The piece below originally appeared on PMI Impact Malaria’s blog.
The miracle of birth and the making of mothers has long fascinated Jenifer Adjei. Now an accomplished midwife at the Oda District Hospital in Ghana, Jenifer helps expectant and new parents plan for and cope with the arrival of their babies.
Through her work, Jenifer has become all too familiar with the adverse effects of malaria in Ghana—especially malaria in pregnancy (MIP). While Ghana has made substantial gains in driving down malaria, with malaria-attributable death declining from 19% in 2010 to 1.5% in 2018, the disease still kills far too many Ghanaians.
Prior to treating malaria, the World Health Organization (WHO) recommends confirmation of malaria by either microscopy or a rapid diagnostic test (RDT). Despite subscribing to WHO’s framework for scaling up malaria diagnostic testing, treatment, and surveillance, the reports from health facilities in Ghana indicate low health worker adherence to malaria testing before treatment.
Jenifer recounts times at her hospital where patients with fevers were treated with antimalarials often without any testing—a practice that increases the risk of antimalarial resistance and fetal loss among pregnant women, and also contributes to drug wastage.
To improve malaria service delivery, PMI Impact Malaria (IM) has supported Ghana’s National Malaria Control Program (NMCP) and Regional Health Administration (RHA) in organizing health facility-based malaria case management trainings for health workers. To determine which facilities were most in need of immediate trainings, IM collaborated with the RHA to prioritize districts and facilities with adverse malaria indicators—ultimately selecting 10 high burden facilities per region.
The training curriculum included the treatment of severe and uncomplicated malaria and MIP, using a quality improvement model that emphasizes the uptake of knowledge and the corresponding behavior change that should result. During the training, Jenifer and her hospital team identified non-testing of uncomplicated malaria before treatment as a challenge—with up to 60% of suspected uncomplicated malaria cases not tested before treatment. Three months after the training, presumptive treatment had dropped to zero.
Today, every patient at Oda District Hospital who shows signs of malaria undergoes microscopy or RDT before treatment. Jenifer has observed that conducting RDTs before treatment has significantly reduced patient wait times and pressure on laboratories. According to her, ‘‘It’s also improving the quality of care and our antimalarial medicines are now used rationally.”
Jenifer is just one of over 1,200 health workers in 37 high burden health facilities across Ghana who has benefitted from the malaria case management training. To continue advancing universal testing of suspected malaria cases, this year IM is supporting the NMCP to scale up on-site training and supportive supervision to 17,475 health workers in 2,140 health facilities. In light of these efforts, 2020 should be a remarkable year for improving the quality and efficiency of malaria diagnosis and treatment in Ghana.
Written by Emmanuel Attramah, Knowledge and Communications Officer, PMI Impact Malaria (IM) Ghana. Contributions from Amos Asiedu, Surveillance, Monitoring and Evaluation Advisor, IM Ghana; Pius Affipunguh, Regional Technical Advisor, IM Ghana; Eric LaFary, Peace Core Volunteer; and Anne Bulchis, IM Communications Manager.
Data Source: Ghana Health Service District Health Information Management System
Header Photo Credit: Emmanuel Attramah for PMI Impact Malaria. Caption: Jenifer Adjei, midwife-in-charge at Ghana’s Oda District Hospital, tests a patient for malaria using a rapid diagnostic test (RDT).
PMI Impact Malaria is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.