Febrile Illness Case Management in Madagascar: Lessons from a Facility Provider Case Scenario Assessment

Rachel Favero, Jean Pierre Rakotovao, Lalanirina Ravony, Reena Sethi, Katherine Wolf, Barbara Rawlins, Eliane Razafimandimby, Andrianandraina Ralaivaomisa, Toky Rakotondrainibe, Mamy Razafimahatratra, Thierry Franchard, Sedera Mioramalala, Joss Razafindrakoto, and Catherine Dentinger of the Maternal and Child Survival Program/Jhpiego, the National Malaria Control Programme and the United States Agency for International Development/Madagascar examine malaria care seeking in Madagascar. Their findings were presented at the 7th Multilateral Initiative for Malaria Conference in Dakar and are shared below.

In 2016, malaria accounted for 5.9% of outpatient visits and 6.7% of all deaths in Madagascar. Care is often delayed and the recommended treatment protocols for management of febrile illness are not systematically applied. Children and adults do not always receive medication for febrile illness and when they do, it is not always the correct medication or dosage, as noted in MEDALI (Mission d’Etude des Déterminants de l’Accès aux Méthodes de Lutte antipaludique et de leur Impact) Quantitative and Qualitative 2014.

Study Goals aimed to Identify gaps, attitudes, and practices that may Prevent timely care seeking for febrile illness (within 24 hours after onset of fever) in the formal health system and Lead to nonadherence to national guidelines for malaria treatment. Key assessment questions included What strategies could be adopted to encourage pregnant women and caregivers of children under age 15 to use the formal health system as their primary resource for treatment of febrile illness? The study also asked What are the reasons that health providers do not systematically apply national malaria treatment guidelines?

Study districts were sampled from eight malaria operational zones. In-depth interviews with the following groups (N = 90). Facility health care providers, both public and private were included as were Community health workers and Caregivers of children under age 15 and pregnant women. Focus group discussions were held with caregivers of children
under the age of 15 years, including pregnant women (N = 16).

A Case scenario was reviewed with facility providers (N = 15). A case scenario is a description of a made-up situation involving a decision to be made or a problem to be solved. The case scenario used was febrile illness in children and pregnant women. This scenario allowed the study team to understand provider response. Provider responses to the scenarios are seen below.

 

From the review of case studies one could see that Facility provider diagnosis and treatment of malaria does not always conform to national protocol. Therefore, Targeted efforts to improve provider knowledge and practice are needed. Effort must be made to Ensure that standards/protocols are available in the health facilities and that providers have received guidance on the standards/protocols. Finally, Supportive supervision should be provided to address gaps in knowledge and practice.

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID, PMI, or the United States Government.

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