TYPE OF ARTICLE: REVIEW ARTICLE
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OBJECTIVE: To assess factors influencing clinicians’ use of
evidence based guidelines in relation to management of malaria in pregnancy.
METHODS: A descriptive cross-sectional
survey was conducted to assess the factors affecting clinicians’ use of evidence based guidelines in management
of malaria at Garissa Provincial Hospital, a level V referral
facility in 2012. Purposive and convenient sampling were employed to
incorporate the health workers interviewed in the study. Level of knowledge of
the clinicians was scored against a standard guideline requirement tool. Both
primary and secondary data were collected, recorded and analysed using SPSS
version 17.
RESULTS: Thirty six health care workers were interviewed; Eighty percent (80%) of
them were aged 40 years and below and had more than 5 years of experience
working at level V hospital. Eighty nine percent (89%) of clinicians had heard
of the evidence based guidelines for treatment of malaria but only 17% were
knowledgeable on the content of the guidelines. A small proportion, 25% of the
clinicians accessed the guideline at point of use. Of those who had heard of the guidelines, (80%)
reported that CMEs were their main source of information. Fifty six percent
(56.7%), 33.3% and 10% who were not knowledgeable on the guideline felt that lack
of access clinical guidelines, lack of access to continuous medical education and
lack of formal training in medical and nursing schools respectively as the
major contributors to lack of knowledge and use of the guidelines. Level of
professional qualification or duration of clinical experience did not
significantly influence use of clinical guidelines (p= 0.596, p=0.641
respectively). Ninety four percent (94%), demonstrated willingness to
effectively use the guidelines if properly guided. Data also showed, contrary
to the guidelines, inappropriate use of antimalarial amongst cases with mild to
moderate malaria with 88% of the cases having inadvertently received parenteral
quinine instead of arthemether-lumafentrine (AL) or oral quinine.
CONCLUSION: There was a huge discrepancy between the acclaimed awareness vis a vis the use and
practice of the malaria treatment guidelines. The main barriers to correct knowledge
were lack of access to malaria guidelines at point of use, lack of access to CMEs
and minimal formal training at medical schools. To improve on the management of
malaria in pregnancy, provision of guidelines at point of care, programmes
enhancing awareness through effective continuous medical education and proper pre-service
training of health care workers are recommended.
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