Improving Malaria Case Management by Health Care Providers in Antenatal Clinics in Akwa Ibom State of Nigeria

by: Bright Orji1, William Brieger1, Emmanuel Otolorin1 and John2 1 Jhpiego, an affiliate of Johns Hopkins University; 2 Akwa Ibom State Ministry of Health

MIS 2011 Revealed Very Poor Indices

Large Problem: Approximately 11% of maternal
deaths are caused by malaria in pregnancy (MIP) Poor Response: Malaria treatment is largely by presumptive diagnosis Ideally parasitological diagnosis followed by ACT if positive
80 70 Percentage 60 50 40 30 20 10 0
ANC attendance at least once with SBA Pregnant women with 2 or more doses of IPTp-SP Pregnant women who slept inside ITN the previous night

Time Frame
Data extraction was
conducted between February 2010 and March 2011 by trained nurses/ midwives The State Ministry of Health approved the study: confidentiality, nonuse of identifiers

Record Quality Issues

The percentage of time that clients temperature was taken and recorded improved from 56.7% at baseline to 61.4%; difference between the two was statistically significant (p-value=0.00)

66.2

Type of Prescriber
19.5 16.9
Midwives CHOs 1.2% 1.9% CHEWs 11.7% Nurses 13.2% 17.0% 32.6% Nurse/ midwives

Pattern of Prescription for Anti-Malarial Medicines after RDT

Anti-Malarial Medicines Drug Base ACTs Quinine Sulfadoxinepyrimethamine Quinine injection Chloroquine Total Baseline (No RDTs at Baseline) 138(27) 132(26) 122(24) 58(12) 56(11) 506 Endline RDT Positive Result 45(64) 4(6) 11(15) 5(7) 6(8) 71 RDT Negative Result 52(64) 4(5) 9(11) 3(4) 13(16) 81

MICS, 2011 (FMoH, NBS, Abuja)

Promoting Integrated Management of Malaria and Fever in Pregnancy

Use of long-lasting insecticide-treated nets (LLINs), Intermittent preventive treatment (IPTp), and Prompt and effective case management of febrile

Medical doctors

22.4% Health workers not indicated

Training Nurses on RDT

illness: With early and proper diagnosis of malaria using rapid diagnostic tests (RDTs) and microscopy

Pattern of Prescription for Antibiotics

Anti-Malarial Medicines Drug Base Septrin Chloamphnicol Ampiclox Baseline (No RDTs at Baseline) 11 0.5 21 37 8 1 7 1 2 0.5 1 198 8 Endline RDT Positive Result 25 RDT Negative Result 2.5 2 62.5 22 5 1 2 1 2 174

Patients Records and Clinical Assessments

100 84.7 Percentage 80 60 40 20 0
Temp was taken

Baseline 76.5 Endline 80.4

63.6 36.4

56.8

61.4

Study Aims
Thisstudy sought to learn whether the introduction of RDTs into government-owned antenatal care (ANC) clinics would influence the pattern of fever and malaria management in Akwa Ibom State, Nigeria

23.5 0
Temp was Presumptive RDT taken and diagnosis conducted recorded conducted

19.6 0
RDT positive

Amoxicillin Ampicillin Gentamycin Ciprofloxacin Amoxil Caps Flagyl Tetracycline Gentamycin Injection Total N

32 30.5 12.5

0
RDT negative

Implications for Intervention

The review of records did show that nursing and
midwifery staff at government clinics could in a relatively short time period adopt the use of RDTs They did improve their prescribing of appropriate anti-malarial medicines Gaps exist in history taking and malaria diagnosis, with inappropriate dispensing of anti-malarial medicines and antibiotics Continued follow-up and supervision will be needed to ensure that correct malaria diagnostic and treatment guidelines are fully practiced

Methods
At baseline, 597 client cards were reviewed at 6
government-owned ANC clinics in Onna and Ibeno Local Government Areas Staff were then trained in RDT use At endline, 472 cards were reviewed The ANC client cards were drawn from first nonfollow-up visits where a complaint of fever was recorded

Pattern of Prescription for Anti-Malarial Medicines

80 70 64 Baseline Endline 27 26 6 ACTs Quinine
SP

Percentage

60 50 40 30 20 10 0 24 15 12 6 11 CQ 8

Quinine

Funding for the production of this poster was provided by Ellicott Dredges, LLC, Baltimore, Maryland, through additional financial support for the use of community-directed intervention for Integrate Community Case Management of Malaria. The opinions herein are those of the authors and do not necessarily reflect the views of Ellicott Dredges, LLC. For further information, please contact Bright Orji: BrightOrji.Clement@jhpiego.org