Wednesday, May 15, 2019

PREDICTORS OF PRESUMPTIVE TREATMENT OF UNCOMPLICATED MALARIA AMONG CHILDREN IN PRIVATE RETAIL OUTLETS IN KENYA: MIXED EFFECTS LOGISTIC REGRESSION MODELLING


A Masters Degree Research Proposal by Diana Kemunto Omache
W62/6828/2017
University of Nairobi

 ABSTRACT

Introduction: Malaria is a global health problem and the World Health Organization (WHO) estimates that nearly a half (3.4 billion) of the world’s population is at risk of the disease. WHO African region continues to have a disproportionately global malaria burden. According to the 2018 WHO malaria report, the estimated morbidity and mortality reported currently is 92% and 93% respectively which is the malaria burden in Africa.
Although the burden of Malaria is high in the Sub-Saharan Africa, the Ministry of Health through the National Malaria Control Program has implemented comprehensive evidence-based strategies and policies to fight this disease in Kenya. About 25% of the population in Kenya seeks medical care form the private retail sector. To attain the Sustainable Development Goals (SDGs), Universal Health Coverage is key in ensuring quality of care for all malaria patients.
The WHO recommends that all suspected malaria cases should be tested with RDTs or microscopy before treatment. However, inappropriate treatment practices (presumptive treatment) of uncomplicated malaria among children has been a major challenge in Kenya.  Several studies have been conducted on presumptive treatment of malaria among children with a major gap in literature identified on predictors of this treatment. The study results will strengthen interventions in malaria management in the private retail sector.
Objectives: The objectives of this study are to determine the proportion of health care providers who treat uncomplicated malaria presumptively; factors associated with presumptive treatment of uncomplicated malaria and predictors of presumptive treatment of uncomplicated malaria among children in private retail outlets in Kenya.
Methodology: The study design will be a secondary data analysis from a cross-sectional, nationally representative, private retail outlet survey. The study populations will include the health care providers in the retail outlets sampled randomly in both the rural and urban settings in Kenya. Descriptive statistics will form the basis of analysis for the selected indicators through frequencies and percentages. Bivariate analysis will be conducted using the chi-square test to determine the factors associated with presumptive treatment of uncomplicated malaria among children. Mixed effects logistic regression modelling to adjust for clustering at the county level will be done to determine the predictors of presumptive treatment of uncomplicated malaria among children. The best fitting model will be examined using the Akaike Information Criterion (AIC).   Data will be cleaned, coded and analyzed using the R software and presented in tables.

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