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