Table 2 Implications of findings for malaria control programmes
Health system building block | In-depth interview theme | Implications for programmes |
|---|---|---|
Health workforce | Perceptions on the treatment of malaria in pregnancy | Positive provider perception is favourable for the programme |
|  | Knowledge of malaria’s effects on pregnancy | Training needed to increase knowledge |
| Â | Training in malaria in pregnancy | Training is required for both health facility and drug outlet providers |
Leadership/Governance | Â | Â |
| Â | Knowledge of national malaria management guidelines | Dissemination is required, especially for healthcare providers in drug outlets and private health facilities not involved in the multiple first-line treatment project |
| Â | Monitoring health worker compliance with malaria management guidelines | Priority to be given to monitoring of drug outlet providers |
Service delivery | Â | Â |
| Â | Diagnosis of malaria | Healthcare providers explain to patients how rapid diagnostic tests work and emphasize the difference with an HIV test kit, a broader social and behavioural change strategy to increase test acceptance |
| Â | Â | Provide adequate rapid diagnostic test kits and gloves to health facilities |
| Â | Â | Educate on infection prevention measures targeting needlestick injuries |
| Â | Â | Training providers to emphasize parasitological diagnosis of malaria and sensitivity of diagnostic test kits |
| Â | Assessing for pregnancy | Regular supervision of drug outlets to ensure the availability of pregnancy test kits |
| Â | Drug stock-outs | Ensure regular supply of anti-malarials by timely procurement and redistribution to health facilities as needed |
Products and technologies or access to essential medicines | Â | Â |
| Â | Antimalarial drug characteristics | The change in WHO recommendation from quinine to artemether-lumefantrine for the treatment of first-trimester uncomplicated malaria means that the preference for artemether-lumefantrine over quinine is no longer contraindicated |
| Â | Factors considered when prescribing anti-malarials | Drug cost and patient preference as factors in prescription imply that some prescribing practices may contravene guidelines. Regular supervision to ensure recommended anti-malarial drug availability in health facilities and drug outlets |
| Â | Challenges of having different drug recommendations | Copies of national guidelines and job aids should be available at health facilities and drug outlets. Regular training of health care providers on current malaria guidelines should be done |