Table 3 Summary of key findings: implementation, practicality and adaptation of SST
Implementation | SST was being correctly implemented in all 8 health centres visited- and 99% of the women attending 1st ANC were tested for malaria, and those who were positive received treatment; Nurses expressed that RDTs were easy to perform compared to microscopy. “RDTs can be performed by any nurse without much experience and expertise; and most of us have been trained on the use of RDTs. I feel it is easy and quick to use compared to microscopy. I can test my patients with no problem”, ANC Nurse, Kilwa DC |
RDTs availability | None of the facilities in the study area had experienced any stock-outs in the past year. The ANC used only RDTs and not microscopy for malaria testing. Ordering of additional tests was completed on time, and facilities performed quantification based on consumption. Redistribution of RDTs was happening within the districts using a group text service, as reported by a respondent. “We are using group texts via an electronic platform which has been created at the district level where we communicate to each other to share stock-out information and this helps us in redistribution of commodities”, ANC nurse, Kilwa DC |
Anti-malarial availability | ACTs were available in all 8 health centres. No HCW reported stock-out of ACTs in the preceding 6 months. On the other hand, most facilities had experienced periodic stock-outs of quinine tablets in the past 1 year. “We have not experienced a stock-out of malaria commodities in our facility. Usually we do our orders on time and we receive the orders according to our requests. The only commodity that has been a challenge is Quinine”, HCW from Lindi DC |
Anti-malarial prescription challenge | Anti-malarials were prescribed by clinicians at OPDs. Women with positive RDT results had to be escorted to OPD for treatment to avoid queues at OPDs and also to make sure no women went home without treatment. Pregnant women with a negative RDT were given IPTp, provided that they were in their second or third trimester. Women with a negative RDT who were symptomatic were referred to the clinician for further assessment and were treated per the Ministry of Health guidelines for symptoms or any other problems which were detected. None of the nurses prescribed anti-malarials. All treatment information was kept/recorded at the outpatient department (OPD). “We only conduct RDT for pregnant women who are coming for their first ANC visits. For those who are positive, we usually escort them to the clinicians for further assessment and are given anti-malarials. Most of us working here at ANC do not prescribe or dispense any anti-malarials to pregnant women. Escorting pregnant women to OPD is sometimes challenging especially when we have many clients to attend to and as you know we are not many who work here but we do our best to help our clients”, HCW from Lindi DC |