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

“This thought provoking abstract of a study in Homa Bay County, Kenya was published 7/20/2023.  It points to continued issues to contend with in the efforts to treat and reduce malaria incidents.  The need for a steady supply of treated bed-nets, the monitoring of usage and replacement of the same; stock outs of antimalarial drugs and rapid diagnostic test kits; malaria education of villagers, vector management, and follow up are critical for successful programs”

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

Authors: Collince J. Omondi, David Odongo, Wilfred O. Otambo, Kevin O. Ochwedo,  Antony Otieno,  Ming-Chieh Lee, James W. Kazura, Andrew K. Githeko, Guiyun Yan

Accurate malaria diagnosis and timely treatment are requirements for effective management of the disease. However, treatment efficacy may be significantly reduced in resource-constrained healthcare facilities with poorly equipped laboratories and frequent drug and rapid diagnostic test kit (RDT) stock-outs. Furthermore, patients may avoid seeking treatment from such facilities. The study’s goal was to determine treatment-seeking behavior, malaria diagnosis and treatment quality, 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 assessed. A household-based survey was also carried out. Structured questionnaires were used to collect knowledge, attitude and practice (KAP) 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- diagnosis. These three dispensaries also experienced frequent RDT stock-outs, which resulted in depending on clinical signs as diagnosis for malaria. 

  • The majority of local residents with fever (50.3%) purchased antimalarial drugs from a chemist. 
  • About 37% of fever patients sought treatment at a healthcare facility while the remaining 12.7% did not treat their fevers. 
  • 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 facilities for treatment compared to 31.4% of children aged 5–14 years or 20.9% of adults (0.0001).
  • Predictors of treatment seeking included access to healthcare facilities (OR = 16.23, 95% CI: 2.74–96.12), and ability to pay hospital bills (OR = 10.6, 95% CI: 1.97–57)
  • Other factors that influenced health-seeking behavior included the severity of symptoms, the age of the patient and knowledge of malaria symptoms.


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