The effect of non-adherence to treatment guidelines, quantification and distribution practices on antimalarial commodities inventory levels in healthcare facilities at Turkana County, Kenya

(2025) 24:298 Muyokani et al. Malaria Journal https://doi.org/10.1186/s12936-025-05560-x Malaria Journal Open Access RESEARCH The effect of non‑adherence to treatment guidelines, quantification and distribution practices on antimalarial commodities inventory levels in healthcare facilities at Turkana County, Kenya Brian N. Muyokani1*, Peter N. Karimi2, Taraiya F. Ntore1, Jean Habagusenga1 and Abiud M. Manyura3 Abstract Background Malaria is a global public health concern and a leading cause of morbidity and mortality, especially in children under the age of 5 years. In Kenya, it is among the top ten causes of morbidity and mortality as reported in the Kenya Health Information System (KHIS2). Adequate inventory levels of antimalarial medicines and rapid diagnostic test (RDT) kits must be available for proper malaria case management. Adherence to the malaria test and treat guidelinesand effective quantification, and distribution practices affect the health facility stock levels of antimalarial medicines and RDT kits. This study assessed the effect of non-adherence to treatment guidelines, quantification, and distribution on the inventory levels of antimalarial commodities in health facilities in Turkana County, Kenya. Methods This was a descriptive cross-sectional study across facilities in Turkana County. Simple random sampling was used to select 152 health facilities, of which 132 participated in the study. Data was collected using a researcheradministered questionnaire and an abstraction tool that was adapted from the standard logistics indicator abstraction tool (LIAT). Data analysis was done using descriptive statistics, including means, proportions, and percentages. Results Data was collected from 132 respondents, and the majority (98, 74.2%) were male. One hundred and eight (81.8%) were nurses. Only 35 (26.5%) facilities adhered to the treatment guidelines. Quantification for antimalarial medicines and RDT kits was done quarterly using the consumption method, and seasonality was not considered to forecast reorder quantities. Most facilities (80, 60.6%) cited the lack of vehicles as a major challenge during the interfacility redistribution of commodities. Most of the health facilities were overstocked with commodities. The facilities that adhered to test and treat had lower average months of stock (9.5) of commodities in all categories, compared to those that treated more patients than those confirmed malaria-positive (13.2). Conclusion Adherence to malaria treatment guidelines, quantification, and distribution practices for antimalarial medicines and RDT kits was suboptimal. This led to most facilities being overstocked with these commodities. Keywords Antimalarial medicines, RDT kits, Stock levels, Turkana County *Correspondence: Brian N. Muyokani Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Muyokani et al. Malaria Journal (2025) 24:298 Background Malaria remains a public health concern globally, with reports indicating that there were 247 million cases and 619,000 deaths in 2021 [1]. In Kenya, malaria is a leading cause of morbidity and mortality, especially in children under the age of 5 years, with Plasmodium falciparum being the commonest malaria-causing parasite. The World Health Organization (WHO) recommends treatment of P. falciparum malaria with artemisininbased combination therapy (ACT). Malaria is diagnosed primarily by microscopy or using RDT kits. In Kenya, the current malaria treatment guidelines recommend treating uncomplicated malaria-positive cases with artemether-lumefantrine (AL). According to commodity data for antimalarial medicines and RDT kits reported in the Kenya Health Information System (KHIS), health facilities in Turkana County were overstocked with an average of 9.7 months of stock of antimalarial medicines, while the average stock level of RDT kits was 4.9 months of stock in 2022. The recommended health facility stock levels for antimalarial medicines and RDT kits are between 3 and 6 months of stocks. Kenya reported 3,239,727 confirmed malaria positive cases between January 2022 and December 2022, of which 3,160,784 (97.8%) were treated with first-line antimalarial medicines. When this data is compared to that for Turkana County over the same period, it shows that 198,091 cases were confirmed as malariapositive, and 251,752 (133.8%) were treated with firstline antimalarial medicines. This cascade suggests that antimalarial medicines were dispensed to some patients without a confirmed positive result, hence non-adherence to the test and treat policy of malaria treatment guidelines. The WHO recommends parasitological testing of suspected malaria cases and treatment of those with malaria with an effective antimalarial medicine [1]. The use of RDT to diagnose and treat positive cases of malaria optimizes malaria case management while avoiding irrational prescribing of AL to patients who are parasite negative [2–4]. High clinical workloads and stockouts of RDTs in the health facilities have been found to contribute to non-adherence to the test and treat policy [5]. This increases the commodities consumption, hence affecting the health facility stock levels. Adequate stock levels of AL and RDT kits are crucial in healthcare workers’ adherence to the test and treat policy [6]. Consistent monitoring of the commodity stock levels and initiation of necessary actions avoid overstocking, understocking, interruptions in service delivery, and wastage [7]. Also, stock level assessments provide information on overstocks, understocks, and products Page 2 of 8 at risk of expiry and inform commodity redistribution activities. Problems with the stock levels can be indicative of distribution challenges, poor quantification, commodity hoarding, or rationing [8]. Turkana County is a seasonal malaria transmission zone. Health facilities forecast and place orders for antimalarial medicines and (...truncated)