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Knowledge and Adherence to the National Guidelines for Malaria Diagnosis in Pregnancy among Health-Care Providers and Drug-Outlet Dispensers in Rural Western Kenya

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  • 1 Rollins School of Public Health, Emory University, Atlanta, Georgia;
  • | 2 Liverpool School of Tropical Medicine, Liverpool, United Kingdom;
  • | 3 KEMRI, Centre for Global Health Research, Kisumu, Kenya;
  • | 4 Malaria Control Unit, Ministry of Health, Nairobi, Kenya;
  • | 5 College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya;
  • | 6 Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia and Kenya;
  • | 7 U.S. President’s Malaria Initiative, Nairobi, Kenya
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Prompt diagnosis and effective treatment of acute malaria in pregnancy (MiP) is important for the mother and fetus; data on health-care provider adherence to diagnostic guidelines in pregnancy are limited. From September to November 2013, a cross-sectional survey was conducted in 51 health facilities and 39 drug outlets in Western Kenya. Provider knowledge of national diagnostic guidelines for uncomplicated MiP were assessed using standardized questionnaires. The use of parasitologic testing was assessed in health facilities via exit interviews with febrile women of childbearing age and in drug outlets via simulated-client scenarios, posing as pregnant women or their spouses. Overall, 93% of providers tested for malaria or accurately described signs and symptoms consistent with clinical malaria. Malaria was parasitologically confirmed in 77% of all patients presenting with febrile illness at health facilities and 5% of simulated clients at drug outlets. Parasitological testing was available in 80% of health facilities; 92% of patients evaluated at these facilities were tested. Only 23% of drug outlets had malaria rapid diagnostic tests (RDTs); at these outlets, RDTs were offered in 17% of client simulations. No differences were observed in testing rates by pregnancy trimester. The study highlights gaps among health providers in diagnostic knowledge and practice related to MiP, and the lack of malaria diagnostic capacity, particularly in drug outlets. The most important factor associated with malaria testing of pregnant women was the availability of diagnostics at the point of service. Interventions that increase the availability of malaria diagnostic services might improve malaria case management in pregnant women.

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Author Notes

Address correspondence to Julie R. Gutman, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd. NE, Mailstop A06, Atlanta, GA 30329-4027. E-mail: fff2@cdc.gov

Financial support: This publication was made possible through support provided by the U.S. President’s Malaria Initiative, U.S. Agency for International Development (USAID), and U.S. Centers for Disease Control and Prevention (CDC), under the terms of an interagency agreement between USAID and CDC and through a cooperative agreement, #1U01GH000048, between CDC and the Kenya Medical Research Institute. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all of the data in the study and had final responsibility for the decision to submit for publication.

Authors’ addresses: Christina Riley, Rollins School of Public Health, Emory University, Atlanta, GA, E-mail: riley.christinam@gmail.com. Stephanie Dellicour, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mail: steph.dellicour@gmail.com. Peter Ouma and Simon Kariuki, KEMRI, Centre for Global Health Research, Kisumu, Kenya, E-mails: oumapet2015@gmail.com and skariuki@kemricdc.org. Urbanus Kioko and Ahmeddin Omar, Malaria Control Unit, Ministry of Health, Nairobi, Kenya, E-mails: ukioks@gmail.com and deen_omar@hotmail.com. Zipporah Ng'ang'a, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya, E-mail: zipnganga@gmail.com. Meghna Desai and Julie R. Gutman, Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, E-mails: mud8@cdc.gov and fff2@cdc.gov. Ann M. Buff, Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, and U.S. President’s Malaria Initiative, Nairobi, Kenya, E-mail: ali3@cdc.gov.

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