Malaria diagnosis in rural healthcare facilities and treatment-seeking behavior in malaria endemic settings in western Kenya

Abstract

Accurate diagnosis and timely treatment are central requirements for effective malaria management in communities. However, in resource-constrained settings, healthcare facilities are likely to be few, inaccessible, and ill-equipped with frequent drug or rapid diagnostic test kit (RDT) shortages. This may jeopardize much-needed quality care for patients and may have an impact on treatment-seeking behavior among the local population. The study’s goal is to determine treatment-seeking behavior, malaria diagnosis and treatment, and likely treatment-seeking determinants in the local population. Passive case detection, which targeted all patients with suspected malaria cases, was conducted in ten public healthcare facilities over a three-month period. Monthly malaria cases, methods of diagnosis and antimalarial drug availability were for use under a CC0 license. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. medRxiv preprint doi: https://doi.org/10.1101/2023.01.05.23284237; this version posted January 6, 2023. The copyright holder for this preprint .

assessed. A household-based survey was also carried out. Structured questionnaires were used to collect data from household heads. Malaria knowledge, treatment seeking behavior, and predictors of malaria treatment-seeking were all determined. Three of the seven dispensaries lacked a laboratory to conduct microscopy-based diagnosis. These three dispensaries also experienced frequent RDT stock-outs, which resulted in a clinical diagnosis of malaria. The majority of local residents with fever (50.3%) purchased antimalarial drugs from a chemist. About 37% of fever patients sought treatment at healthcare facility while the remaining 12.7% did nothing. In irrigated areas, 45.5% (46/64) of fever patients sought treatment at healthcare facilities, compared to 25% (18/64) in non-irrigated areas (p = 0.009). Most children aged below 5 who had fever (77.7%) were taken to healthcare facility for treatment compared to 31.4% of older children or 20.9% of adults (0.0001). Predictors of treatment seeking included access to healthcare facility (OR = 16.23, 95% CI: 2.74-96.12), and ability to pay hospital bill (OR = 10.6, 95% CI: 1.97- 57). Other factors that influenced health-seeking behavior included the severity of symptoms, the age of the fever patient and knowledge of malaria symptoms.