In Uganda and other parts of Africa, presumptive treatment for malaria is common practice. Many cases of fever are treated at home with antimalarial drugs; when patients do access formal health care services, malaria is still often diagnosed empirically due to a lack of diagnostic resources, inadequate staffing, concern for the possible consequences of untreated malaria, and other factors. Even where diagnostic capabilities exist, studies have found that health workers often do not request a diagnostic test for patients suspected to have malaria. When tests are requested, health workers often disregard the results, prescribing antimalarial treatment despite a negative test result. In addition, when antimalarial treatment is prescribed, the prescription is not always for an appropriate regimen.

Presumptive treatment was accepted and even encouraged in official guidelines when older, inexpensive antimalarials such as CQ were widely effective. However, in many settings, empiric treatment results in substantial overuse of antimalarials and delays in the diagnosis of other febrile illnesses. Inappropriate use of antimalarial drugs is increasingly problematic as older antimalarials are replaced by new ACTs that are more costly, are in limited supply, and have less established safety records. The need for improved malaria case management in Africa is recognized as a public health issue requiring urgent attention. Most countries in sub-Saharan Africa recently changed their antimalarial treatment policies, adopting ACTs as the recommended treatment for uncomplicated malaria. The widespread implementation of these new highly effective drugs provides an important opportunity to substantially improve the treatment of malaria. However, it is imperative that these drugs are used rationally to maximize their impact. Training of health workers and improving diagnostic capabilities have been identified as potential avenues for improving malaria case management.

UMSP undertook to improve diagnostic capacity for malaria and management of febrile illness in 6 districts (Iganga, Masindi, Tororo, Jinja, Kabale, and Kanungu) in Uganda by training laboratory health care workers in malaria microscopy

A workshop was conducted to review and adopt a 3 day standard training course curriculum, materials and SOPs for malaria laboratory diagnostic training for health workers. Materials reviewed were previously used for the JUMP Integrated Management of Malaria Training Curriculum.  A number of stakeholders including experts from CPHL, AMREF, MOH, JUMP, UMSP, IDI and Training Institutions attended the workshop. The review was guided by curriculum development and training experts. Through discussions by all participants, a consensus was reached on the desired outputs. The 6-day training course offered by JUMP was modified to a three day comprehensive in service training course emphasizing practical diagnosis of malarial in a district setting.

A team of laboratory expert from UMSP,  MoH, CPHL and the District laboratory focal persons  performed the training. The training targeted all the laboratory personnel in the 6 districts. Prior to the training, information was collected on the status of laboratory facilities, their staffing, the utilization of laboratory services, and other challenges in the laboratory sector. Pre and Post tests were given to participants to evaluate their competencies,   skills and attitudes.  The trainings activities were carried out at a district hospital or Health centre IV with adequate Laboratory facilities. The targeted districts were selected based on MOH priorities.

Malaria Microscopy diagnostics training in six Districts in Uganda

		Number of Participants Trained
No	District	Female	Male	Total
1	Tororo	15	26	41
2	Iganga	11	25	36
3	Jinja	26	68	94
4	Masindi	19	28	47
5	Kanungu	9	17	26
6	Kabale	17	53	70
	Total number of Laboratory personnel trained in six districts			314