Adherence of healthcare providers to malaria case management guidelines of the formal private sector in north-western Ethiopia: an implication for malaria control and elimination

Abstract Background Malaria is an infectious disease which has been globally targeted for elimination in at least 35 of 90 endemic countries by 2030. Most successful malaria elimination country programmes have engaged the private health sector in an effort to identify, document, investigate, provide effective treatment, and follow-up cases. However, there has been limited rigorous research showing evidence of adherence among healthcare providers of the formal private health sector to national malaria diagnosis and treatment guidelines in Ethiopia, starting from malaria control to elimination phases. The aims of this study were to investigate and explain the level of adherence to malaria diagnosis and treatment guidelines among healthcare providers working in formal private health facilities in north-western Ethiopia. Methods An explanatory sequential mixed method design was conducted in the West Gojjam Zone of Ethiopia. Quantitative data were extracted from 1650 medical records of adult uncomplicated malaria outpatients served in 11 private-for-profit health facilities. In addition, using a qualitative approach, 33 in-depth interviews (IDIs) with healthcare providers were conducted. All interviews were audio-recorded, transcribed verbatim, and analysed using eight steps. Results Of 1650 suspected malaria cases in adult outpatients, 80.6% (1330/1650) were screen tested using microscopy and the remainder 19.4% (320/1650) were tested using multispecies rapid diagnosis tests (RDTs). Hence, the results revealed that private healthcare providers universally adhered to diagnosis guidelines. In addition, after following-up and excluding other causes of fever, 4.1% (56/1376) patients were clinically diagnosed with uncomplicated malaria. Despite this, the proportion of private healthcare provider adherence with confirmed malaria case treatment guidelines was 20.9% (69/330). In addition, 1320 (95.9%) of adult outpatients with negative laboratory results were not treated. Some of the identified determinant factors for sub-optimal adherence of healthcare providers to malaria guidelines were interruptions in supply and lack of availability of recommended anti-malarial drugs, lack of availability of quality assured laboratory supplies, and poor knowledge of the recommendations of the national standards. Conclusions Private healthcare providers adhered to universal parasitological diagnosis, providing comprehensive counseling, and linking patients with community health workers. In addition, almost all laboratory negative patients were not treated with anti-malarial drugs. However, only one-fifth of confirmed patients were treated in line with national guideline recommendations. Malaria control and elimination efforts across Ethiopia could be improved through establishing a collaborative function of a win-win public private mix partnership model. In addition, including the data of the private health sector in the health information system could show real malaria burden and use the information to improve the adherence to malaria diagnosis, treatment, and reporting standards within the targeted era of elimination. Therefore, building the capacity of private healthcare providers and ensuring the availability of all nationally recommended drugs and supplies in private health sector facilities is recommended to improve the quality of services

Psychology of Religion of Dr. Martha Anatolievna Popova

The paper is dedicated to the analysis of ideas of Dr. Martha Anatolievna Popova, a famous Soviet specialist in religious studies. Through this analysis, we demonstrate that her theoretical ideas in a sense sum up other studies of Soviet researchers in this field. In the article we show that the goals and lines of investigation defined by Dr. Popova are relevant for contemporary researchers as well, and her theoretical and practical academic heritage related to the understanding of foreign studies in the fi eld is very important today. Dr. Popova’s studies on the history of Western psychology of religion are especially interesting because of her analysis of English and American works on psychology of religion and psychoanalytical theories of religion and culture. In the course of our study of Dr. Popova’s ideas, we found out that in her works she defi ned four general aspects of psychology of religion that are closely related to each other. The first of these aspects is the study of psychology of an individual believer, the study of particular groups and the development of methodology related to it. The second aspect is the specification and precise definition of the fundamental terms and concepts of Psychology of Religion. The third aspect is the practical application of results achieved during the first and second stages. These three problems cannot be solved without study of the theoretical ideas of previous researchers in the field of psychology of religion, or, to put it in other words, without the study of the history of psychology of religion, which is the fourth aspect of research in psychology of religion. In the article, we analyze the ideas of Dr. Popova using her works that are not widely known and this can help us to understand her theoretical ideas deeper than before

Traditional systems and development interventions in LVIA experience in Moyale, pastoral area of Southern Ethiopia

Pastoral development has been a field of fierce confrontation and experimentation throughout the last fifty years. The 12-years experience of an integrated project carried out by an international NGO in Southern Ethiopia is presented, focusing on two inter-related aspects: animal health and natural resources management. The peculiar aspects of the area are described, considering the traditional management systems and their integration in the modern context. Based on some specific project activities (modern water schemes development, community-based animal health program, vaccination campaigns) outcomes and problem raised are discussed, coming out with some general considerations

Prevalence of trachoma at sub-district level in Ethiopia : determining when to stop mass azithromycin distribution

To eliminate blinding trachoma, the World Health Organization emphasizes implementing the SAFE strategy, which includes annual mass drug administration (MDA) with azithromycin to the whole population of endemic districts. Prevalence surveys to assess impact at the district level are recommended after at least 3 years of intervention. The decision to stop MDA is based on a prevalence of trachomatous inflammation follicular (TF) among children aged 1-9 years below 5% at the sub-district level, as determined by an additional round of surveys limited within districts where TF prevalence is below 10%. We conducted impact surveys powered to estimate prevalence simultaneously at the sub-district and district in two zones of Amhara, Ethiopia to determine whether MDA could be stopped.; Seventy-two separate population-based, sub-district surveys were conducted in 25 districts. In each survey all residents from 10 randomly selected clusters were screened for clinical signs of trachoma. Data were weighted according to selection probabilities and adjusted for correlation due to clustering.; Overall, 89,735 residents were registered from 21,327 households of whom 72,452 people (80.7%) were examined. The prevalence of TF in children aged 1-9 years was below 5% in six sub-districts and two districts. Sub-district level prevalence of TF in children aged 1-9 years ranged from 0.9-76.9% and district-level from 0.9-67.0%. In only one district was the prevalence of trichiasis below 0.1%.; The experience from these zones in Ethiopia demonstrates that impact assessments designed to give a prevalence estimate of TF at sub-district level are possible, although the scale of the work was challenging. Given the assessed district-level prevalence of TF, sub-district-level surveys would have been warranted in only five districts. Interpretation was not as simple as stopping MDA in sub-districts below 5% given programmatic challenges of exempting sub-districts from a highly regarded programme and the proximity of hyper-endemic sub-districts