Zambia Standard Treatment Guidelines 2022 Pdf Download [TOP]

A major limitation of this study is the lack of verified process and outcome indicators to use for evaluating hypertension care in developing countries, because most quality improvement indicators are created nationally by developed countries. While the screening, physical exam and diagnosis process indicators were compared to a target of 80%, the remaining indicators did not have an obvious standard (e.g., proportion of visits by hypertensive patients with urinalysis, or on treatment) [18]. These latter indicators are more dependent on clinical judgment and will require more extensive external review to determine appropriate targets. Other limitations include insufficient data on patient characteristics (ie smoking, educational level) to build logistic regression models to predict the likelihood of successful management. Patient compliance with visits or medications was also not assessed. For the qualitative data, social desirability bias may have been present in interviews. Furthermore, we only interviewed providers and did not seek patient perspectives on hypertension management.

Based on the results of this study, antimicrobial-use guidelines will be developed by an interdisciplinary team to help guide clinicians to make the most appropriate antimicrobial decisions according to likely source of infection and individual patient characteristics (such as renal function) in accordance with antimicrobial availability and local resistance patterns. The guidelines will also emphasize obtaining appropriate cultures prior to administration of empiric antimicrobials and narrowing antimicrobial treatment based on susceptibilities. Additionally, providers will be educated on these guidelines and the importance of infection control throughout the implementation of the AMS program.

Zambia Standard Treatment Guidelines 2022 Pdf Download

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HMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility.

This was a cost-effectiveness evaluation of the management of uncomplicated malaria using the HMM strategy versus health facility-based management following the standard malaria treatment guidelines for Zambia. The provider perspective was used because malaria services are offered free of charge to the user since malaria is part of the basic health care package in Zambia. The basic health care package is a package of basic health services for common diseases, which are provided free of charge in government (public) owned health facilities. The government is the main health provider in the country. The main outcome measure was the proportion of uncomplicated malaria cases correctly diagnosed and treated according to national malaria case management guidelines.

This strategy involved training the already existing CHWs on the use of RDTs and ACT in the management of uncomplicated malaria. Further training was provided on the management of biological wastes and sharp objects, such as lancets. Additional orientation on drug and logistics management was given. The CHWs were then provided with malaria registers and medical supplies and re-deployed to their areas of operation. Any fever patient who reported to the CHWs was supposed to be subjected to a finger prick to ascertain malaria status. Complicated malaria cases and non-malaria febrile cases were referred to the nearest health facility for further management. All services were provided free of charge, in line with the country policy on health care financing. Pre-packaged AL was the ACT of choice and HRP-II RDTs were used according to the country stocks. The management of the stocks of AL, RDTs and other consumables was the responsibility of the CHWs under the supervision of the health facility as per routine operation guidelines. Replenishment of drugs and logistics were made by the health facility once the CHW made a request using a specially designed logistics form for RDTs and ACT. Each CHW was provided a new bicycle for transport (this is the standard form of transport for CHWs in Zambia). The study team conducted monthly supervisions to ensure data completeness of the malaria registers.

Under this strategy (standard practice), a clinical officer, environmental health technician or nurse is in charge of managing health facilities at any of the selected 15 health facilities. The health facilities were selected on the basis of being in the locality of the CHWs included in the HMM strategy described above. These health workers were prior to the study already trained in malaria case management using the new guidelines (confirmation plus use of ACT). At the health facility two options are available for diagnosis: microscopy or RDTs. The patient flow has already been described elsewhere [11]. The health workers received additional orientation (refresher) on new treatment guidelines, supervision of CHWs and logistics management. Pre-packaged AL was the ACT of choice and HRP-II RDTs were used according to the country stocks. Other anti-malarials at health facility level included SP for IPT and quinine for severe malaria. Chloroquine is no longer part of the anti-malarial list for health facilities in Zambia. The health facility level manages both complicated and uncomplicated malaria using a tiered referral system. Additional referrals from CHWs were also managed accordingly. Malaria diagnosis and treatment data was recorded in the out-patient department (OPD) malaria register. The study team carried out monthly supervision to ensure data completeness for the purposes of the study.

HMM was more cost-effective for management of uncomplicated malaria in rural areas than the standard of care at health facility level (USD4.22 versus USD6.61). Utilization and adherence to both diagnostic and treatment guidelines was higher in HMM strategy than at health facility level. Scale-up costs for HMM would depend on the expected utilisation and the desired patient to provider ratio.

Similarly, these guidelines also advocate the use of regular prophylactic inhaled medication to prevent symptoms of chronic asthma, and regular bronchodilator therapy as required for symptomatic relief [26]. Inhaled corticosteroids have also been shown to be effective in developing countries, reducing hospital admissions and emergency room visits by up to 80 % [27, 28]. A study in Zambia many years ago showed a reduction in asthma admissions when inhaled therapy was used [29]. Despite this evidence, up until 2013 the Zambian Standard Treatment Guidelines (STG), a set of nationally endorsed treatment guidelines covering various medical conditions used by health workers in the public health sector, emphasized the use of oral therapy as first line for mild cases of asthma with inhaled therapy reserved for acute severe exacerbations [30]. These guidelines were silent on the use of prophylactic inhaled steroids for prevention of chronic asthma symptoms.

In Zambia, the national treatment guidelines for asthma have recently been updated (in 2013) and now recommend inhaled medications as the primary treatment option for individuals with asthma, but this is not yet widely practiced. Alongside this major improvement, however, oral SABAs are still recommended as an alternative treatment option. The STG update will ensure the provision of free and consistent supply of MDIs to health institutions, avoiding cost implications on the patient. The government and other stakeholders have important roles to play in assuring that appropriate education of health workers takes place so that they adhere to the new guidelines and prescribe the drugs rationally in primary health care facilities [39]. Ultimately these measures would have a positive impact on inhaler perception, use, compliance and asthma control.

To inform our work, we presented our proposed methods and inclusion criteria to a panel of 28 infectious disease clinicians and public health experts representing 13 AU Member States. This consultation resulted in exclusion of national and regional guidelines developed by professional bodies and organizations, given that these guidelines may not be widely or systematically available or used in health facilities across the continent. An evaluation of the access and utilization of guidelines developed by these bodies would be required to determine if they are consistently used by clinicians treating infectious diseases. Furthermore, these guidelines may not represent feasible clinical options at the national or continental level given challenges in access to various antimicrobials or other diagnostic or treatment paradigms.

We limited the scope of the review to bacterial infections and clinical syndromes that often have a bacterial cause. Disease-specific guidelines for HIV, malaria, tuberculosis and other infections or syndromes addressed by national or vertical disease control programmes in Africa were excluded. We considered guidelines published in any major continental language. For final review, we included guidelines only if they contained disease-, syndrome- or pathogen-specific treatment recommendations and recommendations included specific name or class of antimicrobial, dosage and duration of therapy.

Standardized treatment guidelines that met the inclusion criteria were assessed for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.9 This included a review of information describing the methods used in guidelines development including whether the guidelines underwent external technical review or were informed by a systematic review of local, national or regional antimicrobial resistance or disease burden data.9

We compiled antimicrobial treatment recommendations provided in each guideline for common bacterial diseases, including information on drug (or class of antimicrobial) selection, dosage and duration of therapy. Recommendations were segregated by adult, paediatric and/or neonatal patient populations as specified in the source guidelines. Special populations (e.g. pregnant women, patients with penicillin allergies) were included if noted in the source guidelines. Alternative and second-line therapy recommendations were also recorded. We did not extract other clinical information, such as case definition, recommended diagnostic testing and non-antimicrobial therapy treatments (e.g. vitamin supplements or pain management). 17dc91bb1f