Background: The burden of disease attributable to malaria has significantly improved in the last 3 years, however, the morbidity and mortality risks are still present, especially so for children under five years of age. In children with uncomplicated P. falciparum malaria, there is strong evidence to suggest that the following artemisinin-based combination therapy (ACTs) are effective in treating malaria. WHO malaria treatment guidelines 2015 have strong recommendations with high-quality evidence guiding practice in the 'test, treat and track' approach using microscopy, rapid diagnostics tests and ACTs.
Objectives: The aim of this evidence implementation project is to make contribution to promoting evidence-based practice in artemisinin-based combination therapy for managing uncomplicated malaria in children less than 5 years old and thereby improve patient outcomes and resource utilisation in the Bali Health District.
Methods: This evidence-implementation project used the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit and feedback tool. The PACES and GRiP framework for promoting evidence-based healthcare involved three phases of activity:
Phase 1: Stakeholder engagement and baseline audit data collection with identification of barriers to implementation.
Phase 2: Design and implementation of strategies to improve practice through Getting Research into Practice.
Phase 3: Phase 3: Follow-up audit post implementation of change strategy.
Results: We compared compliance with best-practice recommendations at baseline against a follow up compliance at 4 months following implementation of strategies identified using JBI GRiP Matrix. Compliance rates improved overall by 31% (R: 20 – 42) for all criteria and all sites with differences noticed between sites
We identified a total of 19 barriers and these could be stratified into clinician, community health workers', patients' and policy maker related barriers.
Conclusions: Despite existing barriers to evidence implementation, getting research into practice is possible and does improve quality of care.