Perceptions of malaria and acceptance of rapid diagnostic tests and related treatment practises among community members and health care providers in Greater Garissa, North Eastern Province, Kenya

Abstract

BackgroundConventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. These methods, if not carried out exactly, easily result in the over- or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes. Using the setting of a pilot introduction of malaria RDTs in Greater Garissa, North Eastern Province, Kenya, this study aims to identify and understand perceptions regarding malaria diagnosis, with a particular focus on RDTs, and treatment among community members and health care workers (HCWs).MethodsThe study was conducted in five districts of Garissa County. Focus group discussions (FGD) were performed with community members that were recruited from health facilities (HFs) supported by the MENTOR Initiative. In-depth interviews (IDIs) and FGDs with HCWs were also carried out. Interview transcripts were then coded and analysed for major themes. Two researchers reviewed all codes, first separately and then together, discussed the specific categories, and finally characterized, described, and agreed upon major important themes.ResultsThirty-four FGDs were carried out with a range of two to eight participants (median of four). Of 157 community members, 103 (65.6%) were women. The majority of participants were illiterate and the highest level of education was secondary school. Some 76% of participants were of Somali ethnicity. Whilst community members and HCWs demonstrated knowledge of aspects of malaria transmission, prevention, diagnosis, and treatment, gaps and misconceptions were identified. Poor adherence to negative RDT results, unfamiliarity and distrust of RDTs, and an inconsistent RDT supply were the main challenges to become apparent in FGDs and IDIs.ConclusionGaps in knowledge or incorrect beliefs exist in Greater Garissa and have the potential to act as barriers to complete and correct malaria case management. Addressing these knowledge gaps requires comprehensive education campaigns and a reliable and constant RDT supply. The results of this study highlight education and supply chain as key factors to be addressed in order to make large scale roll out of RDTs as successful and effective as possible.

Community Health Workers’ knowledge, attitudes and practices about malaria prevention in Gicumbi District, Rwanda

“…A high care taker acceptability was observed, and this may be attributed to the fact that the community members are the ones who choose a person to be trained as a CHW. Another study conducted in Kenya found that CHWs had good knowledge related to malaria transmission, prevention,and management including diagnosis and treatment (Diggle et al, 2014)if not carried out exactly, easily result in the over-or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes.…”

Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa

“…Whilst it is therefore not possible to draw direct conclusions from these data about the causes of ACT non-prescription, a number of possible explanatory factors were suggested by Burchett et al [19], including motivation to perform well in a study context, stability of ACT supplies, and local preferences for different types of antimalarials. More broadly, other previous work has identified some factors that are associated with non-adherence to test results and/ or treatment guidelines, including distrust in the test or test result [36][37][38][39], patient demands or preferences for a particular medication [19,[40][41][42][43], perceptions of low drug efficacy [41], staff workload [44], financial incentives [42], level of health care worker [41,45,46], affordability and accessibility of non-recommended therapies [47,48], and rationing of medications [19,49]. Stock-outs of weightspecific drug packs can also lead to inappropriate prescription of medications [45,50], whilst lack of knowledge on how to prescribe second-line drugs can lead to not prescribing them at all [51].…”

Improving the effectiveness of point of care tests for malaria and anaemia: A qualitative study across three Ghanaian antenatal clinics

“…However, clinical and laboratory staff did feel that POCT may allow the women to become more involved in their healthcare and therefore more likely to comply with healthcare recommendations. Studies reveal complex relationships between active patient participation, patient adherence, intervention implementation and expected health outcomes in malaria and anaemia management (9,20,21). Patient-centred approaches can have an impact on a healthcare practitioners' approach to care and this could be considered in the development of any training package for the implementation of POCT.…”