FACTORS INFLUENCING QUALITY CLINICAL CASE MANAGEMENT OF SEVERE MALARIA AMONG CHILDREN AGED 6 MONTHS TO 59 MONTHS BY HEALTHCARE PROVIDERS IN KISUMU COUNTY

Abstract

Severe malaria in under 5 continues to be public health concern in malaria endemic areas. In Kisumu County, most cases of severe malaria are observed at Kisumu West and Nyakach sub counties in Kisumu West. However, quality of management of this condition is not well understood. The aim of the present study was to determine the effect of caregiver, Healthcare providers, and health system associated factors that influence quality of management of severe malaria in under-five in Kisumu County. This was a mixed methods prospective cross sectional study which took place between April and July 2023. Three hundred and forty-four under-fives, 78 healthcare providers and 8 key informants were recruited into the study. Qualitative data was collected using a key informant interview guide and analyzed using thematic analysis. Quantitative data was obtained through questionnaires and observational checklists and summarized using descriptive statistics and analyzed using SPSS version 27. Most children were ≥12 months (286/344, 83.1%), with a mean age of 12.58±1.67 (1.30 59.00). Most caregivers were between 25 and 34 years (174/344, 50.6%), had a mean age of 32.33±7.13 (18.00-56.00), had attained tertiary level of education (220/344, 63.9%). Most healthcare providers were nurses (52/78, 67%), diploma level of education (65/78, 83%), majority had received Integrated management of neonatal and Childhood illnesses training (46/78, 59%), and had attended a Continued medical education or in-service training on case management (75/78, 96%). Microscopic tests were mainly done in the study area (182/344, 52.9%), oral Artemisinin combined therapy was mainly administered (124/344, 36.0%) as compared to artemether injection(124/344, 36.0%). Under-five Males were 40% less likely to receive optimal malaria treatment (OR: 0.6; 95% CI: 0.4 – 0.9; p = 0.017). Cases managed by in integrated management of neonatal and child illnesses trained healthcare providers were 60% more likely to receive quality malaria treatment compared to non-trained (OR: 0.4; 95% CI: 0.3 – 0.7; p = 0.0005). Children of younger caregivers ≤25 years were 3.5 times more likely to have received optimal management relative those whose caregivers were ≥25 years of age (OR: 3.5; 95% CI: 1.7 – 7.3; p = 0.0005). Similarly, children whose caregivers had attained primary education had higher odds of receiving optimal malaria management unlike those whose parents had higher level of education (OR: 5.8; 95% CI: 2.6 – 12.7; p < 0.0001). The study has demonstrated that factors related to the caregivers, HCPs, and health system significantly influence the quality of management of malaria in under-five in the study area. Key findings indicate that male children are less likely to receive optimal care compared to females.. Moreover, HCPs with IMNCI training significantly enhanced the quality of malaria treatment. Interestingly, caregivers’ age and education level were among the critical determinants, where children of younger caregivers (≤25 years) and those who had primary education being more likely to receive optimal management. These results suggest that caregivers demographic factors and HCPs’ skill levels play a substantial role in the quality of malaria management in the region. These findings suggest that there should be continuous in service training programs, particularly on IMCI, to ensure that HCPs across County Hospitals are equipped with the skills required for optimal malaria management. Therefore, equitable access to quality malaria case management for under-fives is important in that awareness programs targeting gender biases and reinforcing treatment guidelines that emphasize gender neutrality in clinical decisions is in place. Caregivers to be enlightened on the importance of timely and appropriate treatment seeking behavior, regardless of their education level. Most importantly, there is need for strengthening health facilities capacity to provide accurate and timely diagnostic services and also ensuring uniformity in treatment protocol utilization. Finally, there is a need to establish robust monitoring systems to track the implementation of training, caregiver support programs, and adherence to standardized treatment protocols. This will help identify gaps and enable timely adjustments to improve malaria management outcomes.