Recommended Standard Treatment Guidelines [GOK, MOH. Clinical guidelines, Nairobi, 2002]

• Children under age 5 years presenting with diarrhoea are normally prescribed ORS as a policy adopted by the Ministry of Health. The use of antibiotics and/or antiprotozoals should be for dysentery, suspected cholera or for suspected amoebiasis.

• In the treatment of mild/moderate pneumonia in children under 5 years, the first line antibiotic recommended is Amoxycillin or Co-trimoxazole. The use of more than one antibiotic is recommended in cases of severe pneumonia where two injectable antibiotics may be given.

• URTI is treated by using a first line antibiotic (Amoxycillin) and/or analgesic.

• In malaria management, SP drugs are the recommended regimen. However other medicines may be given but only in cases of SP being contraindicated, in cases of resistance or disease progression.

Treatment of diarrhoea in children under the age 5:

• The median percent use of ORS was found to be 25%.

• The median percent use of one or more antibiotics was found to be 50%.

• The median percent use of an antidiarrhoeal and/or antispasmodic was found to be 0%.

• In 29% of the public health facilities more than 90% of diarrhoea cases were treated using ORS, that is, less than 3 out of 10 public health facilities use ORS for the management of more than 90% of diarrhoea cases in children.

• 1 in 4 public health facilities use antibiotics for more than 90% diarrhoea cases in children.

Figure 4.20 Treatment of diarrhoea in children under age 5

Treatment of mild/moderate pneumonia (outpatient) in children under age 5:

• The median percent patients receiving any one first line antibiotic were found to be 50% while the median percent receiving more than one antibiotic was found to be 0%.

• 29% of the facilities were found to use a first line antibiotic in less than 25% of their patients while 58% of the facilities were found to use more than one antibiotic in less than 25% of their patients.

Figure 4.21 Treatment of mild/moderate pneumonia in children under age 5

Treatment of URTI:

• The median percent use of antibiotics was found to be 100%.

• 67% of facilities were found to prescribe antibiotics for more than 90% of their patients whereas 8% of the facilities prescribed antibiotics for less than 25% of their patients.

Figure 4.22 Treatment of URTI using antibiotics

Treatment of malaria:

• The median percent patients receiving SP was found to be 67%.

• The median percent receiving any other one antimalarial and that receiving more than one antimalarial was found to be 30% and 0% respectively.

• In 3 out of every 4 facilities, less than 25% of the patients were prescribed more than one antimalarial.

• 4% of the facilities had less than one quarter of their patients using SP.

• 33% of the facilities had less than one quarter of their patients using any other one antimalarial (other than SP).

• More than half (58%) of the public health facilities prescribed SP to more than 25% of their patients.

• Similarly, more than half (58%) of the public health facilities prescribed any other one antimalarial to more than 25% of their patients.

• Only 25% of the health facilities had more than one quarter of their patients using more than one antimalarial.

Figure 4.23 Trends in malaria treatment in public health facilities.