Barriers to optimum management of malaria among children under five years of age in Garissa provincial hospital
Abstract
Background:
Malaria continues to be a major killer accounting for 16% of under five deaths
in Sub Saharan Africa. In Kenya 34,000 children die annually from malaria.
Kenya’s National Malaria guidelines have been adapted from WHO and rolled
out as National Paediatric Protocols (clinical practice guidelines). The
dissemination of these is ongoing through the ETAT+ course. The
implementation of set guidelines into care has been shown to reduce malaria
case fatality by 34%. The study set out to establish the proportion of children
aged 2-59months managed as per the guidelines as well the barriers to guideline
utilization.
Methods:
A retrospective cross sectional study at Garissa Provincial General Hospital.
The methods employed were an audit of 95 clinical records of children aged 2-
59 months and a self administered to health workers questionanaire.
Results:
Only 25.3% of patients were managed as per the guidelines. Prevalence of
severe malaria among children without (35.5%) co morbidities is two fold
higher than those with (15.8%) co morbidity (Fisher’s exact, P=0.035). An
appropriate anti malarial for malaria severity was administered at the correct
dose in 28.4% (P=0.001) patients while the remaining patients with a correct
dose received an inappropriate anti malarial for the severity of illness.
Barriers to guideline utilization were poor documentation of clinical records,
health care workers (HCW) were not motivated to use the guidelines despite
their availability.
Conclusion: 25.3% of patients were managed as per the guidelines. Diseases
severity was associated with better adherence. Health care workers knowledge
was high but in practice adherence was low. The knowledge to practice gap
needs to be addressed to fully achieve the benefits of these guidelines.
Motivation and Supervision of staff is a key pillar in utilization of guidelines
Citation
A research proposal in partial fulfillment of the degree of Masters of Medicine (Paediatrics and Child Health), University of NairobiPublisher
University of Nairobi School of Medicine