%0 Journal Article
%T Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol
%A Justin Pulford
%A Ivo Mueller
%A Peter M Siba
%A Manuel W Hetzel
%J Malaria Journal
%D 2012
%I BioMed Central
%R 10.1186/1475-2875-11-157
%X In a national cross-sectional survey of 79 randomly selected health facilities, data were collected via non-participant observation of the clinical case management of patients presenting with fever or a recent history of fever. Data were recorded on a structured clinical observation instrument.Overall, 15% of observed fever patients (n£¿=£¿468) were tested for malaria infection by rapid diagnostic test and a further 3.6% were tested via microscopy. An anti-malarial prescription was made in 96.4% (451/468) of cases, including 100% (17/17) of test positive cases and 82% (41/50) of test negative cases. In all, 79.8% of anti-malarial prescriptions conformed to the treatment protocol current at the time of data collection. The purpose of the prescribed medication was explained to patients in 63.4% of cases, dosage/regimen instructions were provided in 75.7% of cases and the possibility of adverse effects and what they might look like were discussed in only 1.1% of cases.The revised national malaria treatment protocol will require a substantial change in current clinical practice if it is to be correctly implemented and adhered to. Areas that will require the most change include the shift from presumptive to RDT/microscopy confirmed diagnosis, prescribing (or rather non-prescribing) of anti-malarials to patients who test negative for malaria infection, and the provision of thorough treatment counselling. A comprehensive clinician support programme, possibly inclusive of ¡®booster¡¯ training opportunities and regular clinical supervision will be needed to support the change.
%U http://www.malariajournal.com/content/11/1/157/abstract