Malaria diagnosis in rural healthcare facilities and treatment-seeking behavior in malaria endemic settings in western Kenya

Abstract

Accurate diagnosis and timely treatment are central requirements for effective malaria management in communities. However, in resource-constrained settings, healthcare facilities are likely to be few, inaccessible, and ill-equipped with frequent drug or rapid diagnostic test kit (RDT) shortages. This may jeopardize much-needed quality care for patients and may have an impact on treatment-seeking behavior among the local population. The study’s goal is to determine treatment-seeking behavior, malaria diagnosis and treatment, and likely treatment-seeking determinants in the local population. Passive case detection, which targeted all patients with suspected malaria cases, was conducted in ten public healthcare facilities over a three-month period. Monthly malaria cases, methods of diagnosis and antimalarial drug availability were assessed. A household-based survey was also carried out. Structured questionnaires were used to collect data from household heads. Malaria knowledge, treatment seeking behavior, and predictors of malaria treatment-seeking were all determined. Three of the seven dispensaries lacked a laboratory to conduct microscopy-based diagnosis. These three dispensaries also experienced frequent RDT stock-outs, which resulted in a clinical diagnosis of malaria. The majority of local residents with fever (50.3%) purchased antimalarial drugs from a chemist. About 37% of fever patients sought treatment at healthcare facility while the remaining 12.7% did nothing. In irrigated areas, 45.5% (46/64) of fever patients sought treatment at healthcare facilities, compared to 25% (18/64) in non-irrigated areas (p = 0.009). Most children aged below 5 who had fever (77.7%) were taken to healthcare facility for treatment compared to 31.4% of older children or 20.9% of adults (0.0001). Predictors of treatment seeking included access to healthcare facility (OR = 16.23, 95% CI: 2.74-96.12), and ability to pay hospital bill (OR = 10.6, 95% CI: 1.97- 57). Other factors that influenced health-seeking behavior included the severity of symptoms, the age of the fever patient and knowledge of malaria symptoms.

Factors Influencing the Acceptability of the Test, Treat and Refer Practice for Malaria among Caregivers of Under 5 Children at Community Pharmacies and Drug Shops in Nigeria

“…Studies conducted in Nigeria have shown that compared with public health facilities, PPMVs are the preferred source of malaria treatment for many people due to their proximity and longer operating hours and that they play a critical role in the provision of ACTs for malaria treatment (31,32). A study conducted in Tanzania revealed that PPMVs were the most common health facility providers visited for fever-related illnesses, including malaria, in rural areas (33,34). Similarly, a study in Kenya showed that PPMVs were the most commonly used healthcare providers for malaria treatment, especially in rural areas with limited access to healthcare facilities (35).…”