Knowledge, Attitudes and Practices On Malaria in Neonates among General Practitioners in District Hospitals in Kigali City A Qualitative Study.

Abstract

Background: Malaria during pregnancy can lead to adverse effects on the mother, fetus and neonate. Neonatal complications include intrauterine growth restriction, low birth weight, prematurity, intrauterine fetal demise, increased risk of anemia and increased risk for malaria during the first month of life. Cases of malaria in neonates have been previously reported in Rwanda with lack of specific guidelines on care to be provided to a neonate exposed to malaria. This study aimed at assessing the knowledge, attitudes and practices of general practitioners working in urban area on neonatal malaria. Methods: Qualitative data was collected through the use of semi structured interviews with 12 general practitioners working in maternity and neonatology wards at district hospitals located in Kigali City. The interview guide focused on the knowledge, attitudes and practices of general practitioners vis-à-vis diagnosing and managing malaria in neonates exposed to malaria in utero. A thematic analysis was applied to analyze data. Results: Thematic analysis revealed ten themes. Most of interviewed general practitioners revealed to know both congenital and acquired neonatal malaria. For neonates born from mothers who had malaria during pregnancy or labor, participants would monitor vital signs, especially fever. Respondents consider malaria in neonates who have fever, jaundice, anemia, hepatosplenomegaly or any neonate whose sepsis is not responding to antibiotics. Participants would exclusively use blood smear to investigate for plasmodia, and consider investigating for sepsis for any neonate suffering from malaria and vise-versa. Some respondents define severe neonatal malaria the same as severe malaria in the older children, while others think that all cases of neonatal malaria should be severe. Artesunate was mostly reported to be used to treat neonatal malaria with some reporting the use of artemether-lumefantrine. Respondents consider giving antibacterials to neonates suffering from malaria. Discussants reported to educate families of neonate recovering from malaria on the diagnosis, management, breastfeeding and prevention strategies; and consider giving a follow up plan for reassessing the baby. Different websites, national and World Health Organization’s guidelines and experienced clinical personnel were reported by participants to be consulted for information on malaria. Conclusion: The study showed the awareness of neonatal malaria existence, different opinions in classifying and managing neonatal malaria. Our study suggests a strong need in the guidelines for management of neonatal malaria, especially at district hospitals.