Diagnostic Practices and Adequacy in the Management of Uncomplicated Malaria among Health Facilities in Buea, Cameroon

Abstract

Background: In Cameroon, artemisinin-based combination therapy (ACT) and parasitological confirmation before treatment are the national standards for managing uncomplicated malaria. However, effective implementation at the point of care is critical for patient outcomes and preventing drug resistance. This study evaluated the real-world clinical diagnostic approaches and the adequacy of antimalarial prescriptions for uncomplicated malaria in the Buea Health District (BHD). Methods: A cross-sectional study was conducted from February to April 2022 in 31 public and private health facilities in the BHD. Data were collected from 251 patients presenting with fever or a history of fever who were diagnosed with uncomplicated malaria. Variables included patient demographics, symptoms, diagnostic test results (RDT/microscopy), and details of the prescribed antimalarial. Prescription adequacy was assessed against national guidelines. Results: The majority of patients were female (56.6%) with a mean age of 18.8 years. Fever (81.3%) and headache (86.1%) were the most common symptoms. Most patients (93.2%) underwent a parasitological test, with microscopy being the most frequent. Overall, 46.2% had a positive thick blood smear and 22.3% a positive RDT. Artemisinin-based combination therapy was prescribed in 93.1% of cases, with Artemether-Lumefantrine (AL) being the most common (53.4%), followed by Artesunate-Amodiaquine (ASAQ) (36.8%). However, a significant portion of ACT treatments (35.5%) were initiated before laboratory confirmation. Documentation of prescription details was high for galenic form and duration (93.2%) but lower for posology (84.1%). Crucially, only 42.6% of all malaria cases were managed in full adherence to national guidelines. Conclusion: While diagnostic testing and ACT use for uncomplicated malaria are high in the BHD, a substantial gap remains between practice and policy. The prevalent use of presumptive treatment and the suboptimal overall adherence to guidelines highlight the need for targeted interventions, including continued prescriber training and strengthened supply chain management, to optimize malaria case management and preserve ACT efficacy.