Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing

Table 3 Summary characteristics of health workers providing outpatient care at surveyed health facilities—Southern Malawi, 2015 (N = 150^a)

	n	%
Cadre of health worker caring for patients in sampled outpatient department
Medical assistant (2 years of formal training plus 1 year internship)	100	66.7
Clinical officer (3 years of formal training plus 1 year internship)	23	15.3
Nurse^b (at least 3 years of formal training)	21	14.0
Patient attendant (no formal training)	4	2.7
Pharmacy technician (2 years of formal training)	1	0.7
Health surveillance assistant (6 weeks of formal training)	1	0.7
Training and guidelines
Malaria case management (in-service)^c training ≥2013	113	75.3
Malaria case management (on-the-job)^d training ≥2013	53	35.3
Either in-service or on-the-job malaria case management training ≥2013	128	85.3
Integrated management of childhood illness (IMCI) training within the last 5 years	27	18.0
Has a copy of the latest malaria treatment guidelines (dated ≥2013)	70	46.7
Supervision
Received any supervision in the past 6 months	101	67.3
Received at least two supervisory visits in the past 6 months	67	44.7
Supervision visits that included observation of patient consultations	55	36.7
At least one supervisory visit with observation of patient consultations that involved assessing health workers’ knowledge and prescription practices of anti-malarial drugs^e	36	24.0
Other characteristics	Median (IQR)	Min–Max
Age	29.0 (26.0, 36.0)	21–75
Years of experience	4.0 (2.0, 7.0)	0–45

^aSix of the 150 HWs did not see any enrolled patients but were interviewed by the survey teams
^bNurse category includes 20 nurse midwife technicians (3 years of formal training) and a Registered nurse (with a 4-year degree)
^cIn-service malaria case-management training refers to a formal, typically off-site multiday training on malaria diagnosis and treatment
^dOn-the-job training is an informal training provided to health workers at their place of employment by the facility in-charge, a co-worker, NGO staff, District Health Management Team or other Ministry of Health staff
^eAssessment of health workers’ knowledge on malaria treatment practices involves any or all of the following: (1) direct in-office observation of patient consultations; (2) review of patients’ health passports for malaria laboratory results and prescriptions; (3) quizzing HWs on national anti-malarial treatment guidelines; (4) reviewing dosing schedule of prescribed malaria prescriptions with patients to evaluate their understanding

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