title: Prescription practices for malaria in Mozambique: poor adherence to the national protocols for malaria treatment in 22 public health facilities.
abstract: BACKGROUND
  Current World Health Organization and national protocols recommend the 'test and treat' strategy for the management of uncomplicated malaria, to reduce over prescription of artemisinin-based combination treatment (ACT). Therefore, adherence to these protocols varies in different sub-Saharan African countries and no information is available for Mozambique. This study was conducted with the aim to evaluate the prescription practices of ACT in Mozambique.
  
  
  METHODS
  Retrospective audit of medical records corresponding to the period between July and December 2011 was conducted in 22 health units across 11 provinces in Mozambique. Two health units were selected per province according to availability of laboratory data (performing microscopy and rapid diagnostics testing-RDT or RDT only) and geographic setting (rural versus urban). At each facility, demographic data, laboratory results (blood smear or RDT), and prescription of ACT were all collected from the existing records.
  
  
  RESULTS
  Between July and December 2011, a total of 61,730 cases were tested for malaria, of which 42.7 % (26,369/61,730) were positive. A total of 35.361 patients were malaria negative, and ACT was prescribed to 72.0 % (25.448/35.361) of them. Prescription of ACT to malaria negative patients was higher in the central region of the country as compared to the northern and southern (81.1 % in the central region versus 72.4 and 63.7 % in the northern and southern, respectively, p = 0.000) and in urban settings (88.7 % in rural versus 58.0 % in urban settings, p = 0.000). Stock out of RDT was observed in six (27.3 %) of the health facilities. When no RDT was available, patients were empirically treated with ACT.
  
  
  CONCLUSIONS
  Findings from this study demonstrate that health care worker's adherence to the new guidelines for malaria treatment is poor in Mozambique and prescription of ACT to malaria negative patients remains very high. Enhanced training and supervision activities, community education and external quality assurance might lead to significant improvements in the clinician's adherence to the new guideline for malaria treatment in Mozambique.
authors.affiliation: National Institute of Health, Ministry of Health, Field Epidemiology and Laboratory Training Program, Av Eduardo Mondlane 1008, 2nd floor, PO Box 264, Maputo, Mozambique. todysalo@gmail.com.
authors.forename: Cristolde A
authors.initials: CA
authors.lastname: Salomão
authors.affiliation: Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, PO Box 257, Maputo, Mozambique. jahityash2002@yahoo.com.br.
authors.forename: Jahit
authors.initials: J
authors.lastname: Sacarlal
authors.affiliation: Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, PO Box 257, Maputo, Mozambique. batazar.chilundo@gmail.com.
authors.forename: Baltazar
authors.initials: B
authors.lastname: Chilundo
authors.affiliation: National Institute of Health, Ministry of Health, Field Epidemiology and Laboratory Training Program, Av Eduardo Mondlane 1008, 2nd floor, PO Box 264, Maputo, Mozambique. esamogudojr@gmail.com.
authors.forename: Eduardo Samo
authors.initials: ES
authors.lastname: Gudo
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D019983:Guideline Adherence; D006268:Health Facilities; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D009073:Mozambique; D010818:Practice Patterns, Physicians'; D055656:Prescriptions; D012189:Retrospective Studies
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin