Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.

<h4>Background</h4>Monitoring implementation of the "test and treat" case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Usi...

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Autores principales:	Dejan Zurovac, Sophie Githinji, Dorothy Memusi, Samuel Kigen, Beatrice Machini, Alex Muturi, Gabriel Otieno, Robert W Snow, Andrew Nyandigisi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4e57d1d7691242ed90f66a8325b7ea4b
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spelling	oai:doaj.org-article:4e57d1d7691242ed90f66a8325b7ea4b2021-11-18T08:26:30ZMajor improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.1932-620310.1371/journal.pone.0092782https://doaj.org/article/4e57d1d7691242ed90f66a8325b7ea4b2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24663961/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Monitoring implementation of the "test and treat" case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Using health facility surveys we monitored health systems readiness and malaria case-management practices prior to and following implementation of the 2010 "test and treat" policy in Kenya.<h4>Methods/findings</h4>Between 2010 and 2013 six national, cross-sectional, health facility surveys were undertaken. The number of facilities assessed ranged between 172 and 176, health workers interviewed between 216 and 237 and outpatient consultations for febrile patients evaluated between 1,208 and 2,408 across six surveys. Comparing baseline and the last survey results, all readiness indicators showed significant (p<0.005) improvements: availability of parasitological diagnosis (55.2% to 90.7%); RDT availability (7.5% to 69.8%); total artemether-lumefantrine (AL) stock-out (27.2% to 7.0%); stock-out of one or more AL packs (59.5% to 21.6%); training coverage (0 to 50.2%); guidelines access (0 to 58.1%) and supervision (17.9% to 30.8%). Testing increased by 34.0% (23.9% to 57.9%; p<0.001) while testing and treatment according to test result increased by 34.2% (15.7% to 49.9%; p<0.001). Treatment adherence for test positive patients improved from 83.3% to 90.3% (p = 0.138) and for test negative patients from 47.9% to 83.4% (p<0.001). Significant testing and treatment improvements were observed in children and adults. There was no difference in practices with respect to the type and result of malaria test (RDT vs microscopy). Of eight dosing, dispensing and counseling tasks, improvements were observed for four tasks. Overall AL use for febrile patients decreased from 63.5% to 35.6% (p<0.001).<h4>Conclusions</h4>Major improvements in the implementation of "test and treat" policy were observed in Kenya. Some gaps towards universal targets still remained. Other countries facing similar needs and challenges may consider health facility surveys to monitor malaria case-management.Dejan ZurovacSophie GithinjiDorothy MemusiSamuel KigenBeatrice MachiniAlex MuturiGabriel OtienoRobert W SnowAndrew NyandigisiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e92782 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Dejan Zurovac Sophie Githinji Dorothy Memusi Samuel Kigen Beatrice Machini Alex Muturi Gabriel Otieno Robert W Snow Andrew Nyandigisi Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
description	<h4>Background</h4>Monitoring implementation of the "test and treat" case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Using health facility surveys we monitored health systems readiness and malaria case-management practices prior to and following implementation of the 2010 "test and treat" policy in Kenya.<h4>Methods/findings</h4>Between 2010 and 2013 six national, cross-sectional, health facility surveys were undertaken. The number of facilities assessed ranged between 172 and 176, health workers interviewed between 216 and 237 and outpatient consultations for febrile patients evaluated between 1,208 and 2,408 across six surveys. Comparing baseline and the last survey results, all readiness indicators showed significant (p<0.005) improvements: availability of parasitological diagnosis (55.2% to 90.7%); RDT availability (7.5% to 69.8%); total artemether-lumefantrine (AL) stock-out (27.2% to 7.0%); stock-out of one or more AL packs (59.5% to 21.6%); training coverage (0 to 50.2%); guidelines access (0 to 58.1%) and supervision (17.9% to 30.8%). Testing increased by 34.0% (23.9% to 57.9%; p<0.001) while testing and treatment according to test result increased by 34.2% (15.7% to 49.9%; p<0.001). Treatment adherence for test positive patients improved from 83.3% to 90.3% (p = 0.138) and for test negative patients from 47.9% to 83.4% (p<0.001). Significant testing and treatment improvements were observed in children and adults. There was no difference in practices with respect to the type and result of malaria test (RDT vs microscopy). Of eight dosing, dispensing and counseling tasks, improvements were observed for four tasks. Overall AL use for febrile patients decreased from 63.5% to 35.6% (p<0.001).<h4>Conclusions</h4>Major improvements in the implementation of "test and treat" policy were observed in Kenya. Some gaps towards universal targets still remained. Other countries facing similar needs and challenges may consider health facility surveys to monitor malaria case-management.
format	article
author	Dejan Zurovac Sophie Githinji Dorothy Memusi Samuel Kigen Beatrice Machini Alex Muturi Gabriel Otieno Robert W Snow Andrew Nyandigisi
author_facet	Dejan Zurovac Sophie Githinji Dorothy Memusi Samuel Kigen Beatrice Machini Alex Muturi Gabriel Otieno Robert W Snow Andrew Nyandigisi
author_sort	Dejan Zurovac
title	Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
title_short	Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
title_full	Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
title_fullStr	Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
title_full_unstemmed	Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
title_sort	major improvements in the quality of malaria case-management under the "test and treat" policy in kenya.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/4e57d1d7691242ed90f66a8325b7ea4b
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Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.

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