Utilization of laboratory services in management of febrile children at a referral hospital in Kenya: a clinicians’ view

Abstract

Problem Statement: Fever is the commonest manifestation of many paediatric infections present in many health facilities in sub-Saharan Africa. The use of laboratory diagnostic services is critical to support diagnosis and treatment of these infections. Setting: Moi Teaching and Referral Hospital. Study Population: Clinicians attending and supervising the outpatient paediatric clinic. Objective: To describe the perception of and the extent of the utilization of the laboratory services to establish cause of fever in outpatient setting at a national referral facility in Kenya. Methodology: A cross-sectional survey involving administration of a questionnaire to the clinicians between July 2010 and February 2011. Fifty four clinicians systematically sampled over the study period filled this questionnaire which captured data on the perception, utilization and reliability of the laboratory services to support outpatient treatment of the febrile children in outpatient settling. Results: There was a high prevalence of presumptive diagnosis with 98.2% clinicians commencing antimalarial treatment without blood smears, 86.7% treating sepsis without blood culture, and 83.3% treating tuberculosis without AFB results. Most clinicians thought that the laboratory tests were reliable (72.3%) and accurate (83.3%). There were variations in the availability of the laboratory tests with malaria test being the commonest (83.4%) and blood culture being the least available (11%). The perceptions of the availability of these tests did not determine the frequency to which they were utilized to support diagnosis and treatment. However, only half of them (50%) perceived them to influence their clinical decision. Conclusion: It is clear that clinicians treat their patients at MTRH based on presumptive diagnosis despite availability of laboratory services that were prescribed to be accurate. Recommendation: Further research is needed to establish the difference between practice and perceptions of laboratory services by clinicians.