Treatment of malaria has relied heavily on clinical (symptom-based) diagnosis in the past, with microscopy used in few facilities. The MoH Malaria Control Programme is introducing rapid diagnostic tests (RDTs) for diagnosis of malaria in health facilities with no functional laboratories in Uganda.

Rapid diagnostic testing offers an accurate, reliable and simple alternative to microscopy for malaria diagnosis. Appropriate training in correctly using RDTs is essential as is correct decision making following the results of the RDT testing both of which are critical to effective malaria control. It is therefore necessary to train health workers in correct RDT use as well as training for rational anti-malarial drug use following the test and for appropriate management of RDT-negative febrile cases. Poor targeting of RDTs, and poor adherence to test results, dramatically decreases their utility and cost-effectiveness. We therefore propose to train health workers on both correct and safe use of RDTs and appropriate fever case management in the two districts as part of a national training program.

Through our JUMP collaboration and partnership with the MOH, we have developed a 2-day on-site training course in fever case management using RDTs. The course has undergone pilot evaluation at six health centers in Uganda and preliminary data show a significant impact of the course and provision of RDTs in safely targeting antimalarial therapy to confirmed malaria cases. UMSP has trained health workers in two pilot districts (Kanungu and Kabale) in fever case management using rapid diagnostic testing. This training was conducted using the cascade training model that has been adopted by the National Malaria Control Program. The training shall be rolled out to the rest of the country in future.

A core team of trainers trained at the national level trained the district-based trainers, who in turn train health center staff within their districts.  A ToT manual and a user’s manual, both tailored to the Ugandan setting, were developed for use in the trainings. The National Training team comprises of personnel with training experience and good understanding of the role of RDTs in clinical care in Uganda. It is composed of people willing and able to commit time and effort in districts and includes personnel from the NMCP, JUMP, FIND, WHO, CPHL, UMRC, MC, Malaria Zonal coordinators, and personnel from UMSP. The national team was familiarized with policy and training materials during a 3-4 day workshop facilitated by the NMCP, manual writers, and those with RDT training experience. Members of the national team obtained practical experience with training materials through delivering a training at a sentinel Health Center, supervised by the expert trainers.

About 2-4 members of the national team (mainly drawn from UMSP for this purpose) travel to the target district to deliver a 3-day ToT training to identified district personnel, including the malaria focal person, district laboratory focal person, and selected district trainers and clinicians. The sessions are guided by the ToT manual. District trainers in turn train the rest of the health care workers. The sessions are guided by the user’s manual. The district team members perform support supervision at individual health centers within one week of training to reinforce the practical steps. Training session are supervised by a member of the national team to ensure quality

Number of staff trained in Kanungu District.
Kinkizi East HSD		Kinkizi West HSD.
HC	No. Trained.	HC	No. Trained.
Bugongi HC II	4	Bihomborwa H/C 11	2
Bulanga HC II	1	Bugiri HC II	1
Kanung HC IV	8	Bushere H/C 11	2
Katete HC III	5	Butogota HC II	4
Kazuru HC II	2	Kambuga Hospital	1
Kifunjo HC II	1	Kanyanshogye H/C 11	2
Kinaaba COU HC II	3	Kanyantorogo HC III	8
Kinaaba HC II	3	Karangara HC II	3
Kirima HC III	6	Kayonza HC III	2
Kiringa HC II	1	Kazinga H/C 111	2
Makiro HC III	3	Kenyage HC II	1
Mazzoldi HC II	2	Kibimbiri HC II	2
Mishenyi HC II	3	Kihembe H/C 11	2
Nyakatare HC III	7	Kihiihi H/C IV	9
Nyarutojo HC II	1	Kyeshero H/C 111	2
Rubimbwa HC II	2	Matanda H/C 11	1
Rugyeyo HC III	8	Mpungu H/C 111	6
Rutenga HC III	8	Ntungamo H C II	2
		Nyakashozi H CII	1
		Nyakinoni HC II	1
		Nyamirama HC III	7
		Nyamwegabire H/C 11	5
		Rushaka H/C II	2
		Samaria HC II	2
		St Annah HC II	2
Total.	68		72

 

Training Summary in Kabale district.

No.	Dates	Training.	No. Trained
1.	29th – 31st July 2009	ToT Training	21
2.	3rd – 4th August 2009.	Training for HSD Staff	329
3.	10th – 14th August 2009	Support Visits to all trained staff.	329 staff visited.