Trends in Health Workers' Compliance with Outpatient Malaria Case-management Guidelines Across Malaria Epidemiological Zones in Kenya, 2010-2016

Overview

Journal Malar J

Publisher Biomed Central

Specialty Tropical Medicine

Date 2020 Nov 12

PMID 33176783

Citations 11

Authors

Beatrice Amboko

Kasia Stepniewska

Peter M Macharia

Beatrice Machini

Philip Bejon

Robert W Snow

Dejan Zurovac

Affiliations

Soon will be listed here.

Abstract

Background: Health workers' compliance with outpatient malaria case-management guidelines has been improving, specifically regarding the universal testing of suspected cases and the use of artemisinin-based combination therapy (ACT) only for positive results (i.e., 'test and treat'). Whether the improvements in compliance with 'test and treat' guidelines are consistent across different malaria endemicity areas has not been examined.

Methods: Data from 11 national, cross-sectional, outpatient malaria case-management surveys undertaken in Kenya from 2010 to 2016 were analysed. Four primary indicators (i.e., 'test and treat') and eight secondary indicators of artemether-lumefantrine (AL) dosing, dispensing, and counselling were measured. Mixed logistic regression models were used to analyse the annual trends in compliance with the indicators across the different malaria endemicity areas (i.e., from highest to lowest risk being lake endemic, coast endemic, highland epidemic, semi-arid seasonal transmission, and low risk).

Results: Compliance with all four 'test and treat' indicators significantly increased in the area with the highest malaria risk (i.e., lake endemic) as follows: testing of febrile patients (OR = 1.71 annually; 95% CI = 1.51-1.93), AL treatment for test-positive patients (OR = 1.56; 95% CI = 1.26-1.92), no anti-malarial for test-negative patients (OR = 2.04; 95% CI = 1.65-2.54), and composite 'test and treat' compliance (OR = 1.80; 95% CI = 1.61-2.01). In the low risk areas, only compliance with test-negative results significantly increased (OR = 2.27; 95% CI = 1.61-3.19) while testing of febrile patients showed declining trends (OR = 0.89; 95% CI = 0.79-1.01). Administration of the first AL dose at the facility significantly increased in the areas of lake endemic (OR = 2.33; 95% CI = 1.76-3.10), coast endemic (OR = 5.02; 95% CI = 2.77-9.09) and semi-arid seasonal transmission (OR = 1.44; 95% CI = 1.02-2.04). In areas of the lowest risk of transmission and highland epidemic zone, none of the AL dosing, dispensing, and counselling tasks significantly changed over time.

Conclusions: There is variability in health workers' compliance with outpatient malaria case-management guidelines across different malaria-risk areas in Kenya. Major improvements in areas of the highest risk have not been seen in low-risk areas. Interventions to improve practices should be targeted geographically.

Citing Articles

Health workers' adherence to malaria case management protocols in Northern Sudan: a qualitative study.

Khalid Mohamed S, Khalid Mohamed D, Ahmed K, Saad F, Zurovac D Malar J. 2024; 23(1):170.

PMID: 38816778 PMC: 11137897. DOI: 10.1186/s12936-024-04998-9.

The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso.

Guissou R, Amaratunga C, de Haan F, Tou F, Cheah P, Yerbanga R Malar J. 2023; 22(1):269.

PMID: 37705004 PMC: 10498571. DOI: 10.1186/s12936-023-04705-0.

Malaria control and elimination in Kenya: economy-wide benefits and regional disparities.

Elnour Z, Grethe H, Siddig K, Munga S Malar J. 2023; 22(1):117.

PMID: 37029370 PMC: 10080938. DOI: 10.1186/s12936-023-04505-6.

The use of routine health facility data for micro-stratification of malaria risk in mainland Tanzania.

Thawer S, Golumbeanu M, Munisi K, Aaron S, Chacky F, Lazaro S Malar J. 2022; 21(1):345.

PMID: 36401310 PMC: 9675286. DOI: 10.1186/s12936-022-04364-7.

Factors influencing health workers' compliance with outpatient malaria 'test and treat' guidelines during the plateauing performance phase in Kenya, 2014-2016.

Amboko B, Stepniewska K, Machini B, Bejon P, Snow R, Zurovac D Malar J. 2022; 21(1):68.

PMID: 35241074 PMC: 8895910. DOI: 10.1186/s12936-022-04093-x.

References

Zurovac D, Tibenderana J, Nankabirwa J, Ssekitooleko J, Njogu J, Rwakimari J . Malaria case-management under artemether-lumefantrine treatment policy in Uganda. Malar J. 2008; 7:181. PMC: 2556699. DOI: 10.1186/1475-2875-7-181. View

Johansson E, Gething P, Hildenwall H, Mappin B, Petzold M, Swartling Peterson S . Diagnostic testing of pediatric fevers: meta-analysis of 13 national surveys assessing influences of malaria endemicity and source of care on test uptake for febrile children under five years. PLoS One. 2014; 9(4):e95483. PMC: 3991688. DOI: 10.1371/journal.pone.0095483. View

Bastiaens G, Schaftenaar E, Ndaro A, Keuter M, Bousema T, Shekalaghe S . Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change. Malar J. 2011; 10:76. PMC: 3080800. DOI: 10.1186/1475-2875-10-76. View

Nyandigisi A, Memusi D, Mbithi A, Angwa N, Shieshia M, Muturi A . Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya. PLoS One. 2011; 6(9):e24781. PMC: 3173476. DOI: 10.1371/journal.pone.0024781. View

Bawate C, Callender-Carter S, Nsajju B, Bwayo D . Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda. Malar J. 2016; 15:112. PMC: 4765189. DOI: 10.1186/s12936-016-1153-5. View

Thwing J, Ba F, Diaby A, Diedhiou Y, Sylla A, Sall G . Assessment of the utility of a symptom-based algorithm for identifying febrile patients for malaria diagnostic testing in Senegal. Malar J. 2017; 16(1):95. PMC: 5333468. DOI: 10.1186/s12936-017-1750-y. View

Zurovac D, Njogu J, Akhwale W, Hamer D, Larson B, Snow R . Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya. Trop Med Int Health. 2008; 13(6):784-7. PMC: 2592476. DOI: 10.1111/j.1365-3156.2008.02072.x. View

Salomao C, Sacarlal J, Chilundo B, Gudo E . Prescription practices for malaria in Mozambique: poor adherence to the national protocols for malaria treatment in 22 public health facilities. Malar J. 2015; 14:483. PMC: 4667420. DOI: 10.1186/s12936-015-0996-5. View

Johansson E, Ekholm Selling K, Nsona H, Mappin B, Gething P, Petzold M . Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census. Malar J. 2016; 15(1):396. PMC: 4972956. DOI: 10.1186/s12936-016-1439-7. View

10.

Muhindo Mavoko H, Ilombe G, Inocencio da Luz R, Kutekemeni A, Van Geertruyden J, Lutumba P . Malaria policies versus practices, a reality check from Kinshasa, the capital of the Democratic Republic of Congo. BMC Public Health. 2015; 15:352. PMC: 4396810. DOI: 10.1186/s12889-015-1670-0. View

11.

Beer N, Ali A, Rotllant G, Abass A, Omari R, Al-Mafazy A . Adherence to artesunate-amodiaquine combination therapy for uncomplicated malaria in children in Zanzibar, Tanzania. Trop Med Int Health. 2009; 14(7):766-74. DOI: 10.1111/j.1365-3156.2009.02289.x. View

12.

Bruxvoort K, Kalolella A, Nchimbi H, Festo C, Taylor M, Thomson R . Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania. Trop Med Int Health. 2013; 18(10):1269-82. PMC: 4282336. DOI: 10.1111/tmi.12168. View

13.

Kachur S, Khatib R, Kaizer E, Fox S, Abdulla S, Bloland P . Adherence to antimalarial combination therapy with sulfadoxine-pyrimethamine and artesunate in rural Tanzania. Am J Trop Med Hyg. 2005; 71(6):715-22. View

14.

Chandramohan D, Jaffar S, Greenwood B . Use of clinical algorithms for diagnosing malaria. Trop Med Int Health. 2002; 7(1):45-52. DOI: 10.1046/j.1365-3156.2002.00827.x. View

15.

Mokuolu O, Ntadom G, Ajumobi O, Alero R, Wammanda R, Adedoyin O . Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria. Malar J. 2016; 15:4. PMC: 4700573. DOI: 10.1186/s12936-015-1064-x. View

16.

Zurovac D, Njogu J, Akhwale W, Hamer D, Snow R . Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. Trop Med Int Health. 2008; 13(1):99-107. PMC: 2592474. DOI: 10.1111/j.1365-3156.2007.01980.x. View

17.

Namuyinga R, Mwandama D, Moyo D, Gumbo A, Troell P, Kobayashi M . Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J. 2017; 16(1):40. PMC: 5260110. DOI: 10.1186/s12936-017-1693-3. View

18.

Zurovac D, Githinji S, Memusi D, Kigen S, Machini B, Muturi A . Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya. PLoS One. 2014; 9(3):e92782. PMC: 3963939. DOI: 10.1371/journal.pone.0092782. View

19.

Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya K, Whitty C . The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy. Am J Trop Med Hyg. 2008; 77(6 Suppl):128-32. View

20.

Talisuna A, Oburu A, Githinji S, Malinga J, Amboko B, Bejon P . Efficacy of text-message reminders on paediatric malaria treatment adherence and their post-treatment return to health facilities in Kenya: a randomized controlled trial. Malar J. 2017; 16(1):46. PMC: 5267364. DOI: 10.1186/s12936-017-1702-6. View