Clinicians' knowledge and practices in the diagnoses and management of non-malarial fever illnesses among under 5 children in Kisii County, Kenya

Abstract

Background: Indiscriminate fever management using antimalarial drugs escalates patients' health risk, especially those <5 years old, with the likelihood of accelerating the emergence and spread of drug-resistant malaria parasites. We assessed clinicians' knowledge and practices in diagnosing and managing non-malarial fever illnesses among children <5 years in Kisii County, Kenya. Methods: 193 nurses and clinical officers working in selected public health facilities in Kisii County were recruited into the study. Semi-structured questionnaires and individual interviews were used in collecting data. Chi-square was used in testing associations between categorical variables. Results: 94% (n=181) of the respondents were aware of other infectious illnesses other than malaria, 71% (n=137) were aware of fever as the primary clinical sign of malaria while 61% (n=118) of the respondents were aware of noninfectious sources where fever is the leading symptom. The frequently prescribed antipyretic drugs were paracetamol and Ibuprofen. Under the hematinic and vitamins category, clinicians commonly prescribed multivitamin syrups and iron blood tonics. 91% (n=176) of the study respondents reported that they occasionally-prescribed anti-malaria drugs for malaria negative diagnostic results. Knowledge and practices in diagnosis management of non-malaria illnesses, varied significantly among clinician’s who were in the rural and urban facilities (p=0.025, OR: 1.16, 95% CI: 0.02- 0.28). However, there was no association between level of knowledge of the enrolled nurses, registered nurse and clinical officer {(p=0.21, OR: 0.88, 95% CI: -0.32-0.07), (p=0.89, OR: 0.98, 95% CI: -0.26-0.23)} Conclusions: Clinicians in Kisii County reported prescribing anti-malarial drugs for malaria negative diagnostic results, highlighting the need for continuous field training in differentiating malarial and non-malarial fevers.

Keywords: Non-malaria, Fever, Clinician, Knowledge, Practices, Diagnosis