Adherence to the test, treat and track malaria policy among selected health facilities in Ghana: the clients’ perspective

TL;DR

This study examines how well health facilities in Ghana follow the WHO's test, treat, and track malaria policy from the perspective of patients and facility managers.

Contribution

The study provides new insights into client adherence and facility compliance with the T3 policy in different malaria zones of Ghana.

Findings

Testing and treating for malaria were high, but tracking of patients was very low across all zones.

Health facilities in the southern zone had higher odds of adhering to the T3 policy compared to the middle zone.

Male clients were less likely to return for follow-up or participate in home visits.

Abstract

Malaria continues to be a major disease burden affecting all ages. The WHO in 2012 introduced the test, treat and track (T3) policy for malaria management in endemic settings. All malaria suspected conditions are to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACT) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence of health facilities and client’s perspective of T3 policy in Ghana.

This cross sectional study was conducted in November 2019 involving 30 health facilities conveniently selected from six districts in the 3 malaria epidemiological zones, and clients exit interviews were performed from each facility. Factors associated with the test, treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients’ perspectives.

Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. Health facilities in the southern zone of Ghana had 2.87 increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review or more likely to miss home visit [aOR = 0.6 (0.3, 0.9): p = 0.018].

Testing and treating for malaria were high among health facilities in the three zones. However, tracking of patients was very low across the zones. Adherence from clients’ perspective was low especially for males. The study recommended among others that the National Malaria Elimination Programme (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy.

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