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Patients treated without diagnosis

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Sixty percent of patients treated for malaria in the county’s facilities and in communities are given medication without being tested.

This has been revealed in the Global Fund Office of the Inspector General (OIG) audit report which was released last month.

But Ministry of Health claims that 69 percent of people treated for malaria have a confirmed positive test and only 31percent are treated without a confirmed positive test.

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Malaria deaths accounted for 25 percent of total in-patient deaths in 2015.

The disease contributes to 40 per cent of all hospitalisations of children under five years old and 30 percent of all outpatients across all ages.

The report says this has been the case due to delayed rollout of malaria rapid diagnosis tests to the community level, insufficient supervision arrangements to ensure prescriber adherence to guidelines, sub-optimal utilisation and training of staff and delayed procurement of malaria rapid diagnosis tests.

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“All suspected malaria cases reported and treated through the country’s integrated community case management programme are taken in the absence of confirmed diagnosis,” it says, adding that national treatment guidelines for malaria have been neither consistently enforced [in the case of health facilities] nor implemented [in the case of communities].

The report says 31 percent of patients who tested negative for malaria, either through microscopy or malaria rapid diagnostic tests, were still given artemisinin–based combination therapy.

It further notes that the country’s health facilities have poor drug storage, where storage temperatures are not observed, non-adherence to expiry drug clearance and non-compliance of standard operating procedures.

Reacting to this development, Executive Director for Malawi Health Equity Network (Mhen) George Jobe said he is not surprised with the reports considering the way the country’s facilities operate.

“This is not the first report that has exposed our health system’s weakness. We need to take such reports as an opportunity to make improvements other than taking the business as usual pace,” he said.

Jobe added: “At the end of the day, lives of poor Malawians are at risk. We need to do something about the gaps in the health system. We can’t ignore this.”

Ministry of Health Spokesperson, Adrian Chikumbe, said the ministry through the Malaria programme is working on reducing the 31 percent which is treated without testing to get to zero.

“It is not true that malaria patients are treated without confirmation due lack of the rapid test kits, this might have been the case in the past. Currently, we have enough rapid malaria test kits in the facilities to last for more than four months,” he said in a written response.

Chikumbe insisted that all district and central hospitals have good drug storage conditions, saying recently the ministry in collaboration with partners built modern drug storage facilities in 80 percent of the facilities including health centres.

The Global Fund has been a partner in Malawi since 2003. Nine grants amounting to $1.2 billion have been signed since the inception of Global Fund investment in the country with 69 percent ($837 million) of the grants disbursed for HIV/Aids, malaria, TB and health systems strengthening interventions.

Malawi received a total envelope of $574 million (including existing funding of $278 million and additional funding of $296 million) under the Global Fund’s new funding model for the period ending December 2017.

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