Health worker’s adherence to the malaria test, treat and track strategy during the COVID-19 pandemic in Malaria High Transmission Area in Eastern Uganda
Authors: Mumali Richard Kabaka , Okolimong Charles , Kabuuka Tonny , Lubaale Yovani Moses , Okibure Ambrose , Okello Francis , Soita David , Olupot-Olupot Peter 
Published: November 2023

Abstract
Background: Malaria remains a public health problem in Sub-Saharan Africa that also suffered Coronavirus disease (COVID-19) pandemic 2020 - 2023. The World Health Organization in 2010 launched the Test, Treat and Track (T3) strategy aimed at evidence-based targeted case management of malaria. We hypothesised that during COVID-19 pandemic the Malaria T3 strategy was below target. In this study we assess health worker’s adherence to the malaria test, treat and track strategy during the COVID-19 pandemic and evaluate the knowledge, skills and practices of health workers towards T3 initiativein Mbale Regional Referral Hospital, an area with high malaria transmission intensity in Uganda.
Methods: We conducted a cross-sectional study at Mbale Regional Referral Hospital in 2020 employing mixed quantitative and qualitative data collection methods. Data were captured on demographics, knowledge, skills, practices, febrile patients tested and treated and tracked. A total of 436 Study subjects were selected randomly and purposively and sample size of 428 was estimated. The relationship between the outcome variable and its predictors was examined by bivariate and multivariate analysis. Quantitative data were analysed using STATA 15.0 and reported as descriptive statistics, proportions and statistical associations. Qualitative data collected using key informed interviews and analyzed using thematic content with the help of NVIVO software. Ethical approval for the study was obtained from Mbale Regional Referral Hospital Research and ethics committee (MRRH-REC).
Results: A total of 436 study participants of whom 103 (24%) and 333 (76%) were health workers (HWs) and malaria suspects, respectively. Among the HWs the mean age 34 years (SD= 8.8 years), 54 (52%) had attained tertiary education. On T3 strategy; 81 (79 %) had good practices, most 63 (61%) had good knowledge, and only 11 (10.7%) had good skills. Among the laboratory personnel 14/19 (74%) had good knowledge, compared to others health cadres OR: 2.0 (95% CI: 0.7 - 6). In addition, laboratory personnel were highly skilled compared to other cadres OR: 4.6 (95% CI: 1.2 - 18.1; P<0.0150).
Among patients suspected of malaria, 177 (53%) were females, a majority 256 (77%) were aged between 3 months and 80 years, and the mean age was 17.8 years, (SD ± 18.5 years). Less than half 132 (40%) had no formal education mainly because of age (<5 years). Among screened 333 patients for malaria, majority (77%) were tested (42%) tested positive while 23% were not tested for malaria but treated. Out of the positive cases, 35% received treatment and tracked while 16% of negative cases treated were not tracked. Association between test and treat indicate that, majority 168/239 (70.3%) of the treated patients were tested of whom 115/168 (68.5%) positive cases were treated, P= 0.0001.
Conclusions: During COVID-19 pandemic period the malaria cases rose, Health workers did not adhere well to the T3 strategy as 27% malaria patients did not receive treatment. Adherence to Malaria T3 was below expected levels in MRRH, Eastern Uganda.