Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya.
OBJECTIVE: To describe the quality of outpatient paediatric malaria case-management approximately 4-6 months after artemether-lumefantrine (AL) replaced sulfadoxine-pyrimethamine (SP) as the nationally recommended first-line therapy in Kenya. METHODS: Cross-sectional survey at all government facili...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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2008
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| _version_ | 1826262685049683968 |
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| author | Zurovac, D Njogu, J Akhwale, W Hamer, D Snow, R |
| author_facet | Zurovac, D Njogu, J Akhwale, W Hamer, D Snow, R |
| author_sort | Zurovac, D |
| collection | OXFORD |
| description | OBJECTIVE: To describe the quality of outpatient paediatric malaria case-management approximately 4-6 months after artemether-lumefantrine (AL) replaced sulfadoxine-pyrimethamine (SP) as the nationally recommended first-line therapy in Kenya. METHODS: Cross-sectional survey at all government facilities in four Kenyan districts. Main outcome measures were health facility and health worker readiness to implement AL policy; quality of antimalarial prescribing, counselling and drug dispensing in comparison with national guidelines; and factors influencing AL prescribing for treatment of uncomplicated malaria in under-fives. RESULTS: We evaluated 193 facilities, 227 health workers and 1533 sick-child consultations. Health facility and health worker readiness was variable: 89% of facilities stocked AL, 55% of health workers had access to guidelines, 46% received in-service training on AL and only 1% of facilities had AL wall charts. Of 940 children who needed AL treatment, AL was prescribed for 26%, amodiaquine for 39%, SP for 4%, various other antimalarials for 8% and 23% of children left the facility without any antimalarial prescribed. When AL was prescribed, 92% of children were prescribed correct weight-specific dose. AL dispensing and counselling tasks were variably performed. Higher health worker's cadre, in-service training including AL use, positive malaria test, main complaint of fever and high temperature were associated with better prescribing. CONCLUSIONS: Changes in clinical practices at the point of care might take longer than anticipated. Delivery of successful interventions and their scaling up to increase coverage are important during this process; however, this should be accompanied by rigorous research evaluations, corrective actions on existing interventions and testing cost-effectiveness of novel interventions capable of improving and maintaining health worker performance and health systems to deliver artemisinin-based combination therapy in Africa. |
| first_indexed | 2024-03-06T19:39:58Z |
| format | Journal article |
| id | oxford-uuid:205175b2-30a8-4c87-9bdc-4c9cbf1a7f29 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:39:58Z |
| publishDate | 2008 |
| record_format | dspace |
| spelling | oxford-uuid:205175b2-30a8-4c87-9bdc-4c9cbf1a7f292022-03-26T11:27:01ZTranslation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:205175b2-30a8-4c87-9bdc-4c9cbf1a7f29EnglishSymplectic Elements at Oxford2008Zurovac, DNjogu, JAkhwale, WHamer, DSnow, R OBJECTIVE: To describe the quality of outpatient paediatric malaria case-management approximately 4-6 months after artemether-lumefantrine (AL) replaced sulfadoxine-pyrimethamine (SP) as the nationally recommended first-line therapy in Kenya. METHODS: Cross-sectional survey at all government facilities in four Kenyan districts. Main outcome measures were health facility and health worker readiness to implement AL policy; quality of antimalarial prescribing, counselling and drug dispensing in comparison with national guidelines; and factors influencing AL prescribing for treatment of uncomplicated malaria in under-fives. RESULTS: We evaluated 193 facilities, 227 health workers and 1533 sick-child consultations. Health facility and health worker readiness was variable: 89% of facilities stocked AL, 55% of health workers had access to guidelines, 46% received in-service training on AL and only 1% of facilities had AL wall charts. Of 940 children who needed AL treatment, AL was prescribed for 26%, amodiaquine for 39%, SP for 4%, various other antimalarials for 8% and 23% of children left the facility without any antimalarial prescribed. When AL was prescribed, 92% of children were prescribed correct weight-specific dose. AL dispensing and counselling tasks were variably performed. Higher health worker's cadre, in-service training including AL use, positive malaria test, main complaint of fever and high temperature were associated with better prescribing. CONCLUSIONS: Changes in clinical practices at the point of care might take longer than anticipated. Delivery of successful interventions and their scaling up to increase coverage are important during this process; however, this should be accompanied by rigorous research evaluations, corrective actions on existing interventions and testing cost-effectiveness of novel interventions capable of improving and maintaining health worker performance and health systems to deliver artemisinin-based combination therapy in Africa. |
| spellingShingle | Zurovac, D Njogu, J Akhwale, W Hamer, D Snow, R Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title | Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title_full | Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title_fullStr | Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title_full_unstemmed | Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title_short | Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. |
| title_sort | translation of artemether lumefantrine treatment policy into paediatric clinical practice an early experience from kenya |
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