title: Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya.
abstract: BACKGROUND
  Monitoring implementation of the "test and treat" case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Using health facility surveys we monitored health systems readiness and malaria case-management practices prior to and following implementation of the 2010 "test and treat" policy in Kenya.
  
  
  RESULTS
  Between 2010 and 2013 six national, cross-sectional, health facility surveys were undertaken. The number of facilities assessed ranged between 172 and 176, health workers interviewed between 216 and 237 and outpatient consultations for febrile patients evaluated between 1,208 and 2,408 across six surveys. Comparing baseline and the last survey results, all readiness indicators showed significant (p<0.005) improvements: availability of parasitological diagnosis (55.2% to 90.7%); RDT availability (7.5% to 69.8%); total artemether-lumefantrine (AL) stock-out (27.2% to 7.0%); stock-out of one or more AL packs (59.5% to 21.6%); training coverage (0 to 50.2%); guidelines access (0 to 58.1%) and supervision (17.9% to 30.8%). Testing increased by 34.0% (23.9% to 57.9%; p<0.001) while testing and treatment according to test result increased by 34.2% (15.7% to 49.9%; p<0.001). Treatment adherence for test positive patients improved from 83.3% to 90.3% (p = 0.138) and for test negative patients from 47.9% to 83.4% (p<0.001). Significant testing and treatment improvements were observed in children and adults. There was no difference in practices with respect to the type and result of malaria test (RDT vs microscopy). Of eight dosing, dispensing and counseling tasks, improvements were observed for four tasks. Overall AL use for febrile patients decreased from 63.5% to 35.6% (p<0.001).
  
  
  CONCLUSIONS
  Major improvements in the implementation of "test and treat" policy were observed in Kenya. Some gaps towards universal targets still remained. Other countries facing similar needs and challenges may consider health facility surveys to monitor malaria case-management.
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Dejan
authors.initials: D
authors.lastname: Zurovac
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
authors.forename: Sophie
authors.initials: S
authors.lastname: Githinji
authors.affiliation: Division of Malaria Control, Ministry of Health, Nairobi, Kenya.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Memusi
authors.affiliation: Division of Malaria Control, Ministry of Health, Nairobi, Kenya.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kigen
authors.affiliation: Division of Malaria Control, Ministry of Health, Nairobi, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Machini
authors.affiliation: Management Sciences for Health, Nairobi, Kenya.
authors.forename: Alex
authors.initials: A
authors.lastname: Muturi
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Otieno
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.affiliation: Division of Malaria Control, Ministry of Health, Nairobi, Kenya.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nyandigisi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D003695:Delivery of Health Care; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D058996:Quality Improvement