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Tibu Homa Project experiences in improving evidence-based treatment of malaria in the Lake Zone
Malaria continues to be a major killer of under-fives, and Tanzania has set strategies to reduce malaria in the country. To complement and support government efforts to reduce morbidity and mortality of under-fives, in 2011 the United States Agency for International Development (USAID) created the Tibu Homa Project (THP) to improve diagnosis and treatment of febrile illnesses among children under five years of age in the Lake Zone of Tanzania. THP is led by University Research Co., LLC (URC) working in partnership with Amref Health Africa and Management Sciences for Health (MSH).
THP is operational in 28 districts of six regions in the Lake Zone: Kagera, Mwanza, Geita, Mara, Shinyanga, and Simiyu. Studies have shown that despite introduction of malaria rapid diagnostic tests (mRDT), presumptive treatment of malaria and non-adherence to test results is still practiced in Tanzania (URT 2008; Mubi et al. 2013). Therefore, in order to improve quality of care, the project included among other improvement activities, capacity building in malaria testing and treatment according to national policy. This paper reports on the THP experience in improving malaria testing so as to improve case management among children under five years of age during the period 2012-2014.
In order to improve malaria case management, the Tibu Homa Project provided training in:
- Quality improvement to health care workers who formed health facility pediatric quality improvement teams (PQITs)
- Use of mRDTs
- Case management using national guidelines
- Supply chain management to ensure constant availability of essential items
- Data management to enable teams to collect, analyze, and make decisions
- Supportive supervision and mentorship to Regional and Council Health Management teams (RHMTs and CHMTs).
Together with RHMT and CHMT staff, Tibu Homa logistic and clinical mentors conducted monthly supportive supervision and mentoring to the PQITs.
Classroom training combined with on-job training through monthly supportive supervision resulted in increased malaria testing rates of under-fives presenting with fever and a change in clinical practice towards adherence to national updated guidelines. Of the malaria-positive under-fives, 90% received proper treatment. ----------- The work shows that trained health care workers applying improvement methods and receiving regular supportive supervision and mentorship can increase malaria testing before treatment and change clinical practice towards adherence to clinical management indicated by test results.