Use of antibiotics and antimalarials in the management of febrile illnesses in children in public health facilities in Western Kenya

Abstract

Background: Malaria is a global tropical disease associated with high morbidity and mortality, especially among the children. Over 90% of its distribution is in Africa with a high burden of the disease being felt in Kenya. Many diseases present clinically with fever and Integrated Management of Childhood Illnesses (IMCI) advocates for the use of antibiotics for other infections and antimalarials for malaria. With the signs and symptoms of malaria resembling those of other diseases, many febrile conditions are treated clinically as malaria. The current first line treatment for malaria is artemisinin-based combination therapy after resistance to earlier medications occurred with its unnecessary use caused by presumptive treatment practices that assume most febrile illnesses are caused by malaria. Without laboratory confirmation of malaria, continued use of artemisinin-based combination therapy on non-malaria cases may soon lead to resistance due to their unnecessary use. A randomized control study was put in place with the primary objective of testing whether financial incentives offered (to intervention group) at the facility level improve targeting of antimalarials to patients with parasitologically diagnosed malaria. This is a sub-study of the above describing the role of antibiotics and antimalarials in the management of febrile illnesses among children. Objectives: The main objective of this study was to describe the prescription habits of both antimalarials and antibiotics in the management of febrile illnesses among children. Methodology: This was a comparative, records-based cross-sectional study carried out in 17 public health facilities of high and low malaria endemicity in the western region of Kenya. Health facility records were reviewed by use of a checklist and data was analysed using STATA analysis package by use of descriptive statistics as well as logistic regressions. These were then presented in prose and in form of tables and graphs. Results: A total of 6086 children under the age of 5 years were included in the study with a mean age of 2 years and 51.2% being female. Among the 2124 study subjects who received antibiotics and other treatment regimens including paracetamol, zinc sulphate, ORS and piriton, (37.5% of intervention and 31.8% of control) most of them received cotrimoxazole dispensed at 46%. Positive blood smear results for public health facilities in Western Province and Rift Valley Province were 26.5% and 11.6% respectively. Among those who received medication, 70% of those with a negative blood smear result were given antibiotics and 68% of those with a positive blood smear result got AL. Conclusions: Antibiotics are used according to IMCI guidelines with healthcare workers in the intervention group using them more than healthcare workers in the control group. Twice as many children had positive malaria smears in the public health facilities in Western Province compared to the public health facilities in Rift Valley Province and patients with positive blood smear results receive AL while those with other diseases receive antibiotics.