Lack of ability and knowledge among health providers to accurately diagnose and treat common illnesses is partly to blame for the growing cases of serious injury and deaths of patients caused by negligence.

Four in five doctors, clinical officers and nurses cannot accurately diagnose all four common conditions, including pneumonia and severe dehydration due to diarrhoea in children, and tuberculosis of the lungs and type 2 diabetes in adults, reveals the Kenya Health Service Delivery Indicator Survey (SDI) 2018 that was released recently. The four illnesses are the tracer conditions in the study that aims to determine the quality of services in basic healthcare.

A higher proportion of doctors can correctly diagnose all four conditions, about a third, followed by clinical officers (about a quarter) and nurses (12 per cent).

Less than half (43 percent) of the providers can correctly diagnose three of the four conditions, more than a quarter are able to accurately detect two cases and 10 percent know how to identify just one illness, according to the survey that was done in 3,094 health facilities across Kenya. About one percent cannot correctly diagnose even one condition.

The rate of correct diagnosis of the tracer conditions varies across different cadres. A higher proportion of doctors can correctly diagnose all four conditions, about a third, followed by clinical officers (about a quarter) and nurses (12 per cent).

The worrying revelation on competency comes against a backdrop of growing complaints over misconduct by health providers. There were at least 115 cases of major medical misconduct, mostly involving doctors (two-thirds), that resulted in the death or injury of patients published by the media in the last 20 months, according to Do No Harm, a NationNewsplex database on medical malpractice compiled from mainstream media stories. Patients died in four out of five of the incidents. In the first eight months of 2019, the number of patients or their family members who complained to the media that they were harmed by the treatment they received from medical facilities was 100, eight times the number in the same period last year (13).

However, data from the Kenya Medical Practitioners and Dentists Board (KMPDB), a statutory authority established to regulate the practice of medicine and dentistry, suggests that many cases of misconduct by doctors go unreported to the regulatory institution. From 1997 to March last year, 985 cases were lodged with the board. Of these, 70 cases were pending and 915 had been determined. About 97 per cent of them were resolved at the preliminary inquiry committee, and two per cent each at the national tribunal and the national professional conduct committee. Over the two decades, only one doctor has been deregistered by the medical board. Four doctors had their licences cancelled while six had theirs suspended for a period of six to 12 months for misconduct over the same period. But a majority walked away with a slap on the wrist, with 16 being sent for supervised training for a period of six to 12 months while 106 were ordered to go through continuous professional development.

Correct treatment

Figures from the World Bank and the Ministry of Health study that was done from March-July last year show that the incompetence of health providers results in misdiagnosis of about a quarter of cases involving the four conditions handled by doctors and clinical officers, and 40 per cent that are managed by nurses.

Diagnostic accuracy rate varies across case conditions, ranging from 97 percent accuracy for pulmonary tuberculosis to 32 percent for severe dehydration. The accuracy rate of pneumonia diagnosis is 82 percent and diabetes (61 percent).

Higher-level facilities can correctly diagnose more cases (hospitals, 76 per cent) than lower-level ones (health centres, 68 per cent, and dispensaries, 64 per cent). Likewise, accuracy is higher for urban (70 percent) than rural (66 percent) facilities and it varies widely across counties.

Providers in Vihiga County can only correctly diagnose about half of the tracer conditions, the worst rate, while their counterparts in Wajir can accurately diagnose nearly 90 percent of the cases, the best proportion in the country.

A correct diagnosis is, however, not a guarantee for providing the correct treatment. There are noticeably large inconsistencies between diagnosis and treatment across the board, and this reveals a critical disconnect in provider knowledge and follow-up, finds the study. For instance, while 97 per cent of health providers were accurate in their TB diagnosis, just 74 per cent got the accurate treatment. This means that almost a quarter of lung TB cases that were correctly diagnosed, were not accurately treated. The results of the other conditions equally show a knowledge gap in clinical diagnosis and patient management.

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