IJE Advance Access originally published online on July 15, 2004
International Journal of Epidemiology 2004 33(5):1080-1091; doi:10.1093/ije/dyh253
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
IJE vol.33 no.5 © International Epidemiological Association 2004; all rights reserved.
Infectious Diseases |
Predictors of the quality of health worker treatment practices for uncomplicated malaria at government health facilities in Kenya
1 Médecins Sans Frontières-France, P.O. Box 39719, Nairobi, Kenya
2 Ministry of Health, Division of Malaria Control, P.O. Box 20750, Nairobi, Kenya
3 KEMRI/Wellcome Trust Collaborative Programme, P.O. Box 43640, 00100 GPO, Nairobi, Kenya
4 Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
5 Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, Georgia 30341, USA
6 Kenyatta National Hospital, P.O. Box 20723, Nairobi, Kenya
7 Center for Geographic Medicine, KEMRI, P.O. Box 230, Kilifi, Kenya
8 Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
Correspondence: Dr Dejan Zurovac, KEMRI/Wellcome Trust Collaborative Programme, P.O. Box 43640, 00100 GPO, Nairobi, Kenya. E-mail: dzurovac{at}wtnairobi.mimcom.net
Background When replacing failing drugs for malaria with more effective drugs, an important step towards reducing the malaria burden is that health workers (HW) prescribe drugs according to evidence-based guidelines. Past studies have shown that HW commonly do not follow guidelines, yet few studies have explored with appropriate methods why such practices occur.
Methods We analysed data from a survey of government health facilities in four Kenyan districts in which HW consultations were observed, caretakers and HW were interviewed, and health facility assessments were performed. The analysis was limited to children 2–59 months old with uncomplicated malaria. Treatment was defined as recommended (antimalarial recommended by national guidelines), a minor error (effective, but non-recommended antimalarial), or inappropriate (no effective antimalarial).
Results We evaluated 1006 consultations performed by 135 HW at 81 facilities: 567 children received recommended treatment, 314 had minor errors, and 125 received inappropriate treatment (weighted percentages: 56.9%, 30.4%, and 12.7%). Multivariate logistic regression analysis revealed that programmatic interventions such as in-service malaria training, provision of guidelines and wall charts, and more frequent supervision were significantly associated with better treatment quality. However, neither in-service training nor possession of the guideline document showed an effect by itself. More qualified HW made more errors: both major and minor errors (but generally more minor errors) when second-line drugs were in stock, and more major errors when second-line drugs were not in stock. Child factors such as age and a main complaint of fever were also associated with treatment quality.
Conclusions Our results support the use of several programmatic strategies that can redress HW deficiencies in malaria treatment. Targeted cost-effectiveness trials would help refine these strategies and provide more precise guidance on affordable and effective ways to strengthen and maintain HW practices.
Keywords Quality, treatment, malaria, health workers, errors, predictors, guidelines, Kenya
Accepted 19 April 2004
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  L. A. Smith, C. Jones, S. Meek, and J. Webster Review: Provider Practice and User Behavior Interventions to Improve Prompt and Effective Treatment of Malaria: Do We Know What Works? Am J Trop Med Hyg, March 1, 2009; 80(3): 326 - 335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L Barber and P. J Gertler Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme Health Policy Plan., January 1, 2009; 24(1): 18 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. I. R. Chandler, B. Nadjm, G. Boniface, K. Juma, H. Reyburn, and C. J. M. Whitty Assessment of Children for Acute Respiratory Infections in Hospital Outpatients in Tanzania: What Drives Good Practice? Am J Trop Med Hyg, December 1, 2008; 79(6): 925 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Barber, P. J. Gertler, and P. Harimurti Differences In Access To High-Quality Outpatient Care In Indonesia Health Aff., May 1, 2007; 26(3): w352 - w366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Leonard and M. C. Masatu Variations In The Quality Of Care Accessible To Rural Communities In Tanzania Health Aff., May 1, 2007; 26(3): w380 - w392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Naimoli, A. K. Rowe, A. Lyaghfouri, R. Larbi, and L. A. Lamrani Effect of the Integrated Management of Childhood Illness strategy on health care quality in Morocco Int. J. Qual. Health Care, April 1, 2006; 18(2): 134 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Zurovac, M. Ndhlovu, A. K Rowe, D. H Hamer, D. M Thea, and R. W Snow Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study BMJ, October 1, 2005; 331(7519): 734. [Abstract] [Full Text] [PDF]
|
|