Assessment of adherence to the National Malaria Guidelines in treatment management of malaria among children under five in integrated community case management in the DRC

Despite improved access to malaria healthcare, adherence to the National Malaria Guidelines for maintaining quality of care remains a concern in the DRC. We aimed to assess whether the management of malaria cases for children under 5 years of age using Integrated Community Case Management (ICCM) is conducted according to the National Malaria Guidelines in the DRC. We used a sample of 2,326 children from 30 ICCM sites. To determine adherence, we compared treatments received with items recommended by the National Malaria Guidelines. The chi-square tests were used to assess adherence to guidelines. Multiple logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to assess the association between the provinces and adherence to guidelines. About 63.8% of children had malaria, and 94.8% (n = 1,407) of children who were clinically diagnosed with malaria received rapid diagnostic test (RDT) vs. 2.8% (n = 42) children who did not receive RDT, p-value = 0.0001. Additionally, those who had malaria were more likely to receive malaria treatment (93.4% vs. 6.6%, p-value = 0.0001). However, 18.5% of children who did not have malaria still received malaria treatment (p-value = 0.0001). Compared to Lualaba, ICCM sites in Kasai Oriental were more likely to adhere to RDT testing (AOR = 1.89, CI: 1.51-2.37) and Tanganyika was less likely to adhere to RDT testing (AOR = 0.40, CI: 0.81-0.92). Our study provides insight into ICCM's compliance with the malaria guidelines in the DRC, which can inform programs and contribute to improving adherence to guidelines and the quality of care.