Assessment of Malaria Treatment Interventions: A Critical Analysis of Government Initiatives and causes of treatment failure at Port Loko Government Hospital, Sierra Leone

Abstract

Background: Malaria disease continues to be a leading cause of morbidity and mortality, particularly among children under five years of age and pregnant women in Sierra Leone. Malaria treatment interventions are the many, various, and conventional methods used to manage and control the disease with little to no harm to human health.While great progress has been made, the challenge persists, necessitating ongoing efforts and solid partnerships among key players to address successes and challenges in malaria control comprehensively. This research is crucial to identify gaps in current strategies, inform policy decisions, and improve the overall effectiveness of malaria prevention and treatment efforts.

 Aims: The study aims to critically evaluate the existing government interventions for malaria diagnosis, treatment and prevention, shedding light on the causes of treatment failure and the accessibility and efficiency of available resources.

Methods: The study utilizes a cross-sectional study design using purposive stratified random sampling of 300 (that is, 150 women of childbearing age and 150 Health Workers) respondents. A structured survey questionnaire was used to obtain data from the respondents. Secondary data were also sourced from documents like the District Health Information System (DHIS). Data were analyzed using Statistical Package for Social Sciences (SPSS), version 28 for which the analysis was stratified by respondent groups, i.e., Health Workers vs. women of childbearing age. Descriptive statistics were computed to summarize participant characteristics and findings were presented using frequency tables and bar plots to enhance data interpretation.

Results: From the analysis, 41.0% of respondents (62 Out of 150 women of childbearing age) said poverty and other socio-economic conditions are responsible for the increase prevalence and spread of malaria and also 40.0% (600) of the same respondents affirm the nearest drug store to be the first point of contact when they feel unwell as a result of poor socio-economic conditions. About 73.3% (110 out 150 health workers) of respondents mentioned malaria as the prevailing disease condition among women of childbearing age and other susceptible groups. 85.0% (128) of health workers’ respondents reveal that there is a stock out of malaria commodities every month and 78.0% (117) of respondents said most malaria diagnoses and treatments are mostly ineffective and inadequate. The study further shows that Bekeh Loko Chiefdom, Port Loko District is at high risk of ACT drug resistance with 93.0% (140) of the health workers respondents referred to non-adherence to prescribed and appropriate treatment as the leading cause of the ineffectiveness of malaria treatment interventions.

Conclusion: Inadequate, inappropriate, and ineffective malaria prevention, control,  treatment services and facilities, such as; RDTs, Microscopic/Laboratory Tests, Malaria Case Management (Antesunate Lumefantrine, Rectal Artesunate, Injectable Artesunate), IPTp and IPTi ;the lack of positive malaria social behaviours coupled with poor socio-economic factors in most malaria-endemic regions like Bekeh Loko Chiefdom, Port Loko District of Sierra Leone might be a contributing factor  to the increase prevalence of the disease in the study area. Active community engagement and education, strengthening healthcare infrastructure, quality improvement in diagnosis and treatment, targeted interventions for pregnant women and women’s livelihood empowerment, are urgently needed to control the high malaria prevalence in the study area and other endemic areas within the nation.

Keywords:  Malaria, Treatment, Interventions, Port, Loko, Bekeh-Loko.