The Quality of Malaria Case Management in Different Transmission Settings in Tanzania Mainland, 2017–2018

Background: Tanzania is currently undergoing an epidemiological transition for malaria transmission with some areas of the country having < 10% (hypoendemic) and other areas ≥ 10% malaria prevalence (mesoendemic). Hypoendemic areas on the continuum toward elimination require higher testing rates for fever cases and appropriate treatment. There is a lack of information about the quality of malaria case management in elimination settings in Tanzania mainland. This study examined the influence of endemicity on the quality of malaria case management at health facilities. Methods An analytical cross-sectional study was conducted among health facilities in Tanzania mainland. Data were collected by the National Malaria Control Program using an assessment tool to monitor the quality of malaria case management at facilities from September 2017 to December 2018. Using standard quality factors, mean scores from facilities in the different endemicity regions were compared by a Student’s t-test. Simple and multiple linear regression analyses were performed to determine the association between facility performance (score) and endemicity (mesoendemic vs. hypoendemic). Results Malaria case management data from 1713 health facilities (1425 public; 288 private), representing 21.3% of all facilities nationally, were available for analysis. Facilities located in mesoendemic regions scored higher compared to those in hypoendemic regions on the overall quality of services [difference in mean scores (d̄) = 2.52; (95% CI 1.12, 3.91)], site readiness [d̄ = 2.97; (95% CI 1.30, 4.61)], availability of malaria reference materials [ d̄ = 4.91; (95% CI 2.05, 7.76)], Health Management Information System tools [d̄ = 5.86; (95% CI 3.80, 7.92)] and patient satisfaction [d̄ = 6.61; (95% CI 3.75, 9.48)]. Facilities in hypoendemic regions scored lower than those in mesoendemic regions [β: -1.54; (95% CI -2.74, -0.53)]. Facilities in urban areas scored lower than those in rural areas [β: -1.56; (95% CI -2.76, -0.38)]. Facilities in regions with implementing partner support scored higher than those without [β: 7.92; (95% CI 6.26, 9.57)]. Conclusion Health facilities located in malaria mesoendemic regions overall scored higher compared to those in hypoendemic regions. There is a need to target improvement efforts in the lower performing facilities regardless of endemicity setting.