Health workers knowledge of the uncomplicated malaria treatment policy in public health facilities in Kenya: a cross-sectional study.

Abstract

Background: Following the paradigm change of the malaria treatment policy from treating all fevers as malaria to parasitological testing of all suspected cases before treating only positives cases, several countries have done in-service trainings, supervision and support of health workers to improve their performance. Despite the trainings and distribution of guidelines and jobs aids, there are still cases of presumptive treatment and low testing rates of suspected malaria cases. Objectives: The study assessed health workers knowledge of the uncomplicated malaria treatment policy in Kenyan public health facilities. Methods: The primary study outcome was the proportion of health workers who were knowledgeable about the malaria treatment policy and predictors of their knowledge. Descriptive statistics including frequencies and tabulations were used to describe the trend and level of health workers’ knowledge. Bivariate and multiple multi-level logistic regression models were used to determine the factors affecting the level of health worker knowledge. Results: A total of 2,206 health workers were included in the analysis (range across surveys 203-237). Majority were female 1,189/2,206 (53.9%) with a mean age of 35.3 years (SD 9.54). The knowledge about universal testing of all suspected malaria cases and the first line treatment drug AL was high across all surveys (range across all surveys74.3-100%). The knowledge of test and treat only positive cases with ACT was sub-optimal with a range of 7.2-43.8% across the surveys. From the multiple logistic regression the following factors were independently associated with health worker knowledge: malaria ABSTRACT xi risk (OR; 2.87 95% Confidence Interval CI; 1.42-6.20) and age of health workers (OR; 2.21, 95% CI; 1.14-4.37). No hospital-level factors were significantly related to correct malaria treatment policy knowledge among the health workers Conclusion: Following changes in malaria treatment policy, there has been improvements in the level of health workers’ knowledge of the current Kenyan malaria treatment policy. The knowledge of the second-line drug for treating malaria is still sub-optimal. The younger health workers and those from high malaria risk areas were more knowledgeable. Investment in focused training and regular supervision may be needed, particularly for first-level health workers working in public health facilities who care for the greatest proportion of malaria patients.