Abstract
BackgroundConventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. These methods, if not carried out exactly, easily result in the over- or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes. Using the setting of a pilot introduction of malaria RDTs in Greater Garissa, North Eastern Province, Kenya, this study aims to identify and understand perceptions regarding malaria diagnosis, with a particular focus on RDTs, and treatment among community members and health care workers (HCWs).MethodsThe study was conducted in five districts of Garissa County. Focus group discussions (FGD) were performed with community members that were recruited from health facilities (HFs) supported by the MENTOR Initiative. In-depth interviews (IDIs) and FGDs with HCWs were also carried out. Interview transcripts were then coded and analysed for major themes. Two researchers reviewed all codes, first separately and then together, discussed the specific categories, and finally characterized, described, and agreed upon major important themes.ResultsThirty-four FGDs were carried out with a range of two to eight participants (median of four). Of 157 community members, 103 (65.6%) were women. The majority of participants were illiterate and the highest level of education was secondary school. Some 76% of participants were of Somali ethnicity. Whilst community members and HCWs demonstrated knowledge of aspects of malaria transmission, prevention, diagnosis, and treatment, gaps and misconceptions were identified. Poor adherence to negative RDT results, unfamiliarity and distrust of RDTs, and an inconsistent RDT supply were the main challenges to become apparent in FGDs and IDIs.ConclusionGaps in knowledge or incorrect beliefs exist in Greater Garissa and have the potential to act as barriers to complete and correct malaria case management. Addressing these knowledge gaps requires comprehensive education campaigns and a reliable and constant RDT supply. The results of this study highlight education and supply chain as key factors to be addressed in order to make large scale roll out of RDTs as successful and effective as possible.
Highlights
Conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears
Current day malaria cases and deaths are indicative of a lack of access to indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) using effective insecticides, and artemisininbased combination therapy (ACT) amongst millions of people currently at risk of malaria
These diagnostic methods require trained staff, expensive and fragile equipment, and, in the case of microscopy, an electricity supply. These requirements and the intrinsic potential for human or technical error have been shown to result in patients who do not have clinical malaria being diagnosed as positive and prescribed anti-malarials [3,4,5,6,7]. This over-diagnosis of malaria and the resultant antimalarial treatment is a waste of resources in often resource-scarce settings, exposes patients to needless anti-malarial therapy, likely contributes to the development of drug resistance, and may compromise patient trust in health care providers as their condition does not improve upon treatment [8,9]
Summary
Conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. Malaria diagnosis Until recently, conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears [3] These diagnostic methods require trained staff, expensive and fragile equipment, and, in the case of microscopy, an electricity supply. These requirements and the intrinsic potential for human or technical error have been shown to result in patients who do not have clinical malaria being diagnosed as positive and prescribed anti-malarials [3,4,5,6,7]. In 2010 the WHO recommended that all suspected cases of malaria be confirmed with a diagnostic test prior to treatment [12]
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