Quality of malaria case management in health facilities in Madagascar: findings from a nationally representative survey
1
Epidemiology and Clinical Research unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
2
Malaria Branch, Center for Global Health,, US Centers for Disease Control and Prevention, Atlanta, GA, United States
3
National Malaria Control Program, Antananarivo, Madagascar
4
US Agency International Development, Antananarivo, Madagascar
5
US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
In Madagascar, healthcare quality and health facility (HF) readiness remain key to malaria control. This study aimed to assess the quality of malaria case management, evaluate health system preparedness, and identify factors associated with correct case management.
METHODS:
A cross-sectional survey, stratified by five malaria epidemiological strata, was conducted during January–June 2024 in 110 randomly selected HFs. Eighteen acute-care patients per HF were enrolled using systematic random sampling. Malaria case management was evaluated using exit interviews, clinical re-examination, and health worker (HW) and HF director interviews. HF readiness was measured by supply availability and staff training and supervision. Estimates were weighted accounting for the sampling design. Multivariate logistic regression identified factors influencing correct management of uncomplicated malaria, defined as patients with fever/history of fever tested with rapid diagnostic tests (RDTs) and, if positive, prescribed correct treatment (typically artemisinin-based combination therapy).
RESULTS:
Among 1,976 patients interviewed, 1,545 (75.7%) had fever/history of fever. Of these, HWs performed RDTs on 1,083 (73.4%); 54.2% (n=610) were positive. HWs prescribed correct treatment to 440 (76.3%) confirmed cases. Correct malaria treatment was significantly associated with RDT availability (adjusted Odds Ratio aOR= 2.31; 95%CI [1.14–4.74]), antimalarial drug availability (aOR= 9.67; [5.69–16.90]), the presence of three or more HWs on-site (aOR= 2.08; [1.29–3.40]), and epidemiological stratum. In the fringe stratum, 53% had RDT stock shortages the day of the HF survey versus 10% for other facies. Antimalarial drug availability ranged from 63.6% in the fringe and desert south to 95.2% in the west. Nearly 40% of HWs reported having ever received malaria case management training.
CONCLUSIONS:
Nearly one-quarter of malaria cases were not managed correctly at HFs in Madagascar. HF readiness varied across epidemiological strata revealing gaps in diagnostic and antimalarial supplies and trained staff. Strengthening supply chains is critical to improving quality of malaria care.
In Madagascar, healthcare quality and health facility (HF) readiness remain key to malaria control. This study aimed to assess the quality of malaria case management, evaluate health system preparedness, and identify factors associated with correct case management.
METHODS:
A cross-sectional survey, stratified by five malaria epidemiological strata, was conducted during January–June 2024 in 110 randomly selected HFs. Eighteen acute-care patients per HF were enrolled using systematic random sampling. Malaria case management was evaluated using exit interviews, clinical re-examination, and health worker (HW) and HF director interviews. HF readiness was measured by supply availability and staff training and supervision. Estimates were weighted accounting for the sampling design. Multivariate logistic regression identified factors influencing correct management of uncomplicated malaria, defined as patients with fever/history of fever tested with rapid diagnostic tests (RDTs) and, if positive, prescribed correct treatment (typically artemisinin-based combination therapy).
RESULTS:
Among 1,976 patients interviewed, 1,545 (75.7%) had fever/history of fever. Of these, HWs performed RDTs on 1,083 (73.4%); 54.2% (n=610) were positive. HWs prescribed correct treatment to 440 (76.3%) confirmed cases. Correct malaria treatment was significantly associated with RDT availability (adjusted Odds Ratio aOR= 2.31; 95%CI [1.14–4.74]), antimalarial drug availability (aOR= 9.67; [5.69–16.90]), the presence of three or more HWs on-site (aOR= 2.08; [1.29–3.40]), and epidemiological stratum. In the fringe stratum, 53% had RDT stock shortages the day of the HF survey versus 10% for other facies. Antimalarial drug availability ranged from 63.6% in the fringe and desert south to 95.2% in the west. Nearly 40% of HWs reported having ever received malaria case management training.
CONCLUSIONS:
Nearly one-quarter of malaria cases were not managed correctly at HFs in Madagascar. HF readiness varied across epidemiological strata revealing gaps in diagnostic and antimalarial supplies and trained staff. Strengthening supply chains is critical to improving quality of malaria care.
| eISSN: | 2654-1459 |
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