|Year : 2017 | Volume
| Issue : 1 | Page : 45-50
Comparative assessment of private and public health care providers' Knowledge on malaria treatment in bassa local government area of plateau state
Nanloh Samuel Jimam, Shalkur David, Bulus J Kaben
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos, Nigeria
|Date of Web Publication||17-Feb-2017|
Nanloh Samuel Jimam
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Jos
Source of Support: None, Conflict of Interest: None
Background: Health-care workers have a major role to play in ensuring that malaria treatment is carried out in accordance to treatment guidelines, to ensure the quality of patient care. Having the requisite knowledge of the ailment and its management is a necessity in achieving optimal treatment outcomes. Objectives: The purpose of this study was to assess and compare health-care workers' knowledge on malaria and its treatment across public and private primary health-care facilities of Bassa Local Government Area, Nigeria. Materials and Methods: Two hundred pretested semi-structured questionnaires were administered to health-care workers across selected public and private facilities; and the generated data were analyzed using Statistical Package for Social Sciences software version 20. Results: A total of 184 health-care workers (92% of the study population of 200) participated in the study. The majority of the health-care workers (65.8%) were from the public sector, while 34.2% were from private health facilities. Most of the respondents were Junior Community Health Extension Workers (23.4%) and Community Health Extension Workers (22.8%). The other health workers included in the study were nurses and laboratory and pharmacy technicians involved in the management of malaria. The respondents had a good knowledge of the cause, symptoms, and diagnosis of malaria across the facilities, based on their item scores; however, their knowledge on anti-malarial drugs was poor. Workers with >10 years in practice had significantly better knowledge (45.3%) than those with lesser experience (28.4%) (P = 0.018). Those in private practice had marginally better knowledge (44.4%) than those in public sectors (38.8%). Conclusion: The respondents had good knowledge of the etiology, symptoms, and diagnosis of uncomplicated malaria across the facilities, but knowledge of the recommended antimalarials and symptoms of complicated malaria was poor. The outcomes will be useful in educating health-care professionals in the facilities, with an emphasis on the recommended drugs for malaria.
Keywords: Health-care providers, knowledge, malaria, public and private, treatment
|How to cite this article:|
Jimam NS, David S, Kaben BJ. Comparative assessment of private and public health care providers' Knowledge on malaria treatment in bassa local government area of plateau state. Curr Med Issues 2017;15:45-50
|How to cite this URL:|
Jimam NS, David S, Kaben BJ. Comparative assessment of private and public health care providers' Knowledge on malaria treatment in bassa local government area of plateau state. Curr Med Issues [serial online] 2017 [cited 2020 Feb 27];15:45-50. Available from: http://www.cmijournal.org/text.asp?2017/15/1/45/200304
| Introduction|| |
Malarial infection is one of the major public health problems, especially in the sub-Saharan Africa where it remains one of the leading causes of morbidity and mortality.,, According to the World Health Organization treatment guideline for malaria, before initiating treatment for malaria, the presence of the parasites should be confirmed using the microscopic or rapid diagnostic test., This decision became necessary due to an increasing incidence of treatment failure resulting from wrong diagnosis of the disease by clinical symptoms since malaria has been shown to share common symptoms with some other acute febrile illnesses of bacterial origin. Hence, differentiating between these causes often becomes difficult, resulting in wrong diagnoses and inappropriate treatment.,
Studies have reported the roles of both the public and private health-care sectors in providing health-care services to people in developing countries, and there are different views as to which of the two render better services, especially in the rural areas where there are limited tertiary health facilities., Where availability of the required material resources exists, whether in the private or public facilities, there may be limitations on the side of the health-care providers in rendering the required services due to lack of appropriate knowledge of a disease and its management resulting in inappropriate medications., The purpose of this study was to assess the levels of knowledge regarding malaria among health workers and to compare public and private primary health-care (PHC) providers' knowledge of malarial treatment.
| Materials and Methods|| |
The study was carried out in Bassa Local Government Area (LGA) of Plateau State, located in the North-Central part of Nigeria, with a population of 186,859. The LGA is divided into three chiefdoms, namely, Pengana, Rukuba, and Irigwe chiefdoms, with a total of 45 government-owned PHC centers and about 28 private clinics unequally distributed across the three chiefdoms.
The study was a facility-based, cross-sectional study across both the public and private PHC facilities of the LGA.
Sampling method and sample size
A multistage sampling technique was used in selecting both the public and private PHC facilities across the LGA. It involved the use of proportionate-stratified and simple random sampling techniques. The LGA was stratified into three chiefdoms, namely, Pengana, Rukuba, and Irigwe chiefdoms. From each of the chiefdoms, approximately, one-third of the total number of PHC facilities were selected for the study by simple random sampling technique. All the health-care workers (doctors, nurses/midwives), Junior Community Health Extension Workers (JCHEWs), Community Health Extension Workers (CHEWs), laboratory and pharmacy technicians, and others involved in the management of malaria were eligible for the study, as summarized in [Figure 1].
|Figure 1: Schematic presentation of the sampling method and study population.|
Click here to view
Permission to conduct the study was obtained from the Ethics Committee of the Faculty of Pharmaceutical Sciences, University of Jos, and the office of the director of PHC, Bassa LGA, Plateau State. The purpose and objectives of the study were explained to the respondents, after which their consents were obtained and they were assured of the confidentiality of their collected information.
Pretested semi-structured questionnaires were administered to all the PHC workers totaling 200 across the thirty selected facilities to obtain information on their sociodemographic characteristics, as well as their level of understanding on the cause, signs and symptoms, diagnosis, and treatment of uncomplicated malaria. There were 184 respondents who completed the study.
Data generated from the filled and returned questionnaires were entered into Microsoft Excel software based on coded format and transferred into Statistical Package for Social Sciences software version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) for analysis. Descriptive statistics were generated for respondents' demography, malaria-related knowledge gaps, and categories. A correct answer to each malaria-related knowledge item was scored one while zero was awarded for incorrect response. The sum of correct response for each item was computed as a percentage of the total respondents' size. Item scoring (for each item) was computed as a percentage of the total respondents' size. A score of <70% for each item was considered a knowledge gap. Quartile was used in categorizing the malaria-related knowledge of respondents, and respondents who had total scores above the third quartile were categorized as having high malaria-related knowledge, while those with scores below the third quartile had low malaria-related knowledge level. The association of knowledge category prevalence and respondents' demography was also investigated using Chi-square test set at P < 0.05 for significance.
| Results|| |
The majority of the health-care workers (65.8%) were from the public sector and were mostly from the Pengana chiefdom, while 34.2% were from private health facilities. A total of 184 health-care workers across the selected facilities participated in the study, of which 42.4% were males and 57.6% were females [Table 1]. Their years of experience in practice ranged between 1 and 25 years. The participants were mostly JCHEWs and CHEWs (23.4% and 22.8%, respectively), followed by nurses (12.5%) and pharmacy technicians (3.8%).
|Table 1: Demographic characteristics of respondents across the facilities (n = 184)|
Click here to view
Malaria-related knowledge gaps of health-care workers
[Table 2] shows the malaria-related knowledge of the respondents across both the public and private health facilities of the LGA. All workers had a good knowledge of the etiology of the disease (100% scores). They were also able to recognize pregnant women as those at risk of the infection (98.4%), with only few (23.9%) recognizing foreigners as being at risk of infection. With respect to the signs and symptoms of uncomplicated malaria, most respondents had a good knowledge of the symptoms. A knowledge gap (46.7%) existed only for the recognition of vomiting as one of the symptoms. For complicated malaria, there was a knowledge gap for the early symptoms of severe malaria such as prostration (35.3%), impaired consciousness (50.0%), and fever (19%). Their knowledge of the confirmatory test for malaria was good (98.9%).
Based on the item scores for knowledge of drug treatment for malaria, the respondents across the facilities had poor understanding of the recommended drugs for uncomplicated, complicated, and malaria in pregnancy. The scores for each of the items fell below 70%.
Malaria-related knowledge categorization across the types of facilities
Most of the respondents across the public and private facilities 58.9% [Figure 2] had a low knowledge of malaria and its management. Considering the private and public facilities separately, it was observed that the private health-care workers had a marginally higher proportion with high knowledge (44.40%) of the disease when compared to those in the public facilities (38.80%) [Figure 2]. The difference in knowledge levels between the two groups was not statistically significant [Table 3].
|Figure 2: Malaria-related knowledge categories across the study facility type. Keys: = High knowledge categories; = Low knowledge categories.|
Click here to view
|Table 3: Associations of knowledge category with respondents' demography (n = 184)|
Click here to view
Malaria-related knowledge categorization across demographic characteristics
Relating the malaria-related knowledge categories with the demographic characteristics of the respondents, there were no statistically significant differences between the genders, age groups, and qualifications.
When considering the years of practice, those who had been practicing for over 10 years had significantly better knowledge of the disease and its management compared to their counterparts who had less than 10 years of experience (P = 0.018).
The practitioners involved in malaria treatment from the Rukuba chiefdom had marginally better understanding on the disease and its management (47.9%) followed by those from the Pengana (42.1%) and Irigwe (24.1%) chiefdoms. The differences were not statistically significant [Table 3].
| Discussion|| |
The main purpose of training health-care workers is to render appropriate treatment services to patients in accordance with the treatment guidelines of the ailment. Their treatment practices generally determine the quality of care received by patients in addition to patients' adherence to medications.,, Their ability to render such effective treatment services is dependent on their levels of understanding of the disease and its management. An understanding of the knowledge gaps that exist in the understanding of the diagnosis and management of malaria may help in designing appropriate measures aimed at improving the service effectiveness in the facilities.
The present study findings showed that the awareness among the participants of the cause and symptoms of uncomplicated malaria was high. The findings were similar to a study conducted in rural areas of Tanzania  where health workers had a good knowledge of the disease. It was, however, in contrast to a similar study conducted among rural health workers of Cambodia which showed low levels of knowledge regarding etiology of the infection.
The respondents also recognized the need for confirmatory tests for the disease before initiation of treatment. This helps to avoid cases of drug resistance. Their recognition of the importance of carrying out confirmatory tests implied that there was possibly a low incidence of the practice of presumptive diagnosis across the facilities. This was in contrast to other earlier studies among health-care workers which showed a dependence only on presumptive diagnosis before initiating treatment.,
Despite their good knowledge of the etiology, symptoms, and diagnosis of the disease, they generally had poor knowledge of the recommended anti-malarial drug for uncomplicated malaria and for malaria in pregnancy. This is of concern as it may result in inappropriate medication prescriptions, such as wrong drugs, dosage, frequency of administration, and duration of treatment.
Although they are trained to treat uncomplicated cases and also to stabilize any patient with suspected complicated case before referral, their poor knowledge of early symptoms of severe malaria might result in late referral of the patients to higher health-care facilities for detailed attentions, which might possibly result in unexpected casualties in serious cases.
The overall knowledge of the health workers was poor with less than half of the respondents falling into the high knowledge category. Private health facilities had a marginally higher percentage of workers with high knowledge than the public facilities [Figure 2]. This result was in contrast to many previous studies,,, showing poor knowledge among private practitioners. This could have implications on the quality of care and safety of medications on the patients, especially on children under 5 years and pregnant women who are more vulnerable to the disease ,,, since public facilities form the major bulk of the centers providing malaria care and are more affordable and accessible to the population.
The respondents' knowledge was significantly associated with their number of years in practices (experience), with those who had been practicing for over 10 years having good knowledge of the disease and its management compared to those having less than 10 years of experience. This result was in agreement with a study in rural Nepal  which was conducted among female community health workers in the setting of maternal and child health-care services.
Although direct causative relationships cannot be derived, the results of this study suggest significant knowledge gaps in the management of malaria, especially regarding the symptoms of complicated malaria and the recommended drugs for both complicated and uncomplicated malaria. This is significant because, in most developing countries, the vast majority of those involved in the primary management of endemic diseases are not physicians. Improving knowledge levels in these health workers is, therefore, an important step toward managing this disease which is associated with a large number of deaths in Nigeria. Greater efforts toward educating health-care workers, both by the government and nongovernmental agencies, will go a long way toward reducing the burden of this killer disease. The outcomes of the study can help guide the decision-making process, so the education can be planned to address particular knowledge gaps and demographic groups.
| Conclusion|| |
The study showed high levels of respondents' knowledge on etiology, symptoms, and diagnosis of uncomplicated malaria, but low knowledge on the recommended antimalarials for treatment and the features of complicated malaria. This poor understanding was observed to be marginally greater in the public health facilities than in the private facilities. The outcomes will be useful in educating the health-care professionals in the facilities on the disease and its management, with more emphasis on the recommended drugs for malaria.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wardrop NA, Barnett AG, Atkinson JA, Clements AC. Plasmodium vivax
malaria incidence over time and its association with temperature and rainfall in four counties of Yunnan Province, China. Malar J 2013;12:452.
Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: A brief review. Korean J Parasitol 2009;47:93-102.
Bartoloni A, Zammarchi L. Clinical aspects of uncomplicated and severe malaria. Mediterr J Hematol Infect Dis 2012;4:e2012026.
Oxfam. Blind Optimism: Challenging the Myths about Private Health Care in Poor Countries. Oxford: Oxfam International; 2009.
World Bank. World Bank Responds to New Oxfam Health Report. Washington, Columbia: World Bank; 2009.
Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304-14.
Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: Clinical applications. JAMA 2002;288:2880-3.
Plateau State Ministry of Health. Annual Health Statistical Bulletin. Jos: Plateau State Government; 2006. p. 17-20.
Federal Ministry of Health. In: Babajide C, Bellay K, David D, Ernest N, Evelyn P, Femi A, et al
, editors. National Guidelines for Diagnosis and Treatment of Malaria. Abuja: Federal Ministry of Health; 2011.
O'Meara WP, Noor A, Gatakaa H, Tsofa B, McKenzie FE, Marsh K. The impact of primary health care on malaria morbidity – Defining access by disease burden. Trop Med Int Health 2009;14:29-35.
Greenley RN, Kunz JH, Walter J, Hommel KA. Practical strategies for enhancing adherence to treatment regimen in inflammatory bowel disease. Inflamm Bowel Dis 2013;19:1534-45.
Jimmy B, Jose J. Patient medication adherence: Measures in daily practice. Oman Med J 2011;26:155-9.
Vijayakumar KN, Gunasekaran K, Sahu SS, Jambulingam P. Knowledge, attitude and practice on malaria: A study in a tribal belt of Orissa state, India with reference to use of long lasting treated mosquito nets. Acta Trop 2009;112:137-42.
Mazigo HD, Obasy E, Mauka W, Manyiri P, Zinga M, Kweka EJ, et al.
Knowledge, attitudes, and practices about malaria and its control in rural Northwest Tanzania. Malar Res Treat 2010;2010:794261.
Yasuoka J, Poudel KC, Poudel-Tandukar K, Nguon C, Ly P, Socheat D, et al.
Assessing the quality of service of village malaria workers to strengthen community-based malaria control in Cambodia. Malar J 2010;9:109.
Chinkhumba J, Skarbinski J, Chilima B, Campbell C, Ewing V, San Joaquin M, et al.
Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi. Malar J 2010;9:209.
Uneke CJ. Concurrent malaria and typhoid fever in the tropics: The diagnostic challenges and public health implications. J Vector Borne Dis 2008;45:133-42.
Minzi OM, Haule AF. Poor knowledge on new malaria treatment guidelines among drug dispensers in private pharmacies in Tanzania: The need for involving the private sector in policy preparations and implementation. East Afr J Public Health 2008;5:117-21.
Bamiselu OF, Ajayi I, Fawole O, Dairo D, Ajumobi O, Oladimeji A, et al
. Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun state, Nigeria. BMC Public Health 2016;16:828.
Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS Med 2012;9:e1001244.
Nayyar GM, Breman JG, Newton PN, Herrington J. Poor-quality antimalarial drugs in Southeast Asia and sub-Saharan Africa. Lancet Infect Dis 2012;12:488-96.
Manyando C, Njunju EM, Virtanen M, Hamed K, Gomes M, Van Geertruyden JP. Exposure to artemether-lumefantrine (coartem) in first trimester pregnancy in an observational study in Zambia. Malar J 2015 14;14:77.
Onwujekwe O, Obikeze E, Uzochukwu B, Okoronkwo I, Onwujekwe OC. Improving quality of malaria treatment services: Assessing inequities in consumers' perceptions and providers' behaviour in Nigeria. Int J Equity Health 2010 11;9:22.
Acharya D, Singh JK, Adhikari S, Jain V. Association between sociodemographic characteristics of female community health volunteers and their knowledge and performance on maternal and child health services in rural Nepal. J Multidiscip Healthc 2016;9:111-20.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]