Comparative Analysis of Antimalarial Prescribing Pattern with Malaria Parasitological Test conducted at Ho Teaching Hospital, Ho.

Introduction: Malaria is a leading cause of morbidity and mortality in Ghana, reported to be responsible for over a third of all outpatient cases noted each year, 20% to 30% of deaths in children under five years of age and 11% of maternal deaths.  The latest WHO Guidelines for the Treatment of Malaria state that “all cases of suspected malaria should have a parasitological test (microscopy or rapid diagnostic test) to confirm the diagnosis”. Therefore, Ghana subscribes to sub-regional and global initiatives such as T3 (Test, Treat and Track) initiative which seeks to ensure that every suspected malaria case is tested, that every case tested positive is treated with the recommended quality assured antimalarial medicine, and that the disease is tracked through timely and accurate reporting to guide policy and operational decisions.

Methodology: A retrospective descriptive cross-sectional study was done where a data collection tool was designed for extraction of data on monthly malaria data returns on antimalarials from District Health Information Management System 2 (DHIMS2).  The data was based on the number of malaria cases clinically diagnosed at Out Patient Department (OPD), number of cases tested for malaria parasites and put on malaria treatment at the hospital and availability of functioning microscopes and malaria Rapid Diagnostic Test (RDT) kits for conducting parasitological tests.

Results: A total of 15,041 OPD cases suspected to be malaria were recorded during the year, 2018.  Out of this number, 11,878 (78.97%, n = 15,041) were put on oral Artemisinin-based combination therapy (ACT).  Parasitological test for malaria was conducted on 10,148 (67.47%, n = 15,041) of the OPD cases out of which 5,862 (38.97%, n = 15,041) A total of 978 (9.64%, n = 10,148) of the screened cases were positive. Thus, 542 (9.25%, n = 5,862) and 436 (10.17%, n = 4,286) of those who went for the test were positive for malaria parasite count and RDT respectively. Availability of RDT kits at the user ends and the hospital stores were 87.5% and 79.2% respectively. Functioning microscopes for conducting parasitological test at the laboratory were also available throughout the year.

Conclusion: It was observed that most of the OPD cases with suspected malaria received oral Artemisinin-based combination therapy (ACT) for malaria treatment despite the fact that they tested negative to the parasitological tests. This was in contrast to the T3 initiative.