Compliance with the Use of Artemisinin-based Combination Therapy in the Treatment of Uncomplicated Malaria amongst Primary Healthcare Workers in Anambra State, Nigeria - The Role of Funding

Background: Nigeria adopted artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria in 2005. Aims: This study aims to determine and compare the compliance of health workers with the National Guideline for the Diagnosis and Treatment of Malaria (National Guidelines) in uncomplicated malaria treatment in Global Fund for AIDS Tuberculosis and Malaria- Supported (GFS)and government-supported (GS) primary healthcare centres (PHCs) in Anambra State. Materials and Methods: This cross-sectional comparative study involved the review of 1536 case records, a questionnaire-based survey of 82 health workers and a health facility assessment in 32 PHCs in Anambra State. Data were analysed using IBM SPSS Statistics version 20. The Chi-square test of independence was used to determine the association between the categorical variables at a 0.05 statistical significance level. Results: Compliance with National Guidelines in uncomplicated malaria treatment was 83.2% overall, 89.1% for GFS PHCs and 76.5% for GS PHCs ( P = 0.00). ACT stock-out occurred in 43.8% of GFS versus 100.0% of GS PHCs, ( P = 0.00). Amongst healthcare workers, access to National Guidelines was 48.8% in GFS PHCs versus 26.8% in GS, ( P = 0.04); access to malaria case management aid was 90.2% in GFS PHCs versus 70.7% in GS, ( P = 0.03) and supervision was received within the last 6 months of 2017 by 31.7% in GFS PHCs versus 2.4% in GS, ( P = 0.00). Conclusion: This study suggests that compliance with National Guidelines in uncomplicated malaria treatment amongst PHC workers was enhanced by increased free ACT availability, access to guidelines, case management aid availability and supervision frequency. This is evidence for Malaria Elimination Programme evaluation in Anambra State and Nigeria.