How do health workers perceive and practice monitoring and evaluation of malaria control interventions in South-east Nigeria?

BACKGROUND: The Anambra state Malaria Control Booster Project (ANMCBP) depends on an effective monitoring and evaluation (M&E) system to continuously improve the implementation of the malaria control interventions. However, it is not clear how the health workers that are expected to be the fulcrum of the malaria M&E perceive and practise M&E. The study was carried out to determine the knowledge, perception, and practice of Malaria M&E among selected health staff, and to identify related socio-demographic factors, including cadre of staff. METHODS: A semi-structured questionnaire and an observation checklist were used to collect information from selected health workers in public primary health centres in all 21 local government areas of the State. Multistage sampling technique was used in selection of respondents. The questionnaire explored knowledge, perception and practice of malaria M&E from 213 health workers. The observation checklist was used to record the actual practice of malaria M&E as observed by trained supervisors. RESULTS: Over 80% of health workers interviewed were able to correctly identify the malaria M&E forms; 25.4% knew the basis for categorizing Artemisinin-based combination therapy (ACT) into ACT1 - ACT4; 97.6% of the respondents felt there was need to keep proper records to have information available and 7.5% of them kept records because they were asked to do so. Over 90% of respondents reported correct practice of M&E, but on verification of actual practice, 55.6% of the respondents had at least one wrongly filled form, and half of these had none of their forms properly filled; about 68.4% of respondents had met specified timeline for data transmission. Differences observed in knowledge, perception and practice of M&E across age categories and cadres were only significant in ability to identify malaria M&E forms; diagnosis of malaria based on blood film microscopy result; perception of how age should be recorded; and reported practice of keeping data till they are requested. Among lower cadre of staff, gaps still exist in knowledge, perception and practice of malaria M&E. CONCLUSIONS: Gaps still exist in health workers' understanding of malaria data management, perception of efficient data transmission and observed practice of malaria M&E.

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra State, Nigeria.

BACKGROUND: In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. METHODS: A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. RESULTS: It was found that 80.5% of the households had an LLIN and 64.4% of the households stated that they actually used the nets the previous night. The findings showed that 42.3% of pregnant women who had fever within the past month received ACTs, while 37.5% of children<5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1-5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. CONCLUSIONS: The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.