Lack of patient risk counselling and a broader provider training affect malaria control in remote Somalia Kenya border: Qualitative assessment

Abstract

Effectiveness of providing health education solely via mass media and the providers’ targeted training in malaria control needs further exploration. During pre-epidemic season, we conducted a qualitative study of 40 providers and community leaders using focus groups, comprehensive semi-structured interviews and consultation observations. Interviews were transcribed, coded and analysed for major themes. Community leaders believe that they can acquire malaria from contaminated water, animal products, air or garbage. Consequently, they underutilise bed nets and other protective measures due to perceived continued exposure to other potential malaria sources. Practitioners do not provide individualised health counselling and risk assessment to patients during sick visits, leading to a range of misconceptions about malaria based on limited knowledge from rumours and mass media, and a strong belief in the curative power of traditional medicine. Providers overdiagnose malaria clinically and underutilise available tests due to time constraints, and the lack of training and resources to correctly diagnose other illnesses. Subsequently, misdiagnoses lead them to question the efficacy of recommended treatments. Promoting counselling during clinical encounters to address patient misconception and change risky behaviour is warranted. Wider-ranging ongoing training could enable providers to properly diagnose and manage differential diagnoses to manage malaria better.

Keywords:

• malaria
• training health provider
• malaria risk counselling
• malaria misdiagnosis
• community leaders
• qualitative

Acknowledgements

The authors wish to thank Dr. Jean Bernard Fournier, former technical director of The MENTOR Initiative, for his invaluable efforts and support to initiate and support MENTOR's programme in Mandera. We also thank the leadership and staff at the Kenyan National Malaria Centre and the Kenyan Red Cross for their invaluable assistance and facilitation of MENTOR's programme in Mandera. Authors declare no financial or other conflict of interest for this study and manuscript.