title: [Adhesion of physicians to the national malaria policy: situation in Antananarivo (Madagascar), 5 years after the policy revision].
abstract: Our goal was to evaluate and analyze physicians' adherence to the national malaria policy in Antananarivo, 5 years after its revision. This prospective descriptive study was conducted in public and private health centers in Antananarivo in 2010, from May 1 to June 30. Adhesion to the new policy included adoption of the rapid diagnostic test for malaria (RDT) and/or microscopy as diagnostic methods and prescription of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. A questionnaire was used to collect data from 106 physicians. Their average age was 43.9 years (range: 26 to 59 years). The male-female sex-ratio was 0.59. Physicians trained in using RDTs were confident in this means of diagnosis (p < 10(-4)). Prescription of ACT by physicians was associated with their participation in malaria training (p = 0.02). Only 2/3 of the physicians adhered to the current policy. Adherence increased with trust (p < 10(-4)), availability of RDT (p < 10(-5)), and training about the policy. Physician adhesion, training and confidence are essential to this policy and to changing physician behavior. Improvement of the health system is also needed.
authors.affiliation: Service des Maladies Infectieuses, CH Joseph-Raseta-Befelatanana, CHU d’Antananarivo, Madagascar. aradonirina@hotmail.com
authors.forename: R L
authors.initials: RL
authors.lastname: Andrianasolo
authors.forename: J
authors.initials: J
authors.lastname: Rakotoson
authors.forename: R A
authors.initials: RA
authors.lastname: Rakotoarivelo
authors.forename: R
authors.initials: R
authors.lastname: Andriamahenina
authors.forename: J D
authors.initials: JD
authors.lastname: Randria Mamy
authors.forename: F
authors.initials: F
authors.lastname: Rapelanoro Rabenja
mesh_terms: D000328:Adult; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D008270:Madagascar; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors