Quality of malaria services offered in public health facilities in three provinces of Mozambique: a cross-sectional study

• Published in: Malaria Journal
• Main Authors: Baltazar Candrinho, Mateusz M. Plucinski, James M. Colborn, Mariana da Silva, Guidion Mathe, Mercia Dimene, Ana Rita Chico, Ana Christina Castel-Branco, Frederico Brito, Marcel Andela, Gabriel Ponce de Leon, Abuchahama Saifodine, Rose Zulliger
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2019
• Subjects: Health facility survey; Quality of care; Mozambique; Malaria case management; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-019-2796-9; https://doaj.org/article/ffb7855e36a848f2a375cf2bc81d91a2

Abstract Background Fever associated with malaria is the leading cause of health care-seeking in Mozambique, yet there is limited evidence on the quality of malaria case management. This study evaluated the quality of malaria service provision offered in public health facilities in Mozambique. Methods A cross-sectional assessment was conducted in April–May 2018 in three provinces of Mozambique: Maputo Province (low malaria burden), Cabo Delgado (high), and Zambézia (high). The study included all secondary and tertiary facilities and a random sample of primary facilities in each province. Data collection included exit interviews and re-examinations of 20 randomly selected outpatient service patients, interviews with up to five health care providers and the health facility director, a stockroom inventory and routine data abstraction. Results A total of 319 health care providers and 1840 patients from 117 health facilities were included. Of these, 1325 patients (72%) had suspected malaria (fever/history of fever) and 550 (30%) had febrile, confirmed malaria with the highest burden in Cabo Delgado (43%), followed by Zambézia (34%) and Maputo Province (2%). Appropriate management of malaria cases, defined as testing malaria suspects and treating confirmed cases with the correct dose of anti-malarial, was highest in Zambézia and Cabo Delgado where 52% (95% CI 42–62) and 49% (42–57) of febrile malaria cases were appropriately managed, respectively. Only 14% (5–34) of febrile cases in Maputo Province were appropriately managed. The biggest gap in the malaria case management pathway was failure to test febrile patients, with only 46% of patients with this indication tested for malaria in Maputo Province. Additionally, anti-malarial treatment of patients with a negative malaria test result was common, ranging from 8% (2–23) in Maputo Province to 22% (14–32) of patients with a negative test in Zambézia. Only 58–62% of patients prescribed an anti-malarial correctly recited dosing instructions. Provider training and malaria ...