Do health care providers adhere to the revised malaria control guidelines?

Introduction: Malaria is a public health problem worldwide with India contributing to 77% cases in the South East Asian region of World Health Organization (WHO). Karnataka is one of the project states under World Bank with API>2. Statistics from the district of Udupi, which is the setting for this study, shows a rise in malaria cases from January-May 2009. There were a total of 1189 malaria cases reported of which 103 were positive for P. falciparum. The National Programme to control malaria has recently revised its strategies, thus involved personnel need to be aware of it for the programme to be effective. Objectives: Keeping in mind the emergence of Choloroquine resistant malaria, The National Malaria Control Programme has revised its strategy. This cross-sectional study was conducted to assess the awareness and practice of National Guidelines for malaria among health care providers in Urban Udupi, Karnataka (which is one of the project states under the World Bank for malaria control) and the problems in implementation of these guidelines. Settings and design: Cross sectional study, Udupi district. Methods: Data was collected by personal interview (structured questionnaire) after obtaining due consent. Statistical analysis used: Data was analyzed by SPSS software. Observations\Results: Most respondents were from both Manipal and Udupi and had been practicing for over 5 years. Chills and headache were used as main guiding symptoms for diagnosis, all insisted on lab diagnosis with QBC being the most preferred test followed by smear. Cases were treated on pure clinical diagnosis in case of typical signs, unresponsiveness to other therapy, unwillingness or non-affordability of tests. Both species of Plasmodium were prevalent, Chloroquine being first line treatment for P. Vivax and Artemisinin compounds for Falciparum. Clinical failure was encountered against Falciparum due to chloroquine resistance and quinine was mainly used to combat it. Medical journals were the most important source of information. Non-availability and increasing costs were the main problems in ACT prescription; notably some physicians had never used ACT. About one-third of the physicians were aware of specific government initiatives for implementation of the revised malaria control guidelines. Conclusion: Despite the implementation of national guidelines for over two years, it was still to be uniformly followed. Chloroquine resistance was found to be the main cause for clinical failure. Cost and availability of ACT were the main hurdles for its use. Access to information about new guidelines could be improved by IEC (information education communication) techniques, CMEs or workshops. Studies to address these issues and studies to test the efficacy of these techniques should be undertaken to ensure adherence to the revised malaria control guidelines.