Abstract

In Gabon, the prompt diagnosis of malaria has been recommended for febrile patients since 2006. However, the medical practices of health workers (HW) have not been investigated since these guidelines were implemented. This study was conducted to assess the prescription practices and attitudes of HW at a sentinel site for malaria surveillance in Libreville. A retrospective, cross-sectional, descriptive study was performed from June to August 2020 at the Operational Research and Clinical Unit in Libreville, Gabon. Data were recorded in a standardized case report form (CRF) and included the socio-demographic and clinical information of patients, the diagnosis decisions of the HW, and the antimicrobial drugs prescribed following the malaria test results. A total of 1,583 CRFs for febrile patients were analyzed. Malaria was confirmed in 672 (42.4%) patients. According to the HW, the main etiology of fever was malaria (55.2%). Among the 672 participants who had positive blood smears (BS), 456 patients (67.8%) received an antimalarial drug, and 61 (9.1%) did not receive any antimalarial treatment. The prescription of antimalarial drugs increased with the age of the patients. Overall, 30.7% (280/911) of patients with a negative BS received an antimalarial drug, and antibiotics were given to 321 patients (35.2%). Antibiotics were frequently prescribed by HW in cases of non-malarial febrile illnesses (NMFI) (59.1%; n=419/709). The concomitant prescription of antimalarial drugs and antibiotics was observed in 20.8% of cases when malaria tests were positive. Drugs were prescribed based on the symptomatology of the patient. HW at the study site prescribed antimicrobials to febrile patients regardless of the results of the malaria tests. Continuous training on the management of fever cases and improved access to NMFI diagnostic tools are necessary to enhance care and prevent antibiotic resistance.

Key words: Adherence, diagnosis, malaria, health workers, acute febrile illnesses, antimicrobials, Gabon.