AUTONOMOUS SECOND ORDER EQUATIONS

Cadre of healtl1care providers and years cf work experience have been found to be associated witl1 adherence (Selemani et cl., _2013). Non-physician clinical officers

�ere _more I kely _to adhere to antimalarials prescription guidelines when compared

\vitl1 physicians. _The researchers found t1at healthcare providers \vho worked for three or more )'ears ,, ere more likely to adhere to antimalarial prescription guidelines tl ¹ an those \Vit�, fe\ver years of ,vork experience. However, this was nJt found in our stud).

\\ e found that training ,vas a predictor of adherence to antimalarials prescription

gu idel ,nes Qveral J, healthcare providers ,vere more I ikely to adhere to prescription guidelines on ,vhich they had been trainej. Focus of the trainings ir ot1r study site depended on the cadre of health care provi jer being trained. For instance, training for patent medicine vendors focused on rccog111tion of basic symptoms of uncomplicated malaria and their treatment. Nurses commltnity health officers and cor111nt1111ty llcoltll

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extension worl<ers were _trained

on mar agement of

. . . . uncompl1cate,j malaria and

1n1t1at1on of prt.!-referral treatment f o suspected severe I • ma aria. Doctors, commt1nit

l1ealth . officers . _and pharmacists _w ere trained on microsc ^. opy, RDT , treatment of severe ^Y malaria and in-patient care.

Des1Jite the relatively high . _pro po rt' _ion o f CHEWs who \Vere trained, fewer proportion of this cadre adhered to the guidelines. . .

This Sligge5ts that the quaJ _{tty of} training, trainees or trainers of this part· 1 icu _{ar ca} d re _c,f healll1care providers may have been sub-opti1nal hence the poor ' _O u come O such tra1n1ng (Mbacham et al., 2014). A very low t f . .

adl 1erence (3.2%) to ACT prescription guidelines has been attributed to Iacl< of

training 011 ^tl 1e guidelines (Mishra et _c.l., 2013). Si _n1 iJarly, poor adherence to antimalat·ial prescription guidelines ⁱⁿ Brazil vvas linl<ed to absence of training prograrn on th 1! national gu idelines(Luz ec al., 2013 ). On the contrary, training of cl i 11 icians mar� .. edly irn proved their adherence to guidelines in Yemen(Bin Ghouth, 2013 ).

In our study patent medici11e vendors who c;onstituted highest proportion of healthcare providers trained on current guidelines adh

¹

�red the least to the guidelines. This was in conformity with previous reports on patent medicine vendors in Jigawa State (Beren des et al., 2012) and elsewhere in Nigeria (Beyeler et al., 2015).

Researchers have shown that prescriptior1 of ACTs based on avai);ibility of such AC Ts \\ as associated

^\V

ith adherence to g11idelines on their prescription (Yeka and Harris. 20 JO) though such association wa, not found in our study. c:o-existence of

,nalaria \Vith c,•her illnesses (co-morbidity) in patients and diagnostic confirmatio11 of malaria ha,,c also been kno\vn to influence: adherence to treatment gt11delines (Dodoo

et al .. , 2009) though such associations were not found in OLJr stL1dy

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5.2 LIMITATIONS

There were limitations t th· 0 15 Shtdy. P_rescriptions by all cadres of healthcare

providers were· not verified by . 1 . VISUa inspe�tion. _This was because past prescriptio11s by patent medicine vendors

. , nurses and phar1nacists were not found. Furthermore, t11ere was chat : enge identifyin a d . . .

, g n sorting prescr1pt1ons by cadre of prescribers in n1ost PHCs as the prescriptio d'd ns ¹ not ca_r ry na111es or s1g11atures of the prescribers.

l-lowever, the few past pr escr1p ions whos,� prescr1bers were i�entified corresponded · t' with pre sc riptic

1 >ns 011 questionnaires when <;ompared.

Medical laboratory personnel \Vere not i11clL1ded i11 _tl1is study even when we l<new that they also prescribe and treat malaria. This exclt1sion was deliberate i ^'1 the design of tl1is study beciuse of concern of getti11g adeqt1ate number of medical laboratory personnel especially at tl1e community a11d PHC levels. We however believe that effect of _tl1is e)tclusion would be minimal as tl1e advent of RDTs has made it possible for the role of laboratory personnel in m,;_i_laria diagnosis to be performed by other cadres of l1ealthcare providers. We also er1sured that questions on the questionnaires

\Vere dra\Vtl fi·om different sections of the current guidelines for diagnosis and treatment of mi1laria.

5.3 CO CLUSION

ln conclusion, the adherence to guidelines on prescription of antimalarials \Vas poor

among healthcare providers in Lokoja. [)espite the fact that more proportions of patent medic in! vendors were trained on antimalarial prescription guidelines, they had the least proportion of healthcare providers with good knowledge of such guidelines and adherent to the guidelines. Nurses al:,o had a low proportion of their mc1nbcrs

'-'lith good kno

¹

..vlcdgc of the gu rdcl incq,

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Effect of traini,ng of health care providers O dh ·

n a erence to PJi Scripti o n guidelines is dependent on t 1e cadre of h 1 h . ea t care providers wh .

. . . . .

o are trained. Healthcare providers w1tl1 higher 1n1t1al education and l'fi .

qua 1 1cat1on appe t dh ar O a ere more tc1 reco1nmended guidelines on antimalari'al pre . . scr1pt1on.

Half of all hea .

lthcare prov·d . .

. 1 ers in th1s Shl,::ly had good knowledge of the guidelines.

Sl1rprisi11g\y, tl·� is good lcnowled d'd ge 1 not translate to l11gl1 adl1erence to guidelines on _ antin1alarial pr,�scription Tl · · 11 _S st1ggests tht!re are other barriers to adl1erence beyond

igt'lorai,ce of contents of gttidelines. From this study, otl1er factors fot1nd to influence adherence include healthcare provider -re :la ted ones sucl1 as training on current

gtiidelines for 1nalaria diagnosis and tre�ttment and knowledge of the guidelines.

Therefore while improvement in kno,vledge of healtl1care providers is beneficial, it 1nay not be sufficient to achieve desiraJle adl1erence. Other factc>rs need to be

addressed to comple1nent knowledge .

5.4 RECO \1MENDATIONS

1. Training of healthcare providers on antimalarial prescription guidelines should continue. Governments should however be more involved in sponsoring and

organizing such trainings in order to ensure sustainability of such programs.

Involvement of government can als:::> improve quality of st1ch trainings.

2. Training of PMV on guidelines should be integrated with training of PMVs on

rapid diagnostic test by non-governmental organizations and government. Th.is integration should be followed by implementation of pre-treat1nent testing for

malaria by P'V!Vs. Government n1ay wish to consider use Jf period short me�sage servi�e reminders to ren1ind patent medicine vendors of need to adhere to antimalarials treatment gt idclines.

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3. Federal and state governments shot1ld improve regulation of e11trance into the busines.3 of patent medicine vendo1 s. This is to ensure that only persons with

certain ininimum level of education and qualification enter the business.

4. Further studies especially qualitati, e studies should be carried out to find out specific reasons for non-adherence to antimalarials prescrip t io n guidelines

among nealtl1care providers \ivho ha:i been trained on the gl1idelines .

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In document Elementary Differential Equations with Boundary Value Problems (Page 171-188)