Is the malaria short course for program managers, a priority for malaria control effort in Nigeria? Evidence from a qualitative study.

BACKGROUND: A Malaria Short Course (MSC) was conceptualized to build the capacity of program managers for malaria control due to the lack of a single comprehensive broad-based programmatic training in Nigeria. Prior to its implementation, a needs assessment was conducted based on the perspectives of stakeholders to plan and develop the curriculum. METHODS: This was an exploratory qualitative study. Fifty-six purposively selected stakeholders at local, state and national levels were interviewed. Opinions on the need for training, its perceived impact, priority focus, likelihood of participation, sustainability of and planned support for the MSC were explored using a pretested researcher-designed interview guide. Interviews were audiotape recorded, and the transcripts were subjected to thematic content analysis. RESULTS: Participants included Directors of Primary Health Care (50%), State Malaria Program Officers (8.9%), State Directors of Public Health Services (7.1%) and Roll Back Malaria Officers (5.4%). Participants' mean number of years of experience in their current positions was 6.2 (SD 4.7) years. The dominant view was "malaria remains a problem in Nigeria, exacerbated by poor funding, knowledge deficit, lack of training opportunities for program managers and prioritized training budget". A common viewpoint was "to achieve the malaria policy goals, MSC should focus on improving program managers' knowledge of the disease, novel interventions, data audit and use of data for decision making, supportive supervision as well as leadership and management skills. The prioritized thematic areas were malaria epidemiology, case management and data management. The consensus opinion was the MSC would have a positive impact on the performance of program managers. All managerial participants were willing to release their staff for the MSC and encouraged step-down training. However, most participants opined they could not guarantee that their institutions would provide financial support to the MSC attendees. CONCLUSIONS: Implementing the MSC for program managers was considered essential towards achieving malaria control. Moreover, there is need for prioritized funding and sustainability mechanisms to actualize the implementation of the course.

Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria.

BACKGROUND: Malaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. This study assessed factors influencing adherence to malaria diagnosis and treatment guidelines among healthcare workers in public and private sectors in Ogun State, Nigeria. METHODS: A comparative cross-sectional study was carried out among 432 (216 public and 216 private) healthcare workers selected from nine Local Government Areas using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on availability and use of malaria Rapid Diagnostic Test (mRDT) and artemisinin combination therapy (ACT), for management of uncomplicated malaria. Adherence was defined as when choice of antimalarials for parasitological confirmed malaria cases was restricted to recommended antimalarial medicines. Association between adherence and independent variables were tested using Chi-square at 5 % level of significance. RESULTS: Malaria RDT was available in 81.9 % of the public health facilities and 19.4 % of the private health facilities (p = 0.001). Its use was higher among public healthcare workers (85.2 %) compared to 32.9 % in private facilities (p = 0.000). Presumptive diagnosis of malaria was higher among private healthcare workers (94.9 %) compared to 22.7 % public facilities (p = <0.0001). The main reason for non-usage of mRDT among private healthcare workers was its perceived unreliability of mRDT (40.9 %). Monotherapy including artesunate (58.3 % vs 12.5 %), amodiaquine (38.9 % vs 8.3 %) and chloroquine (26.4 % vs 4.2 %) were significantly more available in private than public health facilities, respectively. Adherence to guidelines was significantly higher among public healthcare workers (60.6 %) compared to those in private facilities (27.3 %). Availability of antimalarial medicine was the main factor that influenced treatment prescription in both healthcare settings (p = 0.27). However, drug promotion by manufactures (45.8 %) has a major influence on private healthcare workers' prescription practice. CONCLUSION: The findings of this study demonstrate significant difference between public and private healthcare workers on adherence to national malaria diagnosis and treatment guidelines. Interventions to improve private sector engagement in implementation of the guidelines, training and supply of recommended antimalarial medicines should be intensified.