Table 1 Study variables and definitions

Malaria knowledge and availability of malaria treatment guidelines

• Availability and use of the following malaria treatment guidelines were documented: Integrated Malaria Management (IMM) guidelines, Malaria in Pregnancy guidelines, National treatment guidelines on treatment of severe and complicated malaria and Malaria Treatment Algorithms (2011).

• Source of malaria information

• Training of staff on malaria case management

Quantitative and Qualitative approaches

Malaria case management practice assessment based on the Integrated Management of Malaria (IMM) guidelines.

• Correct malaria definition (“Malaria as an acute febrile illness caused by infection with malaria parasites. It can range from mild to severe life-threatening disease”).

• Correct definition of uncomplicated malaria (“Symptomatic malaria without signs of severe disease”)

• Correct definition of complicated/severe malaria (“Severe malaria is a malaria illness that is serious enough to be an immediate threat to the life of the patient”)

• Correct management of a patient with a fever (“All patients presenting with fever should first undergo a malaria test by Rapid Diagnostic Test (RDT) or Microscopy before receiving treatment. If a patient with fever has positive test results, then it’s a confirmed Malaria diagnosis. But if a fever patient has negative malaria test results then think about other differential diagnoses for fever other than malaria”)

• Correct first line treatment of uncomplicated malaria (prescription of an ACT, specifically artemether-lumefantrine)

• Correct first line treatment of complicated/severe malaria (prescription of intravenous artesunate)

• Correct referral of patients (Referral of all patients with severe/complicated malaria to a medical hospital or health facility equipped to treat such cases”)

• Correct antenatal Intermittent Preventive Therapy during pregnancy (IPTp) (prescription of Sulphadoxine-pyremethamine ).

• Adequate malaria case management practices ( “all malaria suspected patients, with a fever, tested for malaria and those who are confirmed to have malaria are treated as per national guidelines. Uncomplicated malaria treated with artemether-lumefantrine and complicated malaria treated with intravenous artesunate)

Quantitative and Qualitative approaches

Laboratory practices

• Presence of laboratory services, laboratory personnel, types of malaria tests, laboratory testing protocols and training of the personnel

• Skilled personnel – those that have been trained on the basic malaria diagnostic practices

• Adequate space – designated space to allow for the diagnosis of malaria according to the national laboratory guidelines

Quantitative and Qualitative approaches

Anti-malarial drugs stocks and stock management

• Anti-malarials used at the facility and occurrence of stock outs

Quantitative and Qualitative approaches

Data management practices

• Having a designated data records person assigned and trained on data recording and management.

• Proper patient documentation process - using the forms on which malaria is reported including the Health Management Information System (HMIS) weekly and monthly forms

• Evidence of data utilization (conducting analysis and presenting data, mostly as graphs)

• Reporting completeness of the weekly and monthly reports as submitted into the District Health Information System 2 (DHIS2) and centrally assessed; defined as proportion of expected reports (among all registered private health facilities) that were reported to the DHIS2.

Quantitative approach