Factors Affecting Adherence to National Malaria Treatment Guidelines in the Diagnosis, Treatment and Prevention of Malaria in Pregnancy among Healthcare Workers in Public Health Facilities in Jowhar District, Somalia

Abstract

Introduction: Early diagnosis and effective treatment remain critical elements of a malaria control strategy in preventing mortality and reducing the incidence of severe malaria illness in Somalia. In Sub-Saharan African countries showed different levels of adherence to their national malaria guidelines for malaria treatment and prevention in pregnancy, while experiences from many countries indicated several challenges and constraints that may make the implementation of the guidelines difficult. Objective: The study aimed to assess factors affecting adherence to revised national malaria treatment guidelines in the diagnosis, treatment and prevention of malaria in pregnancy among health care workers in public health facilities in Jowhar District, Somalia. Methodology: A cross-sectional health facility-based study conducted in Jowhar district. A structured interview questionnaire was used for data collection from (n = 150). Healthcare workers selected from ten public health facilities using proportional to size sampling and an observational checklist was used to assess patient’s medical prescriptions to review their conformity to the guidelines and the availability of antimalarial drug, malaria diagnostic tests (mRDTs and microscopy) and job aids, such as the national malaria treatment guidelines, clinical algorithm (flow chart), malaria rapid diagnosis tests mRDTs’ use of wall charts, and drug dose wall charts at the facilities. Data was analyzed through the application of descriptive statistical analysis that includes frequency, and percentages by using Statistical Package for Social Sciences (SPSS) Version 25. Results: Healthcare workers interviewed were 89 (59.3%) aware of the existence of the revised national malaria treatment guidelines. However, 61 (40.7%) were not aware of the guidelines and only 46 (30.7%) had been trained for the national malaria guidelines in the treatment and prevention of malaria in pregnancy. Overall, 33 (22%) of the workers reported to adhere to guidelines, with 117 (78.0%) reported non-adherence. A significant difference was observed in the training status among different categories of health workers with (p-value of 0.022). Conclusion and Recommendation: In conclusion, the study showed that adherence to the national malaria guidelines for Malaria diagnosis, treatment and prevention in pregnancy among health care workers are associated with inadequate awareness of the revised national malaria guidelines among healthcare workers, inadequate supply of diagnostic tests (mRDTs and microscopy) at the health facilities and lack of access to revised national guidelines for malaria diagnosis and treatment, a lack of regular supervision and monitoring and lack of in-service training respectively. The national malaria control program should intensify efforts to strengthen the readiness of the public health facilities in the district to handle malaria in pregnancy cases, diagnosis, treatment and prevention, improve the availability of antimalarial drugs and malaria diagnostic tests (mRDTs and microscopy), job-aids at the health facilities and undertake regular monitoring and on job training to ensure the proper use of the guidelines at all levels of health care service delivery points across the country.