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Adherence to National Guidelines for the Diagnosis and Treatment of Malaria at the Kisii Teaching and Referral Hospital in Kenya

Author: Bichanga K.P*, Karimi N.P, Guantai E.M
Is Part Of: Pharmaceutical Journal of Kenya, Volume 23, No. 1 (2016)
Background: The Ministry of Health has developed specific national guidelines for diagnosis and treatment of malaria in Kenya. These guidelines assist health workers in making decisions on appropriate management of patients with malaria.
Objectives: The main objective of this study was to determine the proportion of patients with suspected malaria who were treated in accordance with the national guidelines.
Methodology: The study was a hospital-based cross-sectional study involving retrospective review of 430 patient files. Medical records of malaria patients were scrutinized to determine the proportion that was 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.
Results: Majority of the patients [78.1% n=336] were aged <13 years. The mean age of the patients was 11.2 years [± SD 15.0 years]. The median age was 6 years with a range of 0.1 years to 84 years. Only 65% of the suspected cases were tested for malaria by either microscopy or Rapid Diagnostic Test (RDT). All the patients were expected to have been tested for malaria in accordance with the guidelines. Approximately 35% were not subjected to either confirmatory test. Of those tested, 78.4% tested positive and 25.5% tested negative for malaria with 95.8% of those who tested negative being issued antimalarials. Of the 208 patients who tested positive, 109 were classified as uncomplicated malaria but 99.1% of these patients received treatment for severe malaria. The most common co-morbidity 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 Artemether-Lumefantrine (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%].
Conclusion: Malaria management was characterized by poor adherence to diagnosis and treatment guidelines. Antimalarial prescription in patients who test negative and those who are untested is still practiced in Kenya.

Keywords: Clinical guidelines, ACTs, AL
Publisher: The Pharmaceutical Society of Kenya