LONDON, Oct 22 (Reuters) - Strictly enforcing Malaria treatment guidelines and paying hospital workers extra halved mortality from the disease in one children's hospital ward, a study in Guinea-Bissau found.

The researchers in the West African nation had observed that better access to drugs had not clearly reduced mortality, and were questioning whether measures designed to improve the quality of care by staff would have more effect.

In a study at the national hospital they found five percent of children with malaria died in a ward where health workers were paid extra and closely supervised, compared to a 10 percent death rate in a ward where doctors and nurses received no financial incentive or additional supervision.

Malaria is caused by a parasite transmitted by mosquitoes. It has become resistant to some drugs and work on a vaccine has been slow.

The disease kills a child every 30 seconds, mainly African children under the age of 5, according to the World Health Organisation.

The researchers at the Bandim Health Project noted their study was not able to distinguish between the impact of closely supervising the application of care guidelines and the monetary reward, but said staff need to be motivated for training and supervision to have any impact.

"We have shown that quality of care in the paediatric ward ... depends not only on training and availability of drugs but also on financial incentives," they wrote in the British Medical Journal.

"Our results are probably relevant to other national and district hospitals in developing countries that face the same conditions and problems -- namely, low quality of care and staff with little motivation," they wrote.

They added that it was unclear whether financial incentives improved care in developed countries, but that in poorer settings healthcare workers frequently did other work to supplement their income, and that monetary incentives were therefore more likely to have an impact in developing countries.

The researchers, led by Sidu Biai at the Bandim Health Project, conducted their study in a setting where about 12 percent of deaths on the children's ward stem from malaria.

Before setting out, the researchers trained health workers in standardised care, and then closely monitored patients in two wards during the study of 951 children under the age of 5 admitted to the hospital with malaria.

In one ward national guidelines for the management of malaria were rigorously followed, and nurses received an extra $50 and doctors an extra $160 per month in recompense for the extra work and supervision. The amount of money was about equivalent to a month's rent, the researchers said.

In the other ward the staff were supposed to follow the same guidelines, but were not subject to the extra supervision.

"Even a small financial incentive and a specific target can make workers more likely to adhere to standards and improve the quality of their work," the researchers said.

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