[Adherence of private sector providers to uncomplicated malaria management policy in Madagascar].

Abstract

Introduction\nThis study aims to assess the adherence of private health providers to the use of malaria rapid diagnostic tests (RDTs) and to the prescription of artemisinin-containing combinations (ACT) in patients with uncomplicated malaria.\n\n\nMethods\nWe conducted an analytical, retrospective and cross-sectional study in 11 Madagascar s health districts divided into four epidemiological strata in September and in October 2015. A total of 43 health providers from 39 private health care facilities (PHF) were interviewed and visited.\n\n\nResults\nHealth providers declared having read the malaria management manual in 16.3% of cases (4/43). Only one quarter (25.6%) of health providers had RDTs in their office. ACT was reported as first-line drug for the treatment of uncomplicated malaria by 83.7% of health providers. In practice, 55.6% of health providers had doubts about the results of the RDTs. The use of antimalarial drugs, despite having had negative RDTs results (38.2%), was more frequent among those who had raised doubts (p = 0.03). Conversely, despite having had positive RDTs results, half of the health providers did not prescribe ACT (50%). The decision to not participate in periodic reviews by the Health District (p = 0.05) negatively influenced the adherence to the policies.\n\n\nConclusion\nThe low adherence of private health providers to the national guidelines for the management of uncomplicated malaria raises questions about the importance of exercising more control over health providers activities.