BACKGROUND Despite the uptake of parasitological testing into policy and practice, appropriate prescription of anti-malarials and artemisinin-based combination therapy (ACT) in accordance with test results is variable. This study describes a National Malaria Control Programme-led capacity building intervention which was implemented in 10 States of Nigeria. Using the experience of Niger State, this study assessed the effect on malaria diagnosis and prescription practices among febrile under-fives in rural health facilities. METHODS The multicomponent capacity building intervention consisted of revised case management manuals; cascade training from national to state level carried out at the local government area (LGA) level; and on the job capacity development through supportive supervision. The evaluation was conducted in 28, principally government-owned, health facilities in two rural LGAs of Niger State, one in which the intervention case management of malaria was implemented and the other acted as a comparison area with no implementation of the intervention. Three outcomes were considered in the context of rapid diagnostic testing (RDT) for malaria which were: the prevalence of RDT testing in febrile children; appropriate treatment of RDT-positive children; and appropriate treatment of RDT-negative children. Outcomes were compared post-intervention between intervention and comparison areas using multivariate logistic regression. RESULTS The intervention did not improve appropriate management of under-fives in intervention facilities above that seen for under-fives in comparison facilities. Appropriate treatment with artemisinin-based combinations of RDT-positive and RDT-negative under-fives was equally high in both areas. However, appropriate treatment of RDT-negative children, when defined as receipt of no ACT or any other anti-malarials, was better in comparison areas. In both areas, a small number of RDT-positives were not given ACT, but prescribed an alternative anti-malarial, including artesunate monotherapy. Among RDT-negatives, no under-fives were prescribed artesunate as monotherapy. CONCLUSION In a context of significant stock-outs of both ACT medicines and RDTs, under-fives were not more appropriately managed in intervention than comparison areas. The malaria case management intervention implemented through cascade training reached only approximately half of health workers managing febrile under-fives in this setting. Implementation studies on models of cascade training are needed to define what works in what context.

中文翻译：

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对尼日利亚尼日尔州农村卫生机构五岁以下儿童进行疟疾治疗的能力建设干预措施的评估。

背景技术尽管将寄生虫学检测纳入政策和实践中，但根据检测结果，适当的抗疟疾药物和基于青蒿素的联合疗法（ACT）的处方仍是可变的。这项研究描述了在尼日利亚10个州实施的由国家疟疾控制计划主导的能力建设干预措施。利用尼日尔州的经验，本研究评估了农村医疗机构中五岁以下未成年人对疟疾诊断和处方实践的影响。方法多方面的能力建设干预措施包括修订的病例管理手册。在地方政府区域（LGA）级别从国家级到州级进行级联培训；通过支持性监督来提高工作能力。评估是在28日进行的 在尼日尔州的两个农村地方政府中，主要是政府所有的卫生设施，其中一个实施了疟疾干预病例管理，而另一个则作为比较区域而未实施干预措施。在针对疟疾的快速诊断检测（RDT）中考虑了三个结果：发热儿童中RDT检测的普遍性；RDT阳性儿童的适当治疗；对RDT阴性儿童进行适当治疗。使用多元逻辑回归分析比较干预和比较区域干预后的结果。结果干预措施并未改善干预设施中五岁以下儿童的适当管理，超过了比较设施中五岁以下儿童的适当管理。在两个区域，适当使用基于青蒿素的RDT阳性和RDT阴性的五岁以下儿童进行适当治疗。但是，如果将RDT阴性的儿童定义为未接受ACT或任何其他抗疟疾治疗，则在比较区域进行适当的治疗会更好。在这两个地区，少数RDT阳性患者未接受ACT治疗，而是开了另一种抗疟疾药，包括青蒿琥酯单药治疗。在RDT阴性患者中，未有五岁以下青蒿琥酯作为单药处方。结论在ACT药物和RDT都大量缺货的情况下，与比较领域相比，干预中未成年人的干预没有得到更适当的管理。在这种情况下，通过级联培训实施的疟疾病例管理干预措施仅覆盖了处理未成年人五岁以下婴儿的卫生工作者中的大约一半。