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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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Map of the study area. A map of the study area of Greater Garissa, North Eastern Province, Kenya [30].
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Fig2: Map of the study area. A map of the study area of Greater Garissa, North Eastern Province, Kenya [30].

Mentions: The study was conducted in the four original districts of Garissa County: Garissa, Balambala, Lagdera, and Fafi, to which Dadaab was subsequently added (Figure 2). The area suffers regular rebel attacks and is generally very insecure [22, 23]. The study area is prone to malaria epidemics [24]. Immunity is low due to infrequent exposure to infection during the early years of childhood and the occurrence of seasonal, severe flooding resulting in sudden increases in mosquito populations. In areas such as these with typically seasonal epidemics the community is often highly aware of the threat of malaria and in many cases both communities and health workers have come to associate all fevers with malaria despite the fact that outside of the rainy season malaria is a very minor cause of febrile illness [25]. Many other diseases (bacterial, viral, parasitic) which present with fever commonly occur in the same area [26–29].Figure 2


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)

Map of the study area. A map of the study area of Greater Garissa, North Eastern Province, Kenya [30].
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Map of the study area. A map of the study area of Greater Garissa, North Eastern Province, Kenya [30].
Mentions: The study was conducted in the four original districts of Garissa County: Garissa, Balambala, Lagdera, and Fafi, to which Dadaab was subsequently added (Figure 2). The area suffers regular rebel attacks and is generally very insecure [22, 23]. The study area is prone to malaria epidemics [24]. Immunity is low due to infrequent exposure to infection during the early years of childhood and the occurrence of seasonal, severe flooding resulting in sudden increases in mosquito populations. In areas such as these with typically seasonal epidemics the community is often highly aware of the threat of malaria and in many cases both communities and health workers have come to associate all fevers with malaria despite the fact that outside of the rainy season malaria is a very minor cause of febrile illness [25]. Many other diseases (bacterial, viral, parasitic) which present with fever commonly occur in the same area [26–29].Figure 2

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