A Comparative Study on Implementation of National Guidelines for Diagnosis and Treatment of Malaria between Public and Private Health Care Facilities in Cross River State, Nigeria

INTRODUCTION: Malaria remains a major public health problem in Nigeria. Early diagnosis and prompt treatment with recommended drugs is a key strategy to malaria control. The Nigerian national guidelines for diagnosis and treatment of malaria were reviewed in 2005. Little is known about healthcare providers’ implementation of these changes and this could inform more specific steps to facilitate the implementation. This study assessed the implementation of the national guidelines by healthcare providers in Cross River State.   

METHODS: This research was a cross-sectional study of healthcare providers in public and private health facilities using quantitative and qualitative methods. Structured self-administered questionnaire was used to collect information from 228 health workers on the availability of malaria resources in their facilities; their knowledge of, adherence to, and challenges in implementing the guidelines. Key informants in-depth interviews gave data about provider’s perceived role in implementation; perception of government effort to ensure implementation; and challenges in adherence to the guidelines.

Data was analyzed using SPSS version 20.0. Chi-squared test was used to test the hypotheses. Regression analysis was used to identify the true predictors of adherence to the guidelines in the study population. Transcribed IDI data was analyzed by thematic analysis.

RESULTS: Private facilities were more likely to have resources for malaria microscopy and rapid diagnostic tests (p=0.0001). They were also more likely to stock recommended artemisinin-based combination therapy (ACT) drugs (p= 0.0001); and to stock and prescribe non-recommended drugs. There was a generally low knowledge of the guidelines, more so among private providers. Health workers in both public and private facilities were not always adherent to the guidelines. Most of the limitations to the implementation of the guidelines were based on inadequate resources especially at the public facilities. 

CONCLUSIONS: The potential public health benefits from the guidelines may not be realized if the healthcare providers do not conform to the recommended guidelines. It is essential that training, supply of resources, and supervision work hand-in-hand to ensure effective implementation.