Factors influencing the use of evidence based guidelines in the management of malaria in pregnancy among health workers at Garissa Provincial Hospital, Kenya.

Abstract

Introduction: Evidence-based medicine is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patients care. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. Several evidence based guidelines have been developed by World health Organization (WHO) and have been adopted by the Ministry of Public health and Sanitation (MOPHS) and Ministry of Medical Services MOMS to assist the healthcare workers in providing the most cost effective management of patients. However, most of the guidelines still remain unavailable at the point of use. Anecdotal evidence show huge deviations from the guidelines in the management of various diseases at the points of use. Objective: To determined the factors influencing the use of Evidence-Based guidelines (EBG) in the management of malaria in pregnancy among health workers at Garissa Provincial Hospital, Kenya. Methodology: A descriptive, cross sectional study was carried out at Garissa Provincial Hospital in the month of July 2012. Purposive and Convenient sampling was deployed. Primary data was collected using pre-coded, structured questionnaire which was administered one by one to each of the health care workers and secondary data was collected through auditing of the patients files in the records. Key informants were used for collection of qualitative data in the respective heads of departments. Data Management and Analysis: SPSS version 17 was used to analyse data. Data was cleaned through running of frequencies to check for completeness and outliers and finally analysed. Qualitative data was analysed into categories named and coded; comparison of the codes to find consistencies and differences was established. Results 7 Thirty six health care workers were interviewed; the awareness of evidence based guidelines to treatment of malaria was at 88.9%. Of these 88.9%, 93.75% used the guidelines. Sixty percent (60%) of health care workers with more than 5 years of experience were aged at least 30years and above. The availability of the guidelines at point of use was found to be 25%. Eighty percent (80%) reported that CMEs were the main source of information regarding the awareness and use of the guidelines. Sixty six percent (66.7%) of the health care workers and 58.3% felt that lack of related deficiencies to continuous education and training and lack of formal training in medical and nursing school and lack of exposure to evidence respectively as the main contributors to lack of awareness. Sixty four (64%) of the health care workers cited shortage of health care workers as the main contributor to the lack use of the guidelines. Ninety one percent (91.9%) of all the malaria cases were diagnosed parasitologically. Seventy three percent (73%) of all malaria cases received parenteral quinine. Conclusion A huge discrepancy between the awareness, use and practice of the guidelines was established. To improve on the management of malaria in pregnancy, programmes to enhance awareness, continuing education for health care workers and address the health care worker shortage at the facility level should be encouraged.