Participation Of Private General Practitioners In Disease Management Of Malaria In Myanmar

Objective:Myanmar has been trying to improve the disease management of malaria through public health services. The involvement of private general practitioners (GPs) is recognized as one of the key contributory issues in malaria control, but no one has yet made an attempt to study the efficiency of their role. This study aimed to assess the participation of GPs in improvement of disease management. Methods :The study was conducted with all 32 GPs practicing at three randomly selected townships with high malaria load situated in Upper Myanmar from June 2006 to March 2007 using a pretest-posttest design to assess their knowledge of the disease management prior to and after intervention. The intervention package consisted of a one-day workshop on diagnosis and treatment of malaria and the supply of facilities for microscopy. Questionnaires filled in before and after tests were compared to assess the change of knowledge after the intervention. Diagnosis and treatment practice during the study period was analysed by review of registers kept by GPs, together with a follow-up survey of their patients for the reliability of data. Results: An overall improvement of knowledge was observed and significant changes were apparent for three variables; the criteria for referral of severe malaria, the effect of incomplete treatment and recommended treatment of Plasmodium vivax. Pre-test results showed that only 65.6% of GPs perceived microscopy or Rapid Diagnostic Test kits (RDTs) for confirmation of malaria necessary, while only 15.6% and 40.6% of the GPs knew the recommended treatments of falciparum and vivax malaria, respectively. However, after intervention 92% of the patients were diagnosed as malaria by RDTs and 3% by microscopy throughout the study. The GPs prescribed artemisinin-based combination therapy (ACTs) to 95% of confirmed falciparum cases and treated 82.4% of RDT confirmed falciparum negatives with chloroquine and primaquine. Concurrent with our study, an international NGO, Population Service International, supplied GPs with RDTs and ACTs at subsidized rate which was helpful. Conclusion :The study suggests that participation of GPs may help improve the disease management of malaria and thus assist in the country's effort to control malaria.