Published in PLOS One on 2025-11-26, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Abate Atimut Dereje, Dereje Geleta, Tadesse Menjetta, Abinet Takele, Susana Vaz Nery, Techalew Shimelis
Source: PLOS One • DOI 10.1371/journal.pone.0337326
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Early diagnosis and prompt treatment of malaria cases are a crucial component of curative and preventive interventions. There have been reports of healthcare workers overprescribing antimalarial agents against guidelines, but the barriers they face in adhering to the guidelines are not well studied. This study aimed to investigate barriers to adherence to guidelines in prescribing antimalarial drugs in public healthcare facilities in Arba Minch, South Ethiopia.
A cross-sectional descriptive exploratory qualitative method was employed. We included ten participants from public healthcare facilities, including health centres, a hospital, a city health office, and a zonal health bureau. A key informant interview technique was used to collect data. All interviews were audio-recorded, transcribed, and analyzed. Data analysis was performed using ATLAS.ti, version 7.5 software. The results were presented thematically and narrated to support the main themes.
Public healthcare facilities primarily used blood smear microscopy to test all malaria-suspected patients. However, in cases of microscopy service interruptions or when confirming negative results, rapid diagnostic tests (RDTs) were employed in some facilities. Limited availability of microscopes and reagents, and electric power interruptions hindered reliable microscopy services. Drug stock-outs, patient expectations for antimalarial drugs, self-treatment, and delayed care-seeking are barriers to adherence to malaria treatment guidelines. The main reason for non-adherence to withholding antimalarial drugs after negative tests was greater trust in clinical findings over laboratory results. Confidence in experience contributed to trust in clinical judgment, while perceived inexperience and negligence, inconsistent RDT and microscopy results, and poor-quality control assessment results undermined trust in laboratories. Despite supporting the guidelines, study participants emphasized the need for flexibility to allow empirical treatment and highlighted the lack of training and mentoring for healthcare workers.
To improve adherence to malaria treatment guidelines, it is essential to ensure consistent lab operations, enhance quality assurance, maintain effective communication between lab personnel and prescribers, and provide healthcare and patient education. Implementing training and mentoring programs and promoting evidence-based practices are also crucial.
Introduction
Malaria remains a serious global health problem, particularly in the World Health Organization (WHO) African Region, which accounts for 94% of malaria cases (233 million) and 95% of deaths (580,000) in 2022. Children under five years of age account for about 78% of all malaria deaths in the region. From 2019 to 2022, the number of malaria cases in this region rose from 218 million to 233 million [1].
In Ethiopia, about 68% of the population is at risk of malaria, with transmission being seasonal and unstable [2]. Plasmodium falciparum and P. vivax cause 65% and 35% of cases, respectively [3]. Malaria cases decreased significantly from 5.5 million in 2010 to less than 1 million in 2019, while deaths dropped from 3,000 in 2010 to just 212 in 2021 [4]. However, disruptions from the coronavirus disease pandemic, conflict, and displacement led to a 32.5% increase in confirmed cases between 2021 and 2022, reaching 1.5 million. In 2023, cases surged by 150% and 120% compared to the same periods in 2021 and 2022, respectively [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Abate Atimut Dereje, Dereje Geleta, Tadesse Menjetta, Abinet Takele, Susana Vaz Nery, Techalew Shimelis. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Self-medication practice with anti-malarial drugs and its associated factors among patients with fever attending public health facilities in Dera District, Northwest Ethiopia
- Evidence brief: Implementation fidelity of Ethiopia’s Malaria test-and-treat guideline amid a resurgence in Amhara Region: A mixed-methods study
- Evidence brief: Improving the field accuracy of a malaria diagnostic algorithm combining sequential interpretation of rapid diagnostic test detecting PfHRP2 and pLDH in febrile children in a seasonal hyperendemic malaria transmission area in Burkina Faso
