Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya
The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health syste...
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| Veröffentlicht in: | PloS one 2011-09, Vol.6 (9), p.e24781-e24781 |
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| creator | Nyandigisi, Andrew Memusi, Dorothy Mbithi, Agneta Ang'wa, Newton Shieshia, Mildred Muturi, Alex Sudoi, Raymond Githinji, Sophie Juma, Elizabeth Zurovac, Dejan |
| description | The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health systems and case-management indicators between the baseline survey undertaken before implementation of the policy and the follow-up survey following the first year of the implementation activities.
National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation.
Most of the case-management indicators have shown some improvement trends; however differences were smaller than expected, rarely statistically significant and still leaving a substantial gap towards optimistic targets. The quantitative and qualitative improvement of interventions will ultimately determine the success of the new policy. |
| doi_str_mv | 10.1371/journal.pone.0024781 |
| format | Article |
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National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation.
Most of the case-management indicators have shown some improvement trends; however differences were smaller than expected, rarely statistically significant and still leaving a substantial gap towards optimistic targets. The quantitative and qualitative improvement of interventions will ultimately determine the success of the new policy.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0024781</identifier><identifier>PMID: 21935464</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age groups ; Algorithms ; Antimalarials - therapeutic use ; Artemether ; Artemether, Lumefantrine Drug Combination ; Artemisinin ; Artemisinins - therapeutic use ; Case Management ; Clinical medicine ; Combination therapy ; Cross-Sectional Studies ; Diagnosis ; Diagnostic tests ; Drug Combinations ; Epidemiology ; Ethanolamines - therapeutic use ; Exposure ; Female ; Fluorenes - therapeutic use ; Guidelines ; Health care reform ; Health facilities ; Humans ; Indicators ; Kenya ; Malaria ; Malaria - drug therapy ; Male ; Management ; Medical diagnosis ; Medical personnel ; Medical research ; Medically uninsured persons ; Medicine ; Occupational health ; Patient compliance ; Patients ; Polls & surveys ; Public health ; Sanitation ; Statistical analysis ; Surveys ; Training ; Vector-borne diseases ; Workers</subject><ispartof>PloS one, 2011-09, Vol.6 (9), p.e24781-e24781</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Nyandigisi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Nyandigisi et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-b077ffcb3c442408454a49ddc95a69cc7c3c2c585a142d0f4785dee603a0c4c83</citedby><cites>FETCH-LOGICAL-c691t-b077ffcb3c442408454a49ddc95a69cc7c3c2c585a142d0f4785dee603a0c4c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173476/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173476/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21935464$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nyandigisi, Andrew</creatorcontrib><creatorcontrib>Memusi, Dorothy</creatorcontrib><creatorcontrib>Mbithi, Agneta</creatorcontrib><creatorcontrib>Ang'wa, Newton</creatorcontrib><creatorcontrib>Shieshia, Mildred</creatorcontrib><creatorcontrib>Muturi, Alex</creatorcontrib><creatorcontrib>Sudoi, Raymond</creatorcontrib><creatorcontrib>Githinji, Sophie</creatorcontrib><creatorcontrib>Juma, Elizabeth</creatorcontrib><creatorcontrib>Zurovac, Dejan</creatorcontrib><title>Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health systems and case-management indicators between the baseline survey undertaken before implementation of the policy and the follow-up survey following the first year of the implementation activities.
National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation.
Most of the case-management indicators have shown some improvement trends; however differences were smaller than expected, rarely statistically significant and still leaving a substantial gap towards optimistic targets. The quantitative and qualitative improvement of interventions will ultimately determine the success of the new policy.</description><subject>Age groups</subject><subject>Algorithms</subject><subject>Antimalarials - therapeutic use</subject><subject>Artemether</subject><subject>Artemether, Lumefantrine Drug Combination</subject><subject>Artemisinin</subject><subject>Artemisinins - therapeutic use</subject><subject>Case Management</subject><subject>Clinical medicine</subject><subject>Combination therapy</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis</subject><subject>Diagnostic tests</subject><subject>Drug Combinations</subject><subject>Epidemiology</subject><subject>Ethanolamines - therapeutic use</subject><subject>Exposure</subject><subject>Female</subject><subject>Fluorenes - therapeutic use</subject><subject>Guidelines</subject><subject>Health care reform</subject><subject>Health facilities</subject><subject>Humans</subject><subject>Indicators</subject><subject>Kenya</subject><subject>Malaria</subject><subject>Malaria - drug therapy</subject><subject>Male</subject><subject>Management</subject><subject>Medical diagnosis</subject><subject>Medical personnel</subject><subject>Medical research</subject><subject>Medically uninsured persons</subject><subject>Medicine</subject><subject>Occupational health</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Polls & surveys</subject><subject>Public health</subject><subject>Sanitation</subject><subject>Statistical analysis</subject><subject>Surveys</subject><subject>Training</subject><subject>Vector-borne diseases</subject><subject>Workers</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk8tu1DAUhiMEoqXwBggsIYFYzODEzm2DVFVcRhRV4ra1TuyTjCuPHWynMA_C--LpTKsZ1AXKIrH9nf-Pf_tk2dOcznNW528u3eQtmPnoLM4pLXjd5Pey47xlxawqKLu_932UPQrhktKSNVX1MDsq0krJK36c_fkMBrwGIiHgbAUWBlyhjaR3xrhf2g5ELsEOSFxPRme0XJPoyGT1FfoAhozgIejojBu0TGOlYbAu6EDAKhLBDxhREfARVzpoq-2sS1aKSLfqtIWonSVxiR7GNdGWfEK7hsfZgx5MwCe790n2_f27b2cfZ-cXHxZnp-czWbV5nHW0rvtedkxyXnDa8JIDb5WSbQlVK2UtmSxk2ZSQ80LRPkVUKsSKMqCSy4adZM-3uqNxQewSDSJntGko5RVLxGJLKAeXYvR6BX4tHGhxPeH8INLWtDQoQPWdUm2RN8muaaFpsKO0rXPEmkq2cXu7c5u6FSqZYvZgDkQPV6xeisFdCZbXjNdVEni1E_Du54QhihSpRGPAopuCaFpWF7Ssi0S--Ie8e3M7aoD0_9r2LtnKjaY4TX4b7Np1fgeVHpVOVKbb1-s0f1Dw-qAgMRF_xwGmEMTi65f_Zy9-HLIv99glgonL4My0uULhEORbUHoXgsf-NuOcik3z3KQhNs0jds2Typ7tn89t0U23sL-Inhgn</recordid><startdate>20110914</startdate><enddate>20110914</enddate><creator>Nyandigisi, Andrew</creator><creator>Memusi, Dorothy</creator><creator>Mbithi, Agneta</creator><creator>Ang'wa, Newton</creator><creator>Shieshia, Mildred</creator><creator>Muturi, Alex</creator><creator>Sudoi, Raymond</creator><creator>Githinji, Sophie</creator><creator>Juma, Elizabeth</creator><creator>Zurovac, Dejan</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20110914</creationdate><title>Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya</title><author>Nyandigisi, Andrew ; Memusi, Dorothy ; Mbithi, Agneta ; Ang'wa, Newton ; Shieshia, Mildred ; Muturi, Alex ; Sudoi, Raymond ; Githinji, Sophie ; Juma, Elizabeth ; Zurovac, Dejan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c691t-b077ffcb3c442408454a49ddc95a69cc7c3c2c585a142d0f4785dee603a0c4c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Age groups</topic><topic>Algorithms</topic><topic>Antimalarials - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nyandigisi, Andrew</au><au>Memusi, Dorothy</au><au>Mbithi, Agneta</au><au>Ang'wa, Newton</au><au>Shieshia, Mildred</au><au>Muturi, Alex</au><au>Sudoi, Raymond</au><au>Githinji, Sophie</au><au>Juma, Elizabeth</au><au>Zurovac, Dejan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2011-09-14</date><risdate>2011</risdate><volume>6</volume><issue>9</issue><spage>e24781</spage><epage>e24781</epage><pages>e24781-e24781</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The change of malaria case-management policy in Kenya to recommend universal parasitological diagnosis and targeted treatment with artemether-lumefantrine (AL) is supported with activities aiming by 2013 at universal coverage and adherence to the recommendations. We evaluated changes in health systems and case-management indicators between the baseline survey undertaken before implementation of the policy and the follow-up survey following the first year of the implementation activities.
National, cross-sectional surveys using quality-of-care methods were undertaken at public facilities. Baseline and follow-up surveys respectively included 174 and 176 facilities, 224 and 237 health workers, and 2,405 and 1,456 febrile patients. Health systems indicators showed variable changes between surveys: AL stock-out (27% to 21%; p = 0.152); availability of diagnostics (55% to 58%; p = 0.600); training on the new policy (0 to 22%; p = 0.001); exposure to supervision (18% to 13%; p = 0.156) and access to guidelines (0 to 6%; p = 0.001). At all facilities, there was an increase among patients tested for malaria (24% vs 31%; p = 0.090) and those who were both tested and treated according to test result (16% to 22%; p = 0.048). At facilities with AL and malaria diagnostics, testing increased from 43% to 50% (p = 0.196) while patients who were both, tested and treated according to test result, increased from 28% to 36% (p = 0.114). Treatment adherence improved for test positive patients from 83% to 90% (p = 0.150) and for test negative patients from 47% to 56% (p = 0.227). No association was found between testing and exposure to training, supervision and guidelines, however, testing was significantly associated with facility ownership, type of testing, and patients' caseload, age and clinical presentation.
Most of the case-management indicators have shown some improvement trends; however differences were smaller than expected, rarely statistically significant and still leaving a substantial gap towards optimistic targets. The quantitative and qualitative improvement of interventions will ultimately determine the success of the new policy.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21935464</pmid><doi>10.1371/journal.pone.0024781</doi><tpages>e24781</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_plos_journals_1308800463 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Age groups Algorithms Antimalarials - therapeutic use Artemether Artemether, Lumefantrine Drug Combination Artemisinin Artemisinins - therapeutic use Case Management Clinical medicine Combination therapy Cross-Sectional Studies Diagnosis Diagnostic tests Drug Combinations Epidemiology Ethanolamines - therapeutic use Exposure Female Fluorenes - therapeutic use Guidelines Health care reform Health facilities Humans Indicators Kenya Malaria Malaria - drug therapy Male Management Medical diagnosis Medical personnel Medical research Medically uninsured persons Medicine Occupational health Patient compliance Patients Polls & surveys Public health Sanitation Statistical analysis Surveys Training Vector-borne diseases Workers |
| title | Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya |
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