Predictors of health workers’ knowledge about artesunate-based severe malaria treatment recommendations in government and faith-based hospitals in Kenya

Machini, Beatrice; Zurovac, Dejan; Amboko, Beatrice; Malla, Lucas; Snow, Robert W.; Kipruto, Hillary; Achia, Thomas

doi:10.1186/s12936-020-03341-2

Cited by 6 publications

(13 citation statements)

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“…Details of the methodologies have been previously published. 5 Of relevance for this paper, the interviews with health workers were undertaken by trained and experienced study nurses to establish demographic characteristics of the respondents, their exposure to supportive interventions, and knowledge about artesunate treatment using a self-administered multiple-choice questionnaire. The availability of medicines and job aids was assessed in hospital pharmacy and admission wards of interest.…”

Section: Methodsmentioning

confidence: 99%

“…3 4 Health workers' knowledge of evidence-based treatment recommendations is one of the basic requirements for a healthcare system's readiness to implement any new drug policy. 5 In Kenya, concerted efforts have been made to support the WHO policy and monitor its implementation using various health facility surveys that report national levels, trends and predictors of artesunate…”

Section: Introductionmentioning

confidence: 99%

“…3 4 Health workers’ knowledge of evidence-based treatment recommendations is one of the basic requirements for a healthcare system’s readiness to implement any new drug policy. 5 In Kenya, concerted efforts have been made to support the WHO policy and monitor its implementation using various health facility surveys that report national levels, trends and predictors of artesunate knowledge deficiencies among hospital health workers. 5 6 Similar cross-sectional studies have reported inadequate health workers’ knowledge of artesunate-based treatment recommendations.…”

Section: Introductionmentioning

confidence: 99%

“… 5 In Kenya, concerted efforts have been made to support the WHO policy and monitor its implementation using various health facility surveys that report national levels, trends and predictors of artesunate knowledge deficiencies among hospital health workers. 5 6 Similar cross-sectional studies have reported inadequate health workers’ knowledge of artesunate-based treatment recommendations. 7 8 The data from these studies were multilevel and spatially correlated in nature.…”

Section: Introductionmentioning

confidence: 99%

“… 7 8 The data from these studies were multilevel and spatially correlated in nature. Traditionally, such data have been analysed by applying cluster adjustments and correlation matrices based on theoretical assumptions, 5 6 9–11 without considering spatial correlations between clusters. 12–14 Bayesian hierarchical spatial modelling accounts for correlation by introducing effects at different levels of a hierarchy to estimate random effects together with other model parameters accounting for variability within and between sites.…”

Section: Introductionmentioning

confidence: 99%

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Cross-sectional study to predict subnational levels of health workers’ knowledge about severe malaria treatment in Kenya

et al. 2022

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ObjectivesThis study applied a Bayesian hierarchical ecological spatial model beyond predictor analysis to test for the best fitting spatial effects model to predict subnational levels of health workers’ knowledge of severe malaria treatment policy, artesunate dosing, and preparation.SettingCounty referral government and major faith-based hospitals across 47 counties in Kenya in 2019.Design and participantsA secondary analysis of cross-sectional survey data from 345 health workers across 89 hospitals with inpatient departments who were randomly selected and interviewed.Outcome measuresThree ordinal outcome variables for severe malaria treatment policy, artesunate dose and preparation were considered, while 12 individual and contextual predictors were included in the spatial models.ResultsA third of the health workers had high knowledge levels on artesunate treatment policy; almost three-quarters had high knowledge levels on artesunate dosing and preparation. The likelihood of having high knowledge on severe malaria treatment policy was lower among nurses relative to clinicians (adjusted OR (aOR)=0.48, 95% CI 0.25 to 0.87), health workers older than 30 years were 61% less likely to have high knowledge about dosing compared with younger health workers (aOR=0.39, 95% CI 0.22 to 0.67), while health workers exposed to artesunate posters had 2.4-fold higher odds of higher knowledge about dosing compared with non-exposed health workers (aOR=2.38, 95% CI 1.22 to 4.74). The best model fitted with spatially structured random effects and spatial variations of the knowledge level across the 47 counties exhibited neighbourhood influence.ConclusionsKnowledge of severe malaria treatment policies is not adequately and optimally available among health workers across Kenya. The factors associated with the health workers’ level of knowledge were cadre, age and exposure to artesunate posters. The spatial maps provided subnational estimates of knowledge levels for focused interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross-sectional study to predict subnational levels of health workers’ knowledge about severe malaria treatment in Kenya

et al. 2022

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Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

Ojo¹,

Maxwell²,

Oresanya³

et al. 2020

Malar J

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Background Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria. Methods A cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective. Results 73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%. Conclusions Translation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed.

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Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Osoro,

Dellicour,

Ochodo

et al. 2023

Malar J

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Background Emergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to anti-malarials with unknown safety profiles in the first trimester. This qualitative study explored knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women. Methods In-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the World Health Organization health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery). Results Thirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported anti-malarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing anti-malarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine. Conclusion Knowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimizing treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.

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Predictors of health workers’ knowledge about artesunate-based severe malaria treatment recommendations in government and faith-based hospitals in Kenya

Cited by 6 publications

References 16 publications

Cross-sectional study to predict subnational levels of health workers’ knowledge about severe malaria treatment in Kenya

Cross-sectional study to predict subnational levels of health workers’ knowledge about severe malaria treatment in Kenya

Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

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