Predictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya.

Hdl Handle:
http://hdl.handle.net/10144/18915
Title:
Predictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya.
Authors:
Zurovac, D; Rowe, A K; Ochola, S A; Noor, A M; Midia, B; English, M; Snow, R W
Journal:
International Journal of Epidemiology
Abstract:
BACKGROUND: When replacing failing drugs for malaria with more effective drugs, an important step towards reducing the malaria burden is that health workers (HW) prescribe drugs according to evidence-based guidelines. Past studies have shown that HW commonly do not follow guidelines, yet few studies have explored with appropriate methods why such practices occur. METHODS: We analysed data from a survey of government health facilities in four Kenyan districts in which HW consultations were observed, caretakers and HW were interviewed, and health facility assessments were performed. The analysis was limited to children 2-59 months old with uncomplicated malaria. Treatment was defined as recommended (antimalarial recommended by national guidelines), a minor error (effective, but non-recommended antimalarial), or inappropriate (no effective antimalarial). RESULTS: We evaluated 1006 consultations performed by 135 HW at 81 facilities: 567 children received recommended treatment, 314 had minor errors, and 125 received inappropriate treatment (weighted percentages: 56.9%, 30.4%, and 12.7%). Multivariate logistic regression analysis revealed that programmatic interventions such as in-service malaria training, provision of guidelines and wall charts, and more frequent supervision were significantly associated with better treatment quality. However, neither in-service training nor possession of the guideline document showed an effect by itself. More qualified HW made more errors: both major and minor errors (but generally more minor errors) when second-line drugs were in stock, and more major errors when second-line drugs were not in stock. Child factors such as age and a main complaint of fever were also associated with treatment quality. CONCLUSIONS: Our results support the use of several programmatic strategies that can redress HW deficiencies in malaria treatment. Targeted cost-effectiveness trials would help refine these strategies and provide more precise guidance on affordable and effective ways to strengthen and maintain HW practices.
Affiliation:
Médecins Sans Frontières-France, P.O. Box 39719, Nairobi, Kenya. dzurovac@wtnairobi.mimcom.net
Publisher:
Published by Oxford University Press
Issue Date:
Oct-2004
URI:
http://hdl.handle.net/10144/18915
DOI:
10.1093/ije/dyh253
PubMed ID:
15256523
Additional Links:
http://ije.oxfordjournals.org/cgi/content/full/33/5/1080?ijkey=9CXOKUv2PvhOQ&keytype=ref&siteid=intjepid
Language:
en
Description:
To access this article, click on "Additional Links"
ISSN:
0300-5771
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorZurovac, D-
dc.contributor.authorRowe, A K-
dc.contributor.authorOchola, S A-
dc.contributor.authorNoor, A M-
dc.contributor.authorMidia, B-
dc.contributor.authorEnglish, M-
dc.contributor.authorSnow, R W-
dc.date.accessioned2008-02-21T15:57:09Z-
dc.date.available2008-02-21T15:57:09Z-
dc.date.issued2004-10-
dc.identifier.citationPredictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya. 2004, 33 (5):1080-91notInt J Epidemiolen
dc.identifier.issn0300-5771-
dc.identifier.pmid15256523-
dc.identifier.doi10.1093/ije/dyh253-
dc.identifier.urihttp://hdl.handle.net/10144/18915-
dc.descriptionTo access this article, click on "Additional Links"-
dc.description.abstractBACKGROUND: When replacing failing drugs for malaria with more effective drugs, an important step towards reducing the malaria burden is that health workers (HW) prescribe drugs according to evidence-based guidelines. Past studies have shown that HW commonly do not follow guidelines, yet few studies have explored with appropriate methods why such practices occur. METHODS: We analysed data from a survey of government health facilities in four Kenyan districts in which HW consultations were observed, caretakers and HW were interviewed, and health facility assessments were performed. The analysis was limited to children 2-59 months old with uncomplicated malaria. Treatment was defined as recommended (antimalarial recommended by national guidelines), a minor error (effective, but non-recommended antimalarial), or inappropriate (no effective antimalarial). RESULTS: We evaluated 1006 consultations performed by 135 HW at 81 facilities: 567 children received recommended treatment, 314 had minor errors, and 125 received inappropriate treatment (weighted percentages: 56.9%, 30.4%, and 12.7%). Multivariate logistic regression analysis revealed that programmatic interventions such as in-service malaria training, provision of guidelines and wall charts, and more frequent supervision were significantly associated with better treatment quality. However, neither in-service training nor possession of the guideline document showed an effect by itself. More qualified HW made more errors: both major and minor errors (but generally more minor errors) when second-line drugs were in stock, and more major errors when second-line drugs were not in stock. Child factors such as age and a main complaint of fever were also associated with treatment quality. CONCLUSIONS: Our results support the use of several programmatic strategies that can redress HW deficiencies in malaria treatment. Targeted cost-effectiveness trials would help refine these strategies and provide more precise guidance on affordable and effective ways to strengthen and maintain HW practices.en
dc.language.isoenen
dc.publisherPublished by Oxford University Press-
dc.relation.urlhttp://ije.oxfordjournals.org/cgi/content/full/33/5/1080?ijkey=9CXOKUv2PvhOQ&keytype=ref&siteid=intjepid-
dc.rightsArchived on this site with kind permission from Oxford University Press and the International Epidemiological Associationen
dc.subject.meshAntimalarialsen
dc.subject.meshChild, Preschoolen
dc.subject.meshClinical Competenceen
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshDeveloping Countriesen
dc.subject.meshFemaleen
dc.subject.meshGuideline Adherenceen
dc.subject.meshHealth Care Surveysen
dc.subject.meshHealth Personnelen
dc.subject.meshHealth Services Researchen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshKenyaen
dc.subject.meshMalariaen
dc.subject.meshMaleen
dc.subject.meshMedication Errorsen
dc.subject.meshPractice Guidelines as Topicen
dc.subject.meshQuality of Health Careen
dc.subject.meshState Medicineen
dc.titlePredictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya.en
dc.contributor.departmentMédecins Sans Frontières-France, P.O. Box 39719, Nairobi, Kenya. dzurovac@wtnairobi.mimcom.neten
dc.identifier.journalInternational Journal of Epidemiologyen

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