Factors that influence the implementation of new diagnostic and treatment policies of Malaria: a case of Police line dispensary, Garissa District
Kamau, Pauline W
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Effective case management is a key element of malaria control. Healthworkers' performance of assessment, diagnosis, treatment and counseling tasks inaccordance with evidence-based standards is critical to ensure adequate quality of malariacase management. In children below 5 years, the quality of outpatient case management inaccordance with national guidelines and factors influencing treatment practices was measured. In older children and adults, the quality of clinical assessment, the accuracy of diagnosis and the ability of clinical signs and symptoms to predict malaria was evaluated. The effect of routine microscopy on malaria case management was assessed across allage groups. Data was collected at a level 2 rural facility using a full range of quality of care assessment tools including health facility form, health worker interview form, patients exit interview form. The study findings included the results from the assessment of the key indicators both at the facility level on availability of the essential malaria case management commodities and health worker level on adherence to the guidelines and the treatment policies for malaria case management. The facility was observed to have sufficient quantities of ACTS. No stocks of RDT s were available for malaria diagnosis. The facility has a functional laboratory therefore malaria microscopy is done on a daily basis. Out of the 371 febrile patients presenting at the health facility, 17% were below 5 years and 83 % were above 5 years. These patients were tested for malaria and 60% of the children below 5 years were test positive and were treated with the recommended ACTs. None of these patients were treated with other antimalarial drugs. Out of all the febrile patients, 46% of children above 5 years and adults were test positive and subsequently treated with the recommended ACTs. Majority of the febrile patients that had testnegative were not treated for malaria. All the patients that were prescribed for ACTs had the drug dispensed at the facility and advised on how to take the drugs at home. As we embark upon a new era of more expensive and more complex to use antimalarial treatments, assessment of the current case management practice is crucial and improvement in clinical practice advocated. This study has successfully highlighted that the facility is adhering to the treatment policies for malaria, the gaps, challenges experienced suggesting some solutions which might improve health workers performance if implemented effectively at scale.