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Readiness of the Kenyan public health sector to provide pre‐referral care for severe paediatric malaria
Author(s) -
Amboko Beatrice,
Machini Beatrice,
Githuka George,
Bejon Philip,
Zurovac Dejan,
Snow Robert W.
Publication year - 2022
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13728
Subject(s) - kenya , malaria , referral , medicine , public health , public sector , developing country , protozoal disease , health care , environmental health , family medicine , pediatrics , nursing , political science , economic growth , immunology , economics , law
Abstract Objective To assess readiness among primary public health facilities in Kenya to provide pre‐referral antimalarials for severe malaria. Methods Nine national surveys of randomly selected primary public health facilities undertaken bi‐annually between 2017 and 2021 were analysed. The outcomes included the availability of pre‐referral antimalarial drugs at the health facilities and health worker knowledge of recommended pre‐referral treatment for severe malaria. Results A total of 1540 health workers from 1355 health facilities were interviewed. Injectable artesunate was available at 46%, injectable quinine at 7%, and artemether at 3% of the health facilities. None of the facilities had rectal artesunate suppositories in stock. A total of 960 (62%) health workers were trained on the use of injectable artesunate. 73% of the health workers who had ever referred a child with severe malaria were aware that artesunate was the recommended treatment, 49% said that intramuscular injection was the preferred route of administration, and 60% stated the correct dose. The overall knowledge level of the treatment policy was low at 21% and only slightly higher among trained than untrained health workers (24% vs 14%; p < 0.001) and those with access to guidelines versus those without access (29% vs 17%; p < 0.001). Conclusions The readiness of primary health facilities and health workers to deliver appropriate pre‐referral care to children with complicated malaria in Kenya is inadequate. Further investments are required to ensure (a) availability of nationally recommended pre‐referral antimalarials; (b) appropriate training and supervision in their administration, and (c) monitoring of the entire referral process.