Implementation fidelity of malaria test and treat guidelines amongst healthcare providers in Kisumu, Kenya, 2019

Abstract

Background: Malaria is an infection of global importance affecting over 3 billion people annually. Sub-Sahara Africa accounts for over 80% of global infections and nearly 90% of mortalities. In Kenya, malaria contributes 8% of the disease burden in the population nationally and over 50% in the Lake and Coastal regions. The WHO recommended test and treat guidelines for malaria in 2010 thus standardizing the treatment of malaria. Kenya adopted the guideline that year. The purpose of this study was to assess the implementation fidelity of malaria test and treat guidelines amongst healthcare providers working in the outpatient department in health facilities in Kisumu, Kenya.Methods: This was a quantitative cross-sectional study design that utilized multistage sampling. Available and willing providers working in the outpatient departments of study facilities were enrolled upon being informed about the details of the study and their rights. Signed informed consent was obtained before data collection. Data collection was done by the researcher using a web-based questionnaire built-in REDCap. Data analysis was conducted in Stata 15.1. The scores of the items for implementation fidelity and determinants that were assessed on a Likert or binary scale were checked for internal consistency; and, subsequently summed to generate composite scores for the variables for each participant. Descriptive and inferential analyses were done, and a non-parametric regression model fitted.Results: The mean implementation fidelity was 69.5% (±4.0%). Implementation content and dose were the better dimensions of fidelity at 72.4% and 69.7% respectively, intervention differentiation and quality of delivery followed at 66.3% and 61.4%. The determinants that positively influenced implementation fidelity were females, 1.5 (95% CI: 0.28 – 2.95; p=0.0460); knowledge, 0.1 (95% CI: -0.01 – 0.14; p=0.0710); nature of intervention, 0.1 (95% CI: 0.01 – 0.12; p=0.0190); and, implementation context, 0.1 (95% CI: -0.01 – 0.28; p=0.0680). Whereas facilitation strategies, - 0.1 (95% CI: -0.09 - -0.02; p=0.0010); and nonclinicians, - 1.5 (95% CI: -3.0 – 0.06; p=0.0570) negatively influence the outcome variable.Conclusion: The implementation fidelity of 69.5% was moderate considering malaria test and treat guidelines aim at 100%. The sex of the provider and the nature of the intervention were significant facilitators of implementing with fidelity, facilitation strategies were a significant hindrance. Further research on hindering determinants, as well as knowledge of malaria and utilization of non-clinicians which had some evidence of association with implementation fidelity, could generate knowledge on how to better implementation fidelity.