| Background: Health workers (HWs) appropriate malaria case management includes early detection and prompt
treatment with appropriate anti-malarial drugs. Subsequently, HWs readiness and practice are considered authentic
evidence to measure the health system performance regarding malaria control programme milestones and to issue
malaria elimination certifcation. There is no comprehensive evidence based on meta-analysis, to measure the performance of HWs in case management of malaria. This study aimed to evaluate HWs performance in early malaria case
detection (testing) and the appropriate treatment.
Methods: The published literature in English was systematically searched from Medline, Scopus, Embase, and Malaria
Journal up to 30th December 2020. The inclusion criteria were any studies that assessed HWs practice in early case
detection by malaria testing and appropriate treatment. Eligibility assessment of records was performed independently in a blinded, standardized way by two reviewers. Pooled prevalence estimates were stratifed by HWs cadre
type. Meta-regression analysis was performed to explore the impact of the appropriateness of the method and risk of
bias as potential sources of the heterogeneity in the presence of efective factors.
Results: The study pooled data of 9245 HWs obtained from 15 included studies. No study has been found in eliminating settings. The pooled estimate for appropriate malaria treatment and malaria testing were 60%; 95% CI: 53–67%
and 57%; 95% CI: 49–65%, respectively. In the fnal multivariable meta-regression, HWs cadre and numbers, appropriateness of study methods, malaria morbidity and mortality, total admissions of malaria suspected cases, gross domestic product, availability of anti-malarial drugs, and year of the publication were explained 85 and 83% of the total
variance between studies and potential sources of the heterogeneity for malaria testing and treating, respectively.
Conclusion: HWs adherence to appropriate malaria case management guidelines were generally low while no
study has been found in eliminating countries. Studies with the inappropriateness methods and risk of bias could be
overestimating the actual proportion of malaria appropriate testing and treating. Strategies that focus on improving
readiness and early identifcation of acute febrile diseases especially in the countries that progress to malaria elimination should be highly promoted. |