 Umberto D’Alessandro,4,5 Ambrose Talisuna,6,7 and Van geertruyden Jean-Pierre8
1Malaria Consortium, Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
2Foundation for Innovative New Diagnostics, Akii Bua Road Nakasero, Kampala, Uganda
3Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
4Institute of Tropical Medicine, Antwerp, Belgium
5The Medical Research Council Unit, The Gambia
6Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
7Malaria Public Health and Epidemiology Cluster, University of Oxford-KEMRI-Wellcome Trust Research Programme
8Unit International Health, ESOC Department, Faculty of Medicine, Antwerp University, Universiteiplein 1, BE-2610, Antwerpen, Belgium
corresponding authorCorresponding author.
Daniel J Kyabayinze: drdjkyabayinze/at/yahoo.com; Jane Achan: achanj/at/yahoo.co.uk; Damalie Nakanjako: drdamalie/at/yahoo.com; Betty Mpeka: b.mpeka/at/gmail.com; Henry Mawejje: mawejjehenry/at/yahoo.com; Rukaaka Mugizi: rukaakam/at/gmail.com; Joan N Kalyango: nakayaga2001/at/yahoo.com; Umberto D’Alessandro: udalessandro/at/mrc.gm; Ambrose Talisuna: atalisuna/at/yahoo.com; Van geertruyden Jean-Pierre: Jean-Pierre.VanGeertruyden/at/ua.ac.be
Received May 7, 2012; Accepted August 20, 2012.
Abstract
Background
Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda.
Methods
In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD.
Results
Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs.
Conclusion
Primary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems.
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