Adherence to national management guidelines for malaria treatment at the Kisii teaching and referral hospital in Kenya.

Abstract

Background: Clinical practice guidelines in healthcare are evidence-based recommendations, strategies or information that assists healthcare workers and patients in making decisions on appropriate healthcare for specific conditions. Practice guidelines for the management of malaria have been developed at international and national levels. Adherence to clinical guidelines improves the quality of care received by the patients and thus improves patient outcomes. Objective: The main objective of this study was to investigate healthcare workers’ adherence to malaria treatment guidelines. Methodology: The study was a two-part hospital-based cross-sectional study involving retrospective review of 430 patient files and 20 health care worker interviews. Medical records of malaria patients were selected by stratified random sampling and scrutinized to determine the proportion of the patients who were treated according to the guidelines. Data was collected using pre-tested data collection forms. The data was analyzed using descriptive and inferential statistics. The level of significance was set at <0.05. For the qualitative aspect of the study, healthcare workers were interviewed to identify barriers to adherence to guidelines. Results: Majority of the patients [78.1%] were aged <13 years. The mean age of the sample was 11.2 years [± SD 15.0 years]. The median age was 6 years with a range of 0.1 years to 84 years Out of the 430 cases of suspected malaria, only 65% were tested for parasitemia by either microscopy or RDT. Approximately 35% were not subjected to either confirmatory test. Of those tested, 78.4% tested positive and 25.5% tested negative for malaria. The most common comorbidity in the patients treated for malaria was anaemia [29.9%] followed by gastroenteritis (9.9%). Patients with co-morbidities were more likely to receive appropriate treatment [p=0.033] compared with those with none. The most commonly used combination of drugs was quinine and AL [44.7%] followed by artesunate and AL (43.3%). The outcomes in these patients were discharge [95.6%], re-admission [2.6%], death [1.4%] and transfer [0.5%]. The healthcare workers interviewed were clinicians [35%], pharmacy staff [30%], nurses [25%] and laboratory technicians [10%]. All the healthcare workers interviewed were aware of the existence of the malaria treatment guidelines. Many were however not aware of the contents of the guidelines. Only 40% had been trained on the guidelines. Those who indicated agreement with the guidelines were 40% with 15% disagreeing with the guidelines and 45% holding no opinion