Knowledge and Adherence to the National Guidelines for Malaria Case Management in Pregnancy among Healthcare Providers and Drug Outlet Dispensers in Rural, Western Kenya

Abstract

BackgroundAlthough prompt, effective treatment is a cornerstone of malaria control, information on provider adherence to malaria in pregnancy (MIP) treatment guidelines is limited. Incorrect or sub-optimal treatment can adversely affect the mother and fetus. This study assessed provider knowledge of and adherence to national case management guidelines for uncomplicated MIP.MethodsWe conducted a cross-sectional study from September to November 2013, in 51 health facilities (HF) and a randomly-selected sample of 39 drug outlets (DO) in the KEMRI/CDC Health and Demographic Surveillance System area in western Kenya. Provider knowledge of national treatment guidelines was assessed with standardized questionnaires. Correct practice required adequate diagnosis, pregnancy assessment, and treatment with correct drug and dosage. In HF, we conducted exit interviews in all women of childbearing age assessed for fever. In DO, simulated clients posing as first trimester pregnant women or as relatives of third trimester pregnant women collected standardized information.ResultsCorrect MIP case management knowledge and practice were observed in 45% and 31% of HF and 0% and 3% of DO encounters, respectively. The correct drug and dosage for pregnancy trimester was prescribed in 62% of HF and 42% of DO encounters; correct prescription occurred less often in first than in second/ third trimesters (HF: 24% vs. 65%, p<0.01; DO: 0% vs. 40%, p<0.01). Sulfadoxine-pyrimethamine, which is not recommended for malaria treatment, was prescribed in 3% of HF and 18% of DO encounters. Exposure to artemether-lumefantrine in first trimester, which is contraindicated, occurred in 29% and 49% of HF and DO encounters, respectively.ConclusionThis study highlights knowledge inadequacies and incorrect prescribing practices in the treatment of MIP. Particularly concerning is the prescription of contraindicated medications in the first trimester. These issues should be addressed through comprehensive trainings and increased supportive supervision. Additional innovative means to improve care should be explored.

A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016

“…Out of the 1107 papers in the original search and two added due to quoting the 2006 review, 148 papers met the criteria . Extraction of relevant papers from those found by the search strategy was done jointly by two researchers (IB and PN) and independently by a third researcher (AA).…”

Knowledge and Adherence to the National Guidelines for Malaria Diagnosis in Pregnancy among Health-Care Providers and Drug-Outlet Dispensers in Rural Western Kenya

“…Of the 151 patients (94%) who tested positive for malaria, 98% received an antimalarial; no reason was provided for not prescribing an antimalarial to the remaining malaria-positive patients, although all facilities had antimalarials available on the day of the survey. 17 The three (100%) patients who tested negative for malaria were incorrectly prescribed an antimalarial. There was no difference in antibiotic prescribing for patients who were tested for malaria compared with those who were clinically diagnosed.…”

“…Detailed methods have been published elsewhere. 17 Health facility selection. All public and private health facilities, including hospitals, health centers, or dispensaries, in the KEMRI-CDC HDSS study area and within a 5-km radius surrounding the HDSS were assessed for eligibility.…”

Case management of malaria in Swaziland, 2011–2015: on track for elimination?

“…29 Studies in Uganda and Kenya reported contraindicated malaria regimens prescribed for first-trimester women. 30,31 Swaziland recently added 0.25 mg/kg body weight primaquine with ACT for non-pregnant women and adults to the treatment guidelines to reduce the transmission of malaria parasites to the mosquito vector. As this addition was made only recently, in 2014, adherence to primaquine was not assessed.…”