Predictors of presumptive treatment of uncomplicated malaria among children in private retail outlets in Kenya: mixed effects logistic regression modelling

Abstract

Background: The health seeking behavior in Kenya raises concerns in malaria case management at the private sector. Adherence to the national guidelines for the diagnosis, treatment and prevention of malaria is key in management of the disease. Presumptive treatment remains a major challenge in Kenya, especially in the private sector, with major gaps in literature identified on predictors of this treatment. Mixed-effects regression modelling considers county clustering, is more accurate in prediction and is more efficient and flexible. Methods: The study design was a cross-sectional, nationally representative, retail outlet survey secondary data analysis. The study populations included the health care providers in the retail outlets sampled randomly in both the rural and urban settings in Kenya. The primary outcome of interest was the proportion of health care providers who treated patients presumptively. Multivariable analysis was conducted for the significant variables, adjusting for clustering at the county level to determine the predictors of presumptive treatment. The best fitting model was examined using the Akaike Information Criterion (AIC). Results: Out of the 333 health care providers who treated patients, 190 (57%) treated patients presumptively. From the mixed effects logistic regression model, the predictors of presumptive treatment of uncomplicated malaria were case management training (AOR = 0.44; 95% CI = (0.18 – 1.09)), asked signs or symptoms (AOR = 0.19; 95% CI = (0.10 - 0.37)) and results presented (AOR = 0.08 95% CI = (0.03 - 0.19)). Conclusions: Presumptive treatment of uncomplicated malaria remains a challenge in the private retail sector. Malaria case management training and health care providers asking of signs and symptoms and results presented predicts presumptive treatment. To address the issue of presumptive treatment of Malaria, strengthening of malaria case management training is key for health care providers in the private sector.

Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya

“…During this study, it was noted that none of the outlet staff had a copy of the guidelines. This differed significantly from a national survey conducted in September 2018 that found approximately a fifth of outlet staff had access to copies of the guidelines [ 17 ] and an earlier similar national survey in which only 15% had access to the guidelines [ 26 ]. The 5th edition (released in 2016) was in use by then.…”

“…Most mystery clients were offered treatment without confirmation of a positive test for malaria from a laboratory or even asking that the child be taken for parasitological diagnosis. Many patients presenting to private drug outlets receive AL without a positive malaria test [ 12 , 17 , 18 , 28 ]. This is referred to as presumptive treatment.…”

“…Kisumu County is part of the endemic lake region, whose malaria prevalence in children under 14 years was 26.7% in 2015 [ 16 ] and 19% in 2020 [ 5 ]. Between 2018 and 2019, a total of 1804 health facilities in the lake endemic counties reported testing a total of 12.8 million outpatients, with about 6 million of the tests turning positive (test positivity rate 46.7%, mean 309 cases in primary health facilities) in the 24 months [ 17 , 18 ]. A survey conducted in schools in Kisumu County revealed that each person experiences at least 31 infective bites annually [ 19 ].…”

The private sector market for malaria rapid diagnostic tests in Nigeria: results of the 2018 market survey

“…Microscopy is unlikely to be available in many private outlets or in very rural communities [1]. Easyto-use malaria rapid diagnostic tests (RDTs) present an effective option in these settings but correct RDT use appears low and presumptive treatment of fever cases with anti-malarials remains high, particularly in the private healthcare sector [7][8][9][10][11]. Despite this, engagement with the private sector to promote RDT availability and use has been limited; a review found just 12 studies where RDTs had been introduced to drug shops or pharmacies and these were predominantly small-scale pilots [12].…”

The private sector market for mRDTs in Nigeria - results of the 2018 market survey.

“…Microscopy is unlikely to be available in many private outlets or in very rural communities. Easy-to-use mRDTs present an effective option in these settings but correct mRDT use appears low and presumptive treatment of fever cases with anti-malarials remains high, particularly in the private healthcare sector [7][8][9][10][11]. Despite this, engagement with the private sector to promote mRDT availability and use has been limited; a review found just 12 studies where mRDTs had been introduced to drug shops or pharmacies and these were predominantly small-scale pilots [12].…”