Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda


Background: Health worker shortages remain a significant challenge to delivery of health care services globally. Moving tasks, where appropriate, to less specialized health workers is recommended by the World Health Organization as a strategy to address this challenge. However, this concept is feared to raise specific quality concerns. This research aimed at assessing the performance of health workers to correctly prescribe (target) appropriate antimalarial treatment. Methods: We conducted a cross sectional study at three public health centre IVs in Uganda, with varying malaria transmission intensities (Kihihi-low, Kasambya-medium and Nagongera-high). We categorized prescribers into two groups: specialized prescribers (doctors and clinical officers) and less specialized prescribers (nurses and midwives). At each site, 100 records of patients seen between September and November 2011 and prescribed an antimalarial were retrieved for each group of prescribers. Correctness of the antimalarial drug prescribed and dose given were assessed for each group and compared to the 2005 Uganda national malaria treatment guidelines which recommend Artemether Lumefantrine (AL) for treatment of uncomplicated malaria and Quinine for complicated malaria. Results: Findings of the study showed that specialized health workers were more likely to target correctly as compared to the less specialized health workers [OR = 1.49 (1.00 - 2.22), p = 0.046]. Appropriateness of dosing was higher among specialized prescribers compared to less specialized prescribers however this was not significant [OR = 1.58 (0.77 - 3.25), p = 0.206]. Age of the participants, history of fever, diagnosis of malaria and prescription experience were not associated with correct targeting. Conclusion: This study shows that task shifting at the targeting level is not suitable; however, there is inadequate evidence to show that this also applies to anti-malarial dosing. Task shifting for the treatment of Malaria in Uganda should be investigated further using larger studies if it is to be considered as an option for solving the health worker shortages especially in regions with few specialized health workers but high malaria burden.

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Kakeeto, S. , Wanzira, H. , Karyeija, G. , Kamya, M. and Bukirwa, H. (2014) Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda. Health, 6, 2154-2161. doi: 10.4236/health.2014.616250.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] WHO (2006) The World Health Report: Working Together for Health. World Health Organisation, France.
[2] WHO (2007) Strengthening Health Services to fight HIV/AIDs. World Health Organisation, Geneva.
[3] Ucakacon, P.S., Achan, J., Kutyabam, P., Odoi, A.R. and Kalyango, N.J. (2011) Prescribing Practices for Malaria in a Rural Ugandan Hospital: Evaluation of a New Malaria Treatment Policy. African Health Sciences, 11, S53-S59.
[4] Rotich, L. (2011) Reducing Prescription of Antimalarials to Smear Negative Patients. USAID ASSIST Project, April 13, Kampala.
[5] Zurovac, D., Rowe, A.K., Ochola, S.A., Noor, A.M., Midia, B., English, M., et al. (2004) Predictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya. International Journal of Epidemiology, 33, 1080-1091.
[6] Delanyo, D. (2004) Using Mid-Level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa. A Desk Review. Human Resources for Health, 2, 7.
[7] Sserwanga, A., Harris, J.C., Kigozi, R., Menon, M., Bukirwa, H., Gasasira, A., Kakeeto, S., Kizito, F., Quinto, E., Rubahika, D., Nasr, S., Filler, S., Kamya, M.R. and Dorsey, G. (2011) Improved Malaria Case Management through the Implementation of a Health Facility Sentinel Site Surveillance System in Uganda. PLoS One, 6, e16316.
[8] Kigozi, R., Baxi, S.M., Gasasira, A., Sserwanga, A., Kakeeto, S., Nasr, S., Rubahika, D., Dissanayake, G., Kamya, M.R., Filler, S. and Dorsey, G. (2012) Indoor Residual Spraying of Insecticide and Malaria Morbidity in a High Transmission Intensity Area of Uganda. PLoS One, 7, e42857.
[9] Kirkwood, B. and Sterne, J.A.C. (2001) Essential Medical Statistics. 2nd Edition, Blackwell Publishing, Oxford, 35.
[10] MoH (2005) National Policy on Malaria Treatment. In: National Malaria Control Program MoHU, Editor. Kampala.
[11] Zurovac, D., Njogu, J., Akhwale, W.S., Hamer, D.H. and Snow, R.W. (2008) Translation of Artemether-Lumefantrine Treatment Policy into Paediatric Clinical Practice: An Early Experience from Kenya. Tropical Medicine & International Health, 13, 99-107.
[12] Ameme, D.K., Nyarko, K.M., Malm, K.L., Afari, E.A., Wurapa, F. and Sackey, S. (2012) Prescribing Practices for Uncomplicated Malaria in a Rural District in Ghana. Internation Journal of Tropical Diseases, 4.
[13] Dorsey, G., Staedke, S., Clark, T.D., Njama-Meya, D., Nzarubara, B., Maiteki-Sebuguzi, C., Dokomajilar, C., Kamya, M.R. and Rosenthal, P.J. (2007) Combination Therapy for Uncomplicated Falciparum Malaria in Ugandan Children. JAMA, 297, 2210-2219.
[14] Kamya, M.R., Yeka, A., Bukirwa, H., Lugemwa, M., Rwakimari, J.B., Staedke, S.G., Talisuna, A.O., Greenhouse, B., Nosten, F., Rosenthal, P.J., et al. (2007) Artemether-Lumefarntrine versus Dihydroartemesinin-Piperaquine for Treatment of Malaria: A Randomised Trial. PLOS Clinical Trials, 2, e20.
[15] Yeka, A., Dorsey, G., Kamya, M.R., Talisuna, A., Lugemwa, M., Rwakimari, J.B., Staedke, S.G., Rosenthal, P.J., Wabwire-Mangen, F. and Bukirwa, H. (2008) Artemether-Lumefantrine versus Dihydroartemesinin Piperaquine for Treating Uncomplicated Malaria: A Randomised Trial to Guide Policy in Uganda. PLoS One, 3, e2390.
[16] Achan, J., Tibenderana, J.K., Kyabayinze, D., Mangen, F.W., Kamya, M.R., Dorsey, G., D’Alessandro, U., Rosenthal, P.J. and Talisuna, A.O. (2009) Effectiveness of Quinine versus Artemether-Lumefantrine for Treating Uncomplicated Falciparum Malaria in Ugandan Children: Randomised Trial. BMJ, 339, Article ID: b2763.
[17] Masanja, I.M., Selemani, M, Khatib, R.A., Amuri, B., Kuepfer, I., Kajungu, D., Savigny, D., Kachur, S.P. and Skarbinski, J. (2013) Correct Dosing of Artemether-Lumefantrine for Management of Uncomplicated Malaria in Rural Tanzania: Do Facility and Patient Characteristics Matter. Malaria Journal, 12, 446.
[18] Selemani, M., Masanja, I.M., Kajungu, D., Amuri, M., Njozi, M., Khatib, R.A., et al. (2013) Health Worker Factors Associated with Prescribing of Artemisinin Combination Therapy for Uncomplicated Malaria in Rural Tanzania. Malaria Journal, 12, 334.

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