| dc.description.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. | en_US |
