Abstract:
Prompt diagnosis and effective treatment of acute malaria in pregnancy (MiP) is
important for the mother and fetus; data on health-care provider adherence to diagnostic
guidelines in pregnancy are limited. From September to November 2013, a crosssectional survey was conducted in 51 health facilities and 39 drug outlets in Western
Kenya. Provider knowledge of national diagnostic guidelines for uncomplicated MiP
were assessed using standardized questionnaires. The use of parasitologic testing was
assessed in health facilities via exit interviews with febrile women of childbearing age
and in drug outlets via simulated-client scenarios, posing as pregnant women or their
spouses. Overall, 93% of providers tested for malaria or accurately described signs and
symptoms consistent with clinical malaria. Malaria was parasitologically confirmed in
77% of all patients presenting with febrile illness at health facilities and 5% of simulated
clients at drug outlets. Parasitological testing was available in 80% of health facilities;
92% of patients evaluated at these facilities were tested. Only 23% of drug outlets had
malaria rapid diagnostic tests (RDTs); at these outlets, RDTs were offered in 17% of
client simulations. No differences were observed in testing rates by pregnancy trimester.
The study highlights gaps among health providers in diagnostic knowledge and practice
related to MiP, and the lack of malaria diagnostic capacity, particularly in drug outlets.
The most important factor associated with malaria testing of pregnant women was the
availability of diagnostics at the point of service. Interventions that increase the
availability of malaria diagnostic services might improve malaria case management in
pregnant women.