Predictors of health workers\u2019 knowledge about artesunate-based severe malaria treatment recommendations in government and faith-based hospitals in Kenya

Beatrice Machini,Dejan Zurovac,Robert W Snow,Beatrice Amboko,Lucas Malla,Thomas N O Achia,Hillary Kipruto

doi:10.1186/s12936-020-03341-2

Abstract

BackgroundHealth workers’ knowledge deficiencies about artesunate-based severe malaria treatment recommendations have been reported. However, predictors of the treatment knowledge have not been examined. In this paper, predictors of artesunate-based treatment knowledge among inpatient health workers in two hospital sectors in Kenya are reported.MethodsSecondary analysis of 367 and 330 inpatient health workers randomly selected and interviewed at 47 government hospitals in 2016 and 43 faith-based hospitals in 2017 respectively, was undertaken. Multilevel ordinal and binary logistic regressions examining the effects of 11 factors on five knowledge outcomes in government and faith-based hospital sectors were performed.ResultsAmong respective government and faith-based health workers, about a third of health workers had high knowledge of artesunate treatment policies (30.8% vs 32.9%), a third knew all dosing intervals (33.5% vs 33.3%), about half knew preparation solutions (49.9% vs 55.8%), half to two-thirds knew artesunate dose for both weight categories (50.8% vs 66.7%) and over three-quarters knew the preferred route of administration (78.7% vs 82.4%). Eight predictors were significantly associated with at least one of the examined knowledge outcomes. In the government sector, display of artesunate administration posters, paediatric ward allocation and repeated surveys were significantly associated with more than one of the knowledge outcomes. In the faith-based hospitals, availability of artesunate at hospitals and health worker pre-service training were associated with multiple outcomes. Exposure to in-service malaria case-management training and access to malaria guidelines were only associated with higher knowledge about artesunate treatment policy.ConclusionProgrammatic interventions ensuring display of artesunate administration posters in the wards, targeting of health workers managing adult patients in the medical wards, and repeated knowledge assessments are likely to be beneficial for improving the knowledge of government health workers about artesunate-based severe malaria treatment recommendations. The availability of artesunate and focus on improvements of nurses’ knowledge should be prioritized at the faith-based hospitals.

Highlights

Health workers’ knowledge deficiencies about artesunate-based severe malaria treatment recommendations have been reported
This study examined the predictors of the inpatient health workers’ knowledge about artesunate-based severe malaria treatment recommendations in government and faith-based organization (FBO) hospitals in Kenya
Upon the completion of the interviews and knowledge assessments, all participating health workers were informed about the correct responses, given national malaria case-management guidelines, and if absent, distributed artesunate administration posters to be displayed on the walls

Summary

Introduction

Health workers’ knowledge deficiencies about artesunate-based severe malaria treatment recommendations have been reported. Predictors of artesunate-based treatment knowledge among inpatient health workers in two hospital sectors in Kenya are reported. Alongside the World Health Organization (WHO) recommendation in 2012 [4], Kenya was among the first African countries to adopt the artesunate treatment policy for severe malaria [5]. National artesunate implementation targeted government and FBO health workers, but subsidized artesunate was available only to the government hospitals procuring medicines through the Kenya Medical Supply Agency. According to the national guidelines [5], artesunate is the recommended treatment for all patient populations with severe malaria including pregnant women across all trimesters of the pregnancy. After the minimum of three parenteral doses artesunate should be continued at 24 hourly dosing intervals until the patient is able to take oral anti-malarial therapy

Methods

Results

Conclusion