title: Perceptions of malaria and acceptance of rapid diagnostic tests and related treatment practises among community members and health care providers in Greater Garissa, North Eastern Province, Kenya.
abstract: BACKGROUND
  Conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. These methods, if not carried out exactly, easily result in the over- or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes. Using the setting of a pilot introduction of malaria RDTs in Greater Garissa, North Eastern Province, Kenya, this study aims to identify and understand perceptions regarding malaria diagnosis, with a particular focus on RDTs, and treatment among community members and health care workers (HCWs).
  
  
  METHODS
  The study was conducted in five districts of Garissa County. Focus group discussions (FGD) were performed with community members that were recruited from health facilities (HFs) supported by the MENTOR Initiative. In-depth interviews (IDIs) and FGDs with HCWs were also carried out. Interview transcripts were then coded and analysed for major themes. Two researchers reviewed all codes, first separately and then together, discussed the specific categories, and finally characterized, described, and agreed upon major important themes.
  
  
  RESULTS
  Thirty-four FGDs were carried out with a range of two to eight participants (median of four). Of 157 community members, 103 (65.6%) were women. The majority of participants were illiterate and the highest level of education was secondary school. Some 76% of participants were of Somali ethnicity. Whilst community members and HCWs demonstrated knowledge of aspects of malaria transmission, prevention, diagnosis, and treatment, gaps and misconceptions were identified. Poor adherence to negative RDT results, unfamiliarity and distrust of RDTs, and an inconsistent RDT supply were the main challenges to become apparent in FGDs and IDIs.
  
  
  CONCLUSIONS
  Gaps in knowledge or incorrect beliefs exist in Greater Garissa and have the potential to act as barriers to complete and correct malaria case management. Addressing these knowledge gaps requires comprehensive education campaigns and a reliable and constant RDT supply. The results of this study highlight education and supply chain as key factors to be addressed in order to make large scale roll out of RDTs as successful and effective as possible.
authors.forename: Emma
authors.initials: E
authors.lastname: Diggle
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.forename: Georgia
authors.initials: G
authors.lastname: Gore-Langton
authors.forename: Erupe
authors.initials: E
authors.lastname: Nahashon
authors.forename: James
authors.initials: J
authors.lastname: Mungai
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harrison
authors.forename: Abdullahi
authors.initials: A
authors.lastname: Abagira
authors.forename: Katie
authors.initials: K
authors.lastname: Eves
authors.forename: Zoya
authors.initials: Z
authors.lastname: Grigoryan
authors.forename: David
authors.initials: D
authors.lastname: Soti
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juma
authors.affiliation: The MENTOR Initiative, Crawley, UK. richard@mentor-initiative.net.
authors.forename: Richard
authors.initials: R
authors.lastname: Allan
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012111:Residence Characteristics; D055815:Young Adult