How local government health workers in Nigeria manage suspected malaria cases

Evidence suggests that while efforts are made to reduce the burden of uncomplicated malaria, many children and others die of other febrile illness . Therefore, integrated case management of febrile illness is being promoted with early and proper diagnosis of malaria using rapid diagnostic test kits (RDTs) or microscopy. The studey intended to assess treatment of febrile illness in government owned primary health care facilities in Akwa Ibom State, Nigeria. An audit of 3,000 client records at 11 primary health care facilities was undertaken in Ante natal clinnics, child welfare and out-patients units of first non-follow-up visit of the year between February 2010 and March 2011. Prescribers recorded 74.3% of clients had fever or high temperature, but temperature was actually taken and recorded in only 53.7% of clients. Prescribers recorded cough (34.6%); Chills/Rigor (2.7%); and body weakness (18.6%) in clients. Malaria was suspected in only 31.3% of the clients and varied among different age groups. 2.5% and 1.9% of the clients were diagnosed with diarrhea and pneumonia respectively. Only 5.8% of malaria cases were confirmed by microscopy although 91.7% of clients received antimalarial medicines with ACTs topping the list. 63.9% of the clients received antibiotics. 73.9% got antibiotics when only malaria was diagnosed; 68.3% when only fever was diagnosed and 74.3% when only diarrhea was diagnosed. In conclusion gaps exist in history taking, malaria diagnosis, and appropriate dispensing of anti-malarial medicines and antibiotics. The study will be used to design an effective intervention to improve case management of febrile illnesses.