Evaluation of adherence to WHO guidelines for prescription of artemisinin combination therapy (ACTs) and artesunate in Kilifi County, Kenya

Malaria is a vector-borne disease caused by a protozoan parasite in the genus Plasmodium. The parasite is transmitted by female mosquitoes in the genus Anopheles. The disease is common within the tropics, especially in sub-Saharan Africa. The major early clinical features are fever accompanied by headache, joint pains, malaise, vomiting, and diarrhoea. These symptoms are some instances used as a diagnosis for malaria infection without confirmatory laboratory tests; followed by prescription of first-line antimalarials, mainly artemisinin combination therapy (ACTs). This trend of prescribing antimalarials to patients presenting with malaria-like symptoms without confirmatory laboratory tests is contrary to World Health Organization’s (WHO) recommended guidelines. Such practices pose a great risk for suboptimal medication, development of resistance against the drugs, treatment failure, and increased morbidity and mortality. Therefore, this study was conducted to evaluate adherence to WHO-recommended guidelines for prescription of ACTs and artesunate. This was a cross-sectional study in four health facilities in Kilifi County for a period of one year. 9,940 participants consented to inclusion in the survey. Pre- and post-ACTs/artesunate prescription data was captured using standardized case record forms. Out of the 9,940 patients, 80.4% had confirmed malaria infections, out of which 60% (n = 4,795) were males. 48% (n = 3,836), of the malaria cases were from rural areas. 17% (n = 1,359), of the positive cases were severe malaria, with 92% (n = 1,251), being in children under the age of 15 years old. Adherence to WHO guidelines for diagnosis of malaria was, at 99% (9,841/9,940), with Rapid diagnostic test as the most used technique, at 74% (n = 7,356). Adherence to WHO guidelines for prescription of ACTs was, at 48% (3,184/6,633), with Coartem as the most prescribed ACT, at 98% (n = 6,436). Adherence to WHO guidelines for prescription and administration of artesunate was, at 82% (1,114/1,359). Artesunate injection was administered to all cases of severe malaria. Adherence to WHO guidelines for prescription of ACTs and artesunate in Kilifi County had improved substantially, although there exists a room for improvement, especially on instructions on how to take the ACT medications following hospital discharge. Therefore, stakeholders, especially the county’s ministry of health, should put more effort into further improvement through seminars, short training courses, and workshops to reduce the disease burden and prevent the likelihood of the development of ACTs and artesunate resistance by malaria parasites in the region.