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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.

Diggle E, Asgary R, Gore-Langton G, Nahashon E, Mungai J, Harrison R, Abagira A, Eves K, Grigoryan Z, Soti D, Juma E, Allan R - Malar. J. (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: The MENTOR Initiative, Crawley, UK. richard@mentor-initiative.net.

ABSTRACT

Background: Conventional 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).

Methods: The 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.

Results: Thirty-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.

Conclusion: Gaps 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.

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The total numbers of malaria cases and numbers of artemether lumefantrine treatments distributed. Total number of AL treatments dispensed, confirmed malaria cases (microscopy and RDT), microscopy confirmed cases, and RDT confirmed cases across the study area between 2010 and 2013 and broken down in to yearly quarters (except 2010 data which was only collected over the period between September and December).
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Fig1: The total numbers of malaria cases and numbers of artemether lumefantrine treatments distributed. Total number of AL treatments dispensed, confirmed malaria cases (microscopy and RDT), microscopy confirmed cases, and RDT confirmed cases across the study area between 2010 and 2013 and broken down in to yearly quarters (except 2010 data which was only collected over the period between September and December).

Mentions: In 2010 the Department of Malaria Control, Ministry of Public Health, Kenya, and the MENTOR Initiative launched the official introduction of RDTs in 42 HFs in Greater Garissa and the districts it contained at the time: Garissa, Lagdera, Fafi, and Balambala. This programme complemented the Ministry of Health programmes supplying ACT to HFs and was intended to both reduce irrational AL consumption and improve prescription practises. The total numbers of confirmed malaria cases and artemether-lumefantrine (AL) treatments distributed between 2010 and 2013 are shown in FigureĀ 1 (Garro C: Evaluation Report; Building Sustainable and Effective Malaria Control for Vulnerable Communitis in Kenya, unpublished); total malaria cases are separated into those diagnosed by RDTs and those diagnosed by microscopy. As the number of RDTs increased in HFs in 2011, there was a marked and rapid decrease in the total number of confirmed cases, the number of microscopy confirmed cases, and the number of AL treatments dispensed. By 2013, the increasing uptake and usage of RDTs in HFs was evident from the number of RDT-diagnosed cases, which was higher than the number of microscopy-diagnosed cases. Reflecting the reductions in total confirmed cases, the total number of AL doses dispensed in 2013 was at a four-year low of 4,519 treatments, down from the peak of 56,511 treatments dispensed in 2011.Figure 1


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.

Diggle E, Asgary R, Gore-Langton G, Nahashon E, Mungai J, Harrison R, Abagira A, Eves K, Grigoryan Z, Soti D, Juma E, Allan R - Malar. J. (2014)

The total numbers of malaria cases and numbers of artemether lumefantrine treatments distributed. Total number of AL treatments dispensed, confirmed malaria cases (microscopy and RDT), microscopy confirmed cases, and RDT confirmed cases across the study area between 2010 and 2013 and broken down in to yearly quarters (except 2010 data which was only collected over the period between September and December).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4300559&req=5

Fig1: The total numbers of malaria cases and numbers of artemether lumefantrine treatments distributed. Total number of AL treatments dispensed, confirmed malaria cases (microscopy and RDT), microscopy confirmed cases, and RDT confirmed cases across the study area between 2010 and 2013 and broken down in to yearly quarters (except 2010 data which was only collected over the period between September and December).
Mentions: In 2010 the Department of Malaria Control, Ministry of Public Health, Kenya, and the MENTOR Initiative launched the official introduction of RDTs in 42 HFs in Greater Garissa and the districts it contained at the time: Garissa, Lagdera, Fafi, and Balambala. This programme complemented the Ministry of Health programmes supplying ACT to HFs and was intended to both reduce irrational AL consumption and improve prescription practises. The total numbers of confirmed malaria cases and artemether-lumefantrine (AL) treatments distributed between 2010 and 2013 are shown in FigureĀ 1 (Garro C: Evaluation Report; Building Sustainable and Effective Malaria Control for Vulnerable Communitis in Kenya, unpublished); total malaria cases are separated into those diagnosed by RDTs and those diagnosed by microscopy. As the number of RDTs increased in HFs in 2011, there was a marked and rapid decrease in the total number of confirmed cases, the number of microscopy confirmed cases, and the number of AL treatments dispensed. By 2013, the increasing uptake and usage of RDTs in HFs was evident from the number of RDT-diagnosed cases, which was higher than the number of microscopy-diagnosed cases. Reflecting the reductions in total confirmed cases, the total number of AL doses dispensed in 2013 was at a four-year low of 4,519 treatments, down from the peak of 56,511 treatments dispensed in 2011.Figure 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: The MENTOR Initiative, Crawley, UK. richard@mentor-initiative.net.

ABSTRACT

Background: Conventional 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).

Methods: The 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.

Results: Thirty-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.

Conclusion: Gaps 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.

Show MeSH
Related in: MedlinePlus