Monitoring Health Workers’ adherence to malaria case management guidelines for patients with severe malaria at Public Health Facilities in Kenya, 2023

Abstract

Objectives: Among the suspected severe malaria patients admitted in the public health facilities in Kenya, to identify those that are  correctly diagnosed, assess the health workers’ adherence to malaria case management guidelines, health facility and health worker  readiness to implement the policy.

Design: Cross-sectional, cluster sample survey.

Setting: All 47 counties in Kenya, 2023

Subject: 49  Government and 42 faith-based hospitals were assessed, 318 inpatient health workers from paediatric and medical wards were  interviewed and 2073 files for patients admitted with suspected malaria were examined.

Main outcomes: testing suspected malaria  patient, recommended treatment based on severity criteria and test results.

Results: Among all patients 42.6% had documented at least  one feature of malaria severity and 36.8% were diagnosed as severe. Adherence to severe malaria treatment guidelines was 54.6%, 96.7%  of all hospitals provided malaria microscopy, 82.4% stocked artesunate and 41.8% had at least one ward with displayed artesunate poster,  36.5% of health workers were trained on artesunate, 45.3% accessed malaria case-management guidelines and 28.3% had been supervised.

Conclusion: Despite high level health worker adherence to test and treat policy for severe malaria, there was a significant  irrational use of artesunate for non-severe patients with microscopy confirmed positive test. There is a need to focus on programmatic  interventions directed to rationalize the use of artesunate. Health workers' supervision, case-management training, dissemination of  guidelines and job aids should be programmatic priority.