Evaluation of malaria treatment practice of health extension workers (community health workers): a qualitative study conducted in Damot Gale district, Southern Ethiopia

Background: The Ethiopian government introduced the Health Extension Program which is a community-based health care delivery system aimed at accessing essential health services such as malaria diagnosis and treatment through health extension workers (HEWs). Involvement of HEWs in prescribing and dispensing antimalarial drugs improved community access to antimalarial drugs. However, the HEWs compliance to malaria treatment guidelines was not evaluated. Aims and Objectives: This study was conducted to evaluate the HEWs malaria treatment practice based on malaria treatment guidelines. Material and Methods: In-depth interview to 20 HEWs, seven focus discussion with malaria treated patients, and 400 malaria patients medical records review were conducted. Results: The majority of HEWs correctly responded how to diagnose malaria patients using signs and symptoms, and rapid diagnostic test (RDT). Most of malaria-treated patients indicated that they prefer HEWs to other health workers for malaria treatment. Patient record data from patient registration books indicated that about 92%(368) of patients received appropriate drugs in appropriate dose and duration. But some patients (8%, 32) were prescribed with drugs not in line with the guideline. The two main reasons indicated by the HEWs for inappropriate prescription are: the shortage of chloroquine, and patient pressure to take coartem. About 8% (32) and 11% (44) of patients do not know the consequences of not completing antimalarial drugs and what to do after vomiting respectively. Conclusion:The most of HEWs adequately treat malaria patients and the communication with patients is adequate. Improving resource availability, patient education and in-service training are needed to improve malaria treatment practice of the HEWs