Abate application practices in the Guinea worm endemic region of Gambella, Ethiopia: identification of elimination gaps.

INTRODUCTION: Guinea worm disease is caused by Dracunculus medinensis. Transmission of the disease depends on vectors (copepods). Abate applications in targeted water sources to control copepod is the main intervention. The aim of this study was to assess vector control practice in the guinea worm endemic region of Gambela, Ethiopia and to identify elimination gaps. METHODOLOGY: Retrospective analysis of routine program data recorded from 2016 to 2020 was performed. Pre-and post-copepod test is conducted on water ponds to determine the density of copepods. Based on the copepod density, the chemical is applied accordingly. The five years data was obtained from Ethiopian public health institute electronic database with permission. RESULTS: A total of 22,131 water ponds were treated during the past five years. Out of the total treated in 2020, 4,669/7,266 (64%) were found with > 9 Copepods during pre-copepod test. 130/7,266 (1.79%) of water ponds which were post-tested after Abate application failed the requirement of scoring ≤ 9 copepods. Of the 130 water ponds, 115 (88.5%) were observed during the transmission season (April to November). Abate application trend had increased by 28.9% during the 5 years period. According to the database, some of the largest water sources found in infection reporting villages missed their 28 days regular treatment schedule. CONCLUSIONS: A single water source that has not been treated effectively could be a source of infection for both humans and animals. The practice of Abate application should be enhanced and monitored regularly. The documenting system should be improved for quality, timely information and action.

Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study.

BACKGROUND: The World Health Organization World Malaria Report of 2019 indicated an estimated 228 million cases of malaria occurred worldwide in 2018. More than 75% of the total area of Ethiopia is malarious, making malaria a leading public health problem in Ethiopia. Adherence to clinical guidelines improves the quality of care received by patients, thus improving patient outcomes. This study investigates healthcare workers' adherence to malaria testing and treatment guidelines in selected private clinics of Gambela Town, Ethiopia. METHODS: A mixed study design involving a retrospective review of 425 patient files and 20 healthcare worker interviews in private clinics was implemented. Data were collected using pre-tested data collection forms. The collected data were then cleaned and entered into statistical software for analysis, with a level of significance set at < 0.05. A qualitative analysis was also conducted using healthcare worker interviews to identify the existing barriers to guideline adherence. RESULTS: Among the 430 cases of suspected malaria, only 65% were tested for malaria. Of those tested, 75% tested positive and 25% tested negative. The most common co-morbidity in patients treated for malaria was anaemia (30%), followed by gastroenteritis (10%). Patients with co-morbidities were more likely to receive appropriate treatment (p = 0.03) compared to those without co-morbidities. All healthcare workers interviewed were aware of the existence of the malaria treatment guidelines. However, many were not aware of the contents of the guidelines and only 40% had been trained to understand the guidelines. Overall, 85% of the workers claimed to adhere to guidelines, with 15% claiming non-adherence. CONCLUSION: The gap between knowledge of the malaria treatment guidelines and their application by healthcare workers remains wide. The level of knowledge of these guidelines was also low. Continuous training, follow-up, supportive supervision, and improved adherence to the malaria guidelines are therefore recommended.