Adherence to national guidelines in malaria case management among pediatric patients at Kakamega County Referral Hospital.

Abstract

Prompt diagnosis and effective malaria treatment is one of the main pillars of global malaria control programs. As a result, the WHO and various countries have put in place protocols and guidelines to help them achieve this objective. Strict adherence to and implementation of these policies is important to improve treatment outcomes and reduce antimalarial drugs-resistance. Objectives: To evaluate compliance to the Kenya National guidelines on diagnosis and treatment of malaria in children managed for malaria at the Kakamega County Referral hospital. Methodology: We conducted a hospital-based cross-sectional study involving retrospective review of patients’ records; as well as interviews with healthcare workers on barriers to adherence to guidelines on malaria management in children. Scrutiny of hospital medical records identified children aged 4 days to 18 years treated for malaria between June and November 2019. Thorugh systematic sampling 384 files wer selected for study to determine the proportion of the patients treated according to the guidelines. Data was collected using pretested data collection forms and analysed using descriptive and inferential statistics. The level of significance was set at 0.05. Results: Out of the 384 patients suspected of malaria recruited into the study, 73.7% were <5 years, with a median age of 3 (IQR 1-6) years. 364 of the 384 (94.8%) were tested for parasitaemia; 69.2% of them tested positive and 30.5% tested negative for malaria while 1 patient did not have results documented in the file. Overall, 108/121 (89.3%) patients with severe malaria as well as 115/131 patients with uncomplicated malaria as per WHO guidelines were treated with artesunate. Further, 55 patients with a negative blood slide were treated with artesunate. Reasons for non-adherence to the guidelines were reported as lack of resources, and inappropriate healthcare workers’ beliefs and attitudes. Reasons motivating adherence to the guidelines included prevention of antimalarial drug resistance, emphasis on diagnosis and treatment of the right disease and prevention of inappropriate use of antimalarial drugs. Conclusion: Antimalarial prescription in patients who test negative and those who are untested is still practiced in Kenya as in other countries. There is need for better management of febrile illnesses especially in children to avoid the high mortality in this population due to misdiagnosis and Healthcare workers should be reminded about the potential of other febrile conditions.