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Study puts Wajir first in accurate diagnosis

Sunday August 4 2019

public hospitals

Patients queue for consultation at Bondeni Sub-County Hospital in Nakuru on September 4, 2018. Medics at public hospitals have a higher rate of making correct diagnosis. PHOTO | FILE | NATION MEDIA GROUP 

ANGELA OKETCH
By ANGELA OKETCH
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BERNARDINE MUTANU
By BERNARDINE MUTANU
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Nine out of 10 persons treated by healthcare providers in Wajir County are correctly diagnosed, compared to Vihiga County where five out of 10 patients are misdiagnosed, a Kenya Health Service Delivery Indicator Report shows.

The study results released on Thursday revealed that Wajir was the best county in terms of diagnosis that stood at 89 per cent, followed by Garissa at 88 per cent.

Narok and Kajiado tied at third position with 83 per cent diagnosis accuracy. Isiolo emerged fourth with 79 per cent.

The five worst counties included Vihiga at 49 per cent, Lamu 56 per cent and Nyeri 59 per cent. Four counties (Laikipia, Trans Nzoia, Kirinyaga and Siaya) tied at the fourth worst counties at 60 per cent followed by (Homa Bay, Tana River, Machakos and Kisumu) at 61 per cent.

“From the findings, doctors in Wajir are more efficient as far as the diagnosis is concerned. In the next report, I think we will be able to answer the question ‘why’ more comfortably,” National Council for Population and Development director-general Josephine Kibaru said when releasing the data.

BELOW PAR

Surprisingly, counties in the arid regions with fewer doctors got it right as far as correct diagnosis of patients is concerned compared to the ones in urban set-ups with more doctors.

The 2015 Kenya Health Workforce Report, "The Status of Healthcare Professionals in Kenya", prepared by the Ministry of Health and America's Emory University and released in 2017, revealed that Kenya is still far from the World Health Organisation’s recommended ratio of 44.5 nurses, physicians and doctors for 10,000 people.

Kenya is at a distant 14 per 10,000 patients while some of the best counties with diagnostic results (Mandera, Wajir, Tana River, Nandi, Samburu, Narok, Turkana and Busia) had less than one caregiver per 10,000 patients.

The study sampled 3,094 health facilities (1,781 public and 1,313 private facilities) across the country between March and July 2018.

It revealed that the provider's ability and knowledge to diagnose the conditions was very low.

The survey was conducted by the National Council for Population and Development in conjunction with the World Bank and the United Nations Population Fund.

CHILD MORTALITY

According to the findings, researchers chose conditions with presentable symptoms that make it easier for assessing provider ability to reach a correct diagnosis with the simulation tool.

The study looked at successful diagnosis and management of six conditions that are the most common cause of maternal and neonatal deaths during birth.

“Two of the conditions were childhood conditions — severe dehydration and pneumonia. Adult conditions looked at in the study are pulmonary tuberculosis, type 1 diabetes, post-partum haemorrhage and neonatal asphyxia,” the study says.

Ms Kabiru said the successful diagnosis and management of these six conditions could avert a large share of child and adult morbidity and mortality.

“Results from the survey actually tells us that providers’ ability and knowledge on the conditions is low,” she said.

From the survey, the healthcare providers could correctly diagnose about two thirds, at 68 per cent, of the four conditions.

EXPERTISE

Doctors correctly diagnosed the conditions than clinical officers at 76 per cent and 74 per cent respectively, whereas nurses could diagnose only 60 per cent of conditions.

It also revealed that one was better off treated in a public than a private facility.

The data shows that health workers in public facilities are more efficient in diagnosis compared to those working in private facilities, with 83.1 per cent of doctors based in public facilities being able to diagnose correctly against 68.5 per cent in private facilities.

On the other hand, 61.2 per cent of nurses in public health facilities were able to diagnose the conditions correctly compared to 57.3 per cent in private facilities.

The same trend continues with clinical officers with 76.5 per cent (public) against 71.3 per cent (private) being able to diagnose correctly.

TREATMENT

Similarly, higher-level facilities correctly diagnosed the conditions at 76 per cent, health centres at 68 per cent and dispensaries at 64 per cent.

“Across the sector, all levels of public facilities were better in terms of diagnosis than private facilities,” Ms Kibaru said.

According to the research, 76 per cent of doctors in the country can diagnose correctly the conditions, while 74 per cent of clinical officers and 60 per cent of nurses can diagnose the ailments correctly.

Diagnostic accuracy rate varied across case conditions, ranging from 97 per cent accuracy for pulmonary tuberculosis to 32 per cent for severe dehydration.

“An accurate diagnosis however is unfortunately not guaranteed for providing the correct treatment,” she said.

According to the findings, there are discrepancies between diagnosis and treatment across the board, revealing a critical disconnection in providers’ knowledge and follow up.