Background: Prevalence of irrational treatment practices among health providers exist despite improved malaria diagnostics. Special attention needs to be put on the health providers’ adherence to parasitological confirmation before treatment recommendation in order to reduce overtreatment of suspected cases without malaria.
Objectives: 1. To identify the socio-demographic characteristics of the health care providers that influence antimalarial prescription pattern. 2. To describe the prevailing antimalarial prescription pattern among health care providers in public health facilities. 3. To identify the factors that influence antimalarial prescription pattern to test negative cases among health providers in public health facilities.
Methods: Cross sectional mixed method study design was utilized to collect information on health providers and health facility in public health facilities in Uasin Gishu County, Kenya. Qualitative interviews conducted enabled in-depth investigation of the reasons for statistical data obtained. Multivariable logistic regression model was utilized, the odds ratios (OR) and respective 95% confidence intervals were used to evaluate potential factors influencing prescription of artemether lumefantrine to patients with malaria negative test. p-value of less than 0.05 was considered significant.
Results: Thirty six percent of malaria test negative cases were prescribed antimalarial of which more than half (58%) were under 5 years’. Clinical officers compared to the nursing officers’ were 2.68 times more likely to prescribe antimalarial to patients with a negative test (aOR= 2.68; 95% CI =1.11-6.46, p=0.028). There was no statistically significant difference in the distribution of age, gender, or duration in service among health providers who prescribed antimalarials to patients with negative test for malaria. The health providers in facilities that provides 24 hours laboratory diagnostic services were significantly less likely to prescribe antimalarial to patients with a negative test compared to those without (aOR= 0.36; 95% CI= 0.15-0.87; P=0.024). The health providers who trained recently (less than 6 months) were less likely to prescribe antimalarial without lab confirmation (OR=0.38; 95% CI 0.14-1.00, P=0.051).
Conclusions: Antimalarial prescription to test negative cases is still evident in public health facilities. This can be reduced by provision of frequent training and updates on the current malaria case management, provision of targeted interventions to improve reliability of malaria diagnostics as well as ensuring constant availability of the diagnostics.