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    Jan 17, 2021
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    Predictors of the Quality of Health Worker Treatment Practices for Uncomplicated Malaria at Government Health Facilities in Kenya.

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    Authors
    Zurovac, D
    Rowe, A K
    Ochola, S A
    Noor, A M
    Midia, B
    English, M
    Snow, R W
    Affiliation
    Médecins Sans Frontières-France, P.O. Box 39719, Nairobi, Kenya. dzurovac@wtnairobi.mimcom.net
    Issue Date
    2004-10
    
    Metadata
    Show full item record
    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.
    Publisher
    Published by Oxford University Press
    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
    ae974a485f413a2113503eed53cd6c53
    10.1093/ije/dyh253
    Scopus Count
    Collections
    Malaria

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