Performance of the test-and-treat policy for uncomplicated malaria in Kenyan Health Facilities in 2022

Abstract

Objective: To assess the capacity of health facilities in Kenya to implement the test-and-treat policy, adherence to the guidelines in  outpatient departments, and health facility factors associated with adherence to the guidelines.

Design: Retrospective review of health facility data from a routine crosssectional survey.

Setting: Public and faith-based facilities in Kenya, 2022.

Participants: Suspected malaria cases visiting outpatient departments in health facilities.

Intervention: Implementation of the test-and-treat strategy for malaria case management.

Main outcome measures: Adherence to the policy was a composite indicator defined as confirmed malaria cases receiving Artemether- Lumefantrine (AL), or negative-testing patients not receiving antimalarials, or untested patients not receiving antimalarials.

Results:  Malaria diagnostic services were offered in 95% of the facilities, while AL availability was 86%. Hospitals contributed 69% of the 1068  outpatient consultations. Adherence to guidelines was observed in 60.4% of the cases. The odds of adherence were higher in public  health facilities (OR 3.1, 95%CI 1.57- 6.15) and facilities with malaria treatment posters (OR 2.8, 95%CI 2.00-3.78). Factors independently  associated with guideline adherence were public health facilities, availability of information, education, and communication (IEC) materials (OR 1.8, 95%CI 1.30-2.59), stockout of malaria Rapid Diagnostic Tests (mRDTs) (OR 0.3, 95%CI 0.22-0.39), and availability of  pediatric AL packs (AL 6s) (OR 2.3, 95%CI 1.71-3.20).

Conclusion: Most facilities could test and treat malaria cases. However, adherence to guidelines was relatively low and mainly observed in public facilities and those with malaria IEC materials and commodities. The National Malaria Control Program (NMCP) should strengthen commodity security and IEC material dissemination.