Guideline-concordant care and outcomes for pediatric malaria cases: descriptive evidence from pharmacy-based fever management in Kenya.

backgroundFebrile illness remains a leading cause of morbidity and mortality among children under five in sub-Saharan Africa. In Kenya, pharmacies are a common first point of care for childhood fevers, yet important questions remain about the quality of care provided in these settings and how consistently it aligns with national malaria treatment guidelines. This study examines the care received and outcomes for pediatric suspected malaria illness episodes managed in private pharmacies in malaria-endemic regions of Kenya.

methodsA longitudinal cohort study was conducted at 39 private stand-alone pharmacies. Caregivers of children under five presenting with fever were surveyed at the point of care and followed up via phone two weeks later. The study assessed whether children received malaria diagnostic testing, whether treatment was guideline-concordant (i.e., antimalarial treatment for confirmed malaria), and whether the child had recovered at follow-up. Logistic regression models using Lasso-selected covariates identified predictors of diagnostic testing and appropriate treatment.

resultsAmong 239 febrile children treated at an included pharmacy, 69% received a malaria diagnostic test. Of those tested, 59% were malaria-positive, and 78% of these received appropriate antimalarial treatment. Only 3% of malaria-negative children received antimalarials. Among malaria-positive children treated with antimalarials, 88% had fully recovered at follow-up. Predictors of diagnostic testing included caregiver education, younger child age, and provider malaria knowledge. Appropriate treatment was more likely for older children, male children, and when providers had more years of experience.

conclusionsPharmacies in this sample demonstrate high adherence to malaria diagnostic and treatment guidelines for pediatric febrile illness, with strong alignment between diagnosis and treatment and high rates of illness resolution. However, heterogeneity in care quality based on caregiver, child, and provider characteristics suggests opportunities to improve equity and consistency in pharmacy-based care. These findings underscore the importance of pharmacies in malaria case management and highlight the need for further research and policy attention to this critical access point in the healthcare system. Trial registration Not applicable.