Wisdom Takramah

Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNS) in malaria prevention in the Hohoe Municipality, Ghana

Introduction Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. Methods In August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. Results A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). Conclusion Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.

Implementation and challenges of test, treat and track (T3) strategy for malaria case management in children under five years in the Bongo District, Ghana

Background: Malaria is a very deadly vector borne disease, which causes high morbidity and mortality, especially among children less than five years. In 2010, Ghana subscribed to the World Health Organization’s recommendation and developed guidelines for implementing the test, treat and track (T3) strategy. This study examined the extent to which the T3 strategy was being adhered to by clinicians and the challenges with its implementation at various levels of the health system in the Bongo district of Ghana. Method: This was a descriptive cross-sectional study carried out in March 2016 in 28 public health facilities comprising one (1) District Hospital, 6 Health Centres and 21 Community-based Health Planning and Services (CHPS) compounds. Semi-structured questionnaires were used to collect information from parents/ guardians of children under five years who visited the outpatient department (OPD). Information collected included whether the children reported with fever, were tested for malaria, treated with an antimalarial and asked to return to the health facility for review. The clinicians were asked if they were trained on the T3 strategy and the challenges they had with the implementation. Results: Overall, 322 (91.2%) out of the 353 children with fever were tested and 318 (98.8%) of them were positive for malaria parasites. All (353) children including those 31 (8.8%) not tested were treated with antimalarial drugs. Majority 351 (99.4%) of the children were treated with ACTs and only 2 (0.6%) were treated with Quinine. Less than half 167 (48.3%) were asked to return for review. Only 150(42.5%) of the children completed the T3 protocol. Completing T3 at facility level was highest at the CHPS compound 72 (60.5%), followed by the District Hospital 32 (39.5%) and the least was the Health Centre 46 (30.1%). Completing T3 by clinicians was highest among Doctors 4 (80.0%), followed by Health Assistants 24 (51.1%), Nurses 92 (47.2%) and the least was Medical/Physician Assistants (MA/ PA) 30(28.3%). Overall, the main challenges confronting clinicians were frequent malaria rapid diagnostic test (RDT) kits stock-outs 11(39.3%), lack of diagnostic facilities 10 (35.7%), ACTs stock-outs 1 (3.6%) and RDTs not giving accurate or valid results 3 (10.7%). These challenges were mainly with clinicians at the CHPS compounds and the health centres. The District hospital had no challenges with logistics. Conclusion: Testing fever cases for malaria parasitaemia was very high and ACTs were the main drugs for treating malaria at all levels. The main determinant of completing T3 was asking clients to return for review. Compliance with the T3 strategy was better at the CHPS compounds than Hospitals and Health Centres. Doctors and Health Assistants were more likely to complete T3 than nurses and MA/PA. Recommendations: The National Malaria Control Programme (NMCP) should ensure that CHPS compounds and Health Centres are regularly stocked with RDTs and ACTs. More training and monitoring support for clinicians are required to improve patient tracking and management of non-malaria fever cases at the lower levels of the health system. Correspondence to: Elvis Tarkang, Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Ghana, Tel: +233 505754478; E-mail: ebeyang1@yahoo.com