What is it about?

Malaria remains an endemic disease in Africa and causes high morbidity and mortality, especially among children under five years. According to the latest World malaria report, there were 247 million cases of malaria in 2021 compared to 245 million cases in 2020. The estimated number of malaria deaths stood at 619 000 in 2021 compared to 625 000 in 2020. Presumptive management of malaria based on signs and symptoms presented by patients was the practice in the middle to low-income countries for many years. Presumptive treatment leads to neglect of the actual causes of fever and inappropriate treatment of malaria resulting in missing the actual burden of malaria in the Africa. The test, treat, and track (T3) strategy directed at ensuring proper diagnosis and prompt treatment of uncomplicated malaria cases was recommended by the World Health Organization (WHO). Adherence to T3 strategy reduces wrong treatment and prevents delays in treating the actual cause of fever that may otherwise lead to complications or death. Data on adherence to all three aspects of the T3 strategy is sparse with previous studies focusing on the testing and treatment aspects. We determined adherence to the T3 strategy and associated factors in the Mfantseman Municipality of Ghana.

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Why is it important?

We conducted a health facility based cross-sectional survey in health facilities in Mfantseman Municipality. We retrieved electronic records of febrile outpatients and extracted variables related to testing, treatment and tracking of malaria cases. Prescribers were interviewed prescribers on factors associated with adherence using a semi-structured questionnaire. We characterised patient, health facility and prescriber possible levels factors that could affect adherence. About 43.5% of febrile patients were tested, all sampled febrile patients received antimalarial medications and 92% of the positive cases were reviewed after treatment. Prescriber adherence to the strategy was higher for patients aged 5-25 years compared to older patients. Adherence was low among physician assistants compared to medical doctors and adherence was higher among prescribers who had been trained on the T3 strategy. We recommend prioritization of low cadre prescribers during the planning and implementation of interventions to improve adherence to T3.


“I hope this research will be an eye opener to prescribers as well as program officers to see the need to ensure adherence to the T3 strategy in malaria endemic countries to drive the efforts towards the control, elimination and final eradication of malaria”.

Magdalene Akos Odikro
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana

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This page is a summary of: Adherence to the test, treat and track strategy for malaria control among prescribers, Mfantseman Municipality, Central Region, Ghana, PLoS ONE, February 2023, PLOS,
DOI: 10.1371/journal.pone.0279712.
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