Masters Dissertations

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Browsing Masters Dissertations by Author "Akim, Caroline Sekela"

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    Management of malaria in underfive by primary health care workers in Bagamoyo district
    (University of Dar es Salaam, 1994) Akim, Caroline Sekela
    The Primary Health Care (PHC) strategy recognises the necessity for proper management of malaria at the peripheral level of the health services. A cross-sectional study was done to determine the management of malaria in underfive by primary health care workers in Bagamoyo district. In the study, 38 Primary health care workers and 368 underfive patients were studied. The study revealed that the good knowledge that the health workers had did not go hand in hand with their clinical skills for managing malaria. 94.4% of the health workers had good knowledge of malaria and its management but only 32.3% of the children received proper treatment. Only 51.3% of the patients were physically examined and only 35.2% had their temperature taken before being treated. As many as 55.4% of patients were seen for less than 5 minutes. In the interactions of the health workers and patients who were observed, in only 51.6% of them were patients physically touched by the health workers. No relevant explanations were given to patients (67.9%). Thermometers, stethoscopes and weighing scales were present but were not utilized in the health units. The sensitivity and specificity of clinical diagnosis by the health workers was 62.4% and 34.2% respec¬tively. Health workers were able to classify acute respiratory infections (ARI) and malaria and were also aware of diarrhoea. The problems encountered by health workers were erratic drug supply (45.9%), patients’ pressure (68.7%) and lack of supervision (55.3%). In-service training improved the skills in managing malaria (P=().()l). The commonest obstacle encountered in referring patients as given by health providers, was lack of transport (86.9%). The second commonest obstacle was patients preferring to be attended by traditional healers (68.4%). Patients who had been referred indicated not being satisfied with the food (33.3%), treatment (21.2%), health workers (18.1%), and the health units' cleanliness (18.1%). Lack of money for transport and upkeep while in hospital was also a problem, such that patients had to sell food stuffs (77.2%) or dairy products (9.1%) to meet transport costs. 13.2% of patients were aided by relatives on transport. It is suggested that in order to improve on the management of malaria, in-service training should be given. Intersectional approach should be used to tackle the problem of the referral system, and to ensure that priority is given to the whole malaria problem by policy makers. Emphasis should be on prompt diagnosis and treatment and it is recommended that more research should be carried out on the problems of the referral system.