Effect of training on the clinical management of malaria by medical assistants in Ghana

Malaria accounts for over 40% of all outpatient consultations in Ghana. A common drug use problem associated with its treatment with chloroquine is over- and under-dosage and a preference for the intramuscular route of administration. Inadequate treatment is an important factor in the selection of resistant strains of malaria parasites. To ensure the proper management of diseases at health centres the Ministry of Health instituted an in-service training programme for medical assistants in 1987. We evaluated the effect of this training on the clinical management of malaria using a quasi-experimental design. Three methods of data collection were used; prescription survey, assessment questionnaires and focus group discussions. Our findings revealed that gains in knowledge following the training had deteriorated within a year. There was also a discrepancy between knowledge and practice of malaria treatment. This was shown by over- and under-dosing of chloroquine in children and adults respectively. There was also overwhelming preference (85% of all cases) for injections and a high tendency towards polypharmacy (average of five drugs per visit). The motivating reasons for these were mainly socio-cultural and included patient demand and attitudes, prescriber self interests and stereotypes and the daily practical challenges of the community. While paying greater attention to supervision of clinical work at health posts, consideration must be given to socio-cultural context of drug use in any such future training programmes if rational use of drugs is to be achieved.