Monitoring health systems readiness and inpatient malaria case-management at Kenyan county hospitals

Zurovac, Dejan; Machini, Beatrice; Kiptui, Rebecca; Memusi, Dorothy; Amboko, Beatrice; Kigen, Samuel; Njiri, Patricia; Ejersa, Waqo

doi:10.1186/s12936-018-2364-8

Cited by 19 publications

(36 citation statements)

References 23 publications

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“…For example, in a large survey of severe malaria management in 103 health units in Uganda, referral practices to formal health care centers were reported to be appropriate in less than 10% of cases, while less than 30% of those with severe malaria were diagnosed and treated promptly [ 14 ]. Similar problems may exist elsewhere in malaria-endemic areas [ 12 , 15 , 16 ]. As with other life-threatening infections, delays in the recognition and treatment of severe malaria result in increased mortality and long-term morbidity in survivors [ 10 , 11 , 17 ], whereas over-referral and admission of uncomplicated cases misallocates limited health resources and causes harm [ 10 , 14 ].…”

Section: Introductionmentioning

confidence: 73%

Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness

McDonald

Weckman

Richard-Greenblatt

et al. 2018

Malar J

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Febrile symptoms in children are a leading cause of health-care seeking behaviour worldwide. The majority of febrile illnesses are uncomplicated and self-limited, without the need for referral or hospital admission. However, current diagnostic tools are unable to identify which febrile children have self-limited infection and which children are at risk of progressing to life-threatening infections, such as severe malaria. This paper describes the need for a simple community-based tool that can improve the early recognition and triage of febrile children, with either malarial or non-malarial illness, at risk of critical illness. The integration of a disease severity marker into existing malaria rapid diagnostic tests (RDT) could enable detection of children at risk of severe infection in the hospital and community, irrespective of aetiology. Incorporation of a disease severity marker could inform individualized management and early triage of children at risk of life-threatening infection. A child positive for both malaria and a disease severity marker could be prioritized for urgent referral/admission and parenteral therapy. A child positive for malaria and negative for a disease severity marker could be managed conservatively, as an out-patient, with oral anti-malarial therapy. An RDT with a disease severity marker could facilitate an integrated community-based approach to fever syndromes and improve early recognition, risk stratification, and prompt treatment of severe malaria and other life-threatening infections.

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Section: Introductionmentioning

confidence: 73%

Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness

McDonald

Weckman

Richard-Greenblatt

et al. 2018

Malar J

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“…The absence of parasitological diagnostic capacities from nearly a quarter of hospitals preclude implementation of universal test and treat policy for malaria. During the past decade lack of malaria diagnostics has been reported from the peripheral facilities across Africa [ 16 , 17 ] however this has not been common finding at the hospitals where malaria microscopy has been the traditional mainstay of the laboratory services [ 12 , 18 ]. Furthermore, when malaria microscopy is provided at the study hospitals, the basic microscopy practices such as smear preparations, staining, parasite differentiation and density reporting were largely in discordance with national standards [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study did not investigate the supply chain, however, anecdotal reports suggest that poor quantification, loss of medicines during distributions, and central artesunate stock-outs result in insufficient artesunate supplies, local procurements of less expensive medicines, and subsequently compromised implementation of the most effective and policy free treatment for severe malaria. While not unique to Nigeria [ 12 ], artesunate stock-outs experienced by over a third of the hospitals and artesunate administration posters displayed in less than a third of hospitals to support its use highlight further policy implementation gaps. Moreover, while delivery of the treatment should never be precluded, conditional recommendations on the use of artemether and quinine treatments in absence of artesunate may also create implementation ambiguities which do not facilitate delivery of the optimum treatment [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is, however, limited evidence from Nigerian hospitals about the systems readiness for the new case-management standards and actual care delivered to the patients admitted with suspected malaria [ 5 ]. Such deficiencies are not unique to Nigeria—there is a generally dearth of studies evaluating compliance with inpatient malaria guidelines across Africa [ 6 – 12 ], only a few have examined this topic beyond the paediatric population [ 6 , 10 , 12 ] and hardly any after the artesunate policy has been implemented [ 11 , 12 ]. Despite the differences in scope, scale, context and methodological aspects of these studies, most have however reported deficiencies related to the suboptimal coverage of interventions and common practices in discordance with national guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

Ojo¹,

Maxwell²,

Oresanya³

et al. 2020

Malar J

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Background Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria. Methods A cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective. Results 73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%. Conclusions Translation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed.

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“…National surveys, carried out in sub-Saharan Africa, indicate that 10% or less of malaria cases are appropriately triaged for care. Moreover, when a child presents to an emergency department with SM, less than 30% are diagnosed and treated promptly, resulting in increased mortality and neurocognitive deficits in survivors [16][17][18]. Early recognition and treatment of SM can save lives and prevent brain injury, however, we currently lack rapid and accurate triage tools for SM.…”

Section: Introductionmentioning

confidence: 99%

New insights into microvascular injury to inform enhanced diagnostics and therapeutics for severe malaria

Erice

Kain

2019

Virulence

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Severe malaria (SM) has high mortality and morbidity rates despite treatment with potent antimalarials. Disease onset and outcome is dependent upon both parasite and host factors. Infected erythrocytes bind to host endothelium contributing to microvascular occlusion and dysregulated inflammatory and immune host responses, resulting in endothelial activation and microvascular damage. This review focuses on the mechanisms of host endothelial and microvascular injury. Only a small percentage of malaria infections (≤1%) progress to SM. Early recognition and treatment of SM can improve outcome, but we lack triage tools to identify SM early in the course of infection. Current point-of-care pathogen-based rapid diagnostic tests do not address this critical barrier. Immune and endothelial activation have been implicated in the pathobiology of SM. We hypothesize that measuring circulating mediators of these pathways at first clinical presentation will enable early triage and treatment of SM. Moreover, that host-based interventions that modulate these pathways will stabilize the microvasculature and improve clinical outcome over that of antimalarial therapy alone. ARTICLE HISTORY

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Monitoring health systems readiness and inpatient malaria case-management at Kenyan county hospitals

Cited by 19 publications

References 23 publications

Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness

Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness

Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

New insights into microvascular injury to inform enhanced diagnostics and therapeutics for severe malaria

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