Lack of patient risk counselling and a broader provider training affect malaria control in remote Somalia Kenya border: Qualitative assessment

Abstract

Effectiveness of providing health education solely via mass media and the providers' targeted training in malaria control needs further exploration. During pre-epidemic season, we conducted a qualitative study of 40 providers and community leaders using focus groups, comprehensive semi-structured interviews and consultation observations. Interviews were transcribed, coded and analysed for major themes. Community leaders believe that they can acquire malaria from contaminated water, animal products, air or garbage. Consequently, they under-utilise bed nets and other protective measures due to perceived continued exposure to other potential malaria sources. Practitioners do not provide individualised health counselling and risk assessment to patients during sick visits, leading to a range of misconceptions about malaria based on limited knowledge from rumours and mass media, and a strong belief in the curative power of traditional medicine. Providers overdiagnose malaria clinically and underutilise available tests due to time constraints, and the lack of training and resources to correctly diagnose other illnesses. Subsequently, misdiagnoses lead them to question the efficacy of recommended treatments. Promoting counselling during clinical encounters to address patient misconception and change risky behaviour is warranted. Wider-ranging ongoing training could enable providers to properly diagnose and manage differential diagnoses to manage malaria better.

Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment

“…This lack of trust in test result has been reported in other studies for microscopy as well as for RDTs [21,23,24] and have often resulted in continued prescription of antimalarials [8,24,25]. Other interpretations of negative test results were also found in this study, for instance there were views that in the event of a negative result, the illness could then be due to the activities of witchcraft or poison, or could be due to supernatural forces.…”

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

“…These interviews were used to help probe questions and areas of focus, and to ensure the cultural adaptability, reliability, and validity of the study design and questions. The interview tools were informed based on a previous study in the Mandera region of Kenya [ 31 ] and subsequent pilot evaluations performed during ongoing implementation of the MENTOR services/programme over several months prior to the study implementation. This pilot evaluation included informal discussions with local key informants and was used to highlight key issues to be covered in study interviews.…”