Strategic intervention: Malaria Case Management

The main objective of the case management strategic intervention is the provision of good quality, safe and effective treatment for malaria patients. It's objective as outlined in the Kenya Malaria Strategy 2014 – 2018 is to have 100% of all suspected malaria cases presenting to a health provider managed according to the national malaria treatment guidelines by 2018.

This objective will be achieved through the following strategies:

  1. Capacity building of health workers in malaria diagnosis and treatment at health facilities.
  2. Access to affordable malaria medicines and diagnostics through the private sector.
  3. Strengthening  community case management of malaria using the community strategy through Community Health Workers (CHW).
  4. Ensuring commodity security of anti-malarials and diagnostics in the public sector.

Kenya changed her treatment policy to the more effective ACTs in 2004 in line with the WHO recommendations for the management of uncomplicated malaria. The policy was implemented in June 2006. The table below shows a summary of the treatment policy.

Table 1: Summarized Malaria Standard Treatment Guidelines

Condition Medication Strength Formulation
Uncomplicated malaria Artemether-Lumefantrine tablets packed differently for the different weight categories 20mg Artemether + 120mg Lumefantrine Tablets single dose packed for the different weight categories
Severe malaria   Artesunate 120mg Vials
Artemether Vials
Quinine 300mg Ampoule
Quinine dihydrochloride 300mg tablets
Quinine bisulphate 300mg tablets
Quinine Sulphate 300mg tablets
Quinine hydrochloride 300mg tablets
Intermittent Preventive Treatment Sulphadoxine/pyrimethamine 500mg Sulphadoxine + 25mg pyrimethamine Tablets
Prophylaxis non-immune visitors Mefloquine hydrochloride 250mg Tablets
Atovaquone – Proguanil adult 250mg Atovaquone + 100mg Proguanil
Atovaquone – Proguanil pediatric 62.5mg Atovaquone + 25mg Proguanil
Doxycycline hydrochloride 100mg
Prophylaxis for sickle cell disease patients and persons with splenomegaly Proguanil hydrochloride 100mg Tablets
Pre-referral treatment Artemether injection

80mg/ml adult

20mg/ml pediatric

Vials
Artesunate injection 60mg/ml
Artesunate rectal caps 100mg or 400mg Suppositories
  • The ministry ensures that national guidelines for malaria diagnosis and treatment are distributed free of charge to both government and private sectors health facilities in order to ensure effective management of patients at all levels.

    • Artenether-Lumefemtrine (AL) drugs are provided at no cost to the patients in the public and mission health facilities.

      • Given the high cost of the AL drugs, it has been found prudent to ensure that there is confirmatory diagnosis of all suspected malaria cases, hence the government aims at improving diagnostics and using Rapid Diagnostic Tests (RDT) in peripheral health facilities without microscopy facilities.


Training of health workers on malaria case management

  • At the National level, treatment guidelines, training modules and reference materials on malaria diagnosis and treatment have been updated and are issued to health workers during training.

  • Training of health workers has been carried out targeting both government and private sectors.

  • NMCP and CHMT support supervision visits is regularly done to monitor the effective trainings of malaria case management. This is done by standard checklist which was developed by the National trainers.

  • The caretakers’ of febrile children common action is to seek care from private and OTCs. Private pharmacy and OTC staffs have been trained on malaria case management, recognition of severe malaria signs, referral advices and appropriate drug storage in order to improve prescriber practices among the outlets.



Access to effective care

  • In order to improve effective case management, it is important that care-seeking behaviours are changed. The care givers need to promptly seek care for febrile illness from a health facility or in a registered pharmacy and recognise the danger signs of severe febrile illness.

  • Due to this, the NMCP has made various efforts such as training health workers in both public and private health facilities in order to increase access to effective malaria case management.

  • In the endemic regions such as Nyanza and Western, CHW have been trained on the malaria case management and is currently being practiced in those regions.

 


Drug regulation, supply and effectiveness

  • Kenya Medical Supplies Agency (KEMSA) purchases drugs used in the public sector. It has its own quality control mechanisms. The ongoing liaison between the NMCP and KEMSA will ensure a continuous supply of high quality anti-malarial drugs to public health facilities.

  • The commodities once purchased are supplied to health facilities based on a distribution list generated by the NMCP. The system operates on a pull basis. The health facilities have been issued with tools for consumption reporting on a monthly basis. They record each dose dispensed and at the end of the month give a summary of stock status, consumption, stock out days and early expiries.

  • County pharmacists have been supported to do intra county re-distribution by moving the drugs from overstocked facilities to stock-outs facilities.

  • Pharmacovigilance, described as the science and activity relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine-related problem has also been implemented by the Pharmacy and Poison's Board in Kenya. The NMCP which is keen on closely monitoring the safety of all anti-malarials in the country especially AL drug has been actively involved in the implementation of the system.

  • The main achievement includes training of the health workers in public and private health care workers on malaria case management.

  • The NMCP together with research organisation continues to monitor the efficiency of currently used and alternative anti-malarial treatments drugs every two years.

  • The NMCP undertakes annual surveys on the quality of anti-malarials in circulation as part of Post Market Surveillance in conjunction with the PPB, WHO, HAI Africa and NQCL and partners.



Diagnostics

  • Many health workers in the public and private sectors do the diagnosis of malaria on a clinical basis. In order to increase diagnostic capacity the NMCP has introduced RDTs at health facilities without microscopy in order to ascertain diagnosis. Microscopy has also been strengthened through supply of microscopes along with the training of health workers on microscopy.

  • Quality control mechanism for laboratory diagnosis is currently being implemented through trainings and regular support supervision visits at facilities with laboratory services in order to improve the performance of laboratory services to support the correct management of malaria cases and to detect malaria treatment failures.

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