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Health facility ledgers of 11 rural health facilities in western Kenya were reviewed to evaluate diagnostic and prescribing practices. Clinics lacked laboratory facilities. Of 14,267 sick child visits (SCVs), 76% were diagnosed with malaria and/or upper respiratory infections. Other diagnoses were recorded in less than 5% of SCVs. Although two-thirds of malaria cases were diagnosed with co-infections, less than 3% were concomitantly diagnosed with anemia. Chloroquine and penicillin constituted 94% of prescriptions. Half of children given a sole diagnosis of measles or pneumonia were prescribed chloroquine, and 22% of children with a sole diagnosis of malaria were given penicillin. Antimalarials other than chloroquine were rarely prescribed. Only 12% of children diagnosed with anemia were prescribed iron supplementation, while 53% received folic acid. This study highlights limited diagnostic and prescribing practices and a lack of adherence to national treatment guidelines in rural western Kenya.
Acknowledgments: The health facility recorders and their supervisor, Caleb Ouma, are thanked for their contribution to this study. We are grateful to Gideon Ogude and the out-patient department team for their precision with data management. We acknowledge the residents of Asembo for their cooperation during this study. Kathleen A. Wannemuehler acknowledges administrative support from the Oak Ridge Institute for Science and Education (Oak Ridge, TN). This paper has been published with the permission of the Director of the Kenya Medical Research Institute.
Financial support: The bed net project was funded by the United States Agency for International Development.
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Penelope A. Phillips-Howard, Kathleen A. Wannemuehler, Feiko O. ter Kuile, William A. Hawley, and Margarette S. Kolczak, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Amos Odhacha, and John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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