Care-seeking behaviour and treatment practices for malaria in children under 5 years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets

Abstract

Background In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria. Methods Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data. Results A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether–lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15–4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83–1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34–0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03–6.01]), Sofala ([AOR = 2.91 [1.03–8.24]), Inhambane (AOR = 3.95 [1.25–12.45]), Gaza (AOR = 3.25 [1.22–8.65]) and Maputo Province (AOR = 2.65 [1.10–6.41]) were more likely to seek care than people from Maputo City. Conclusion Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.

Utilization of insecticide-treated bed nets and care-seeking for fever and its associated socio-demographic and geographical factors among under-five children in different regions: evidence from the Myanmar Demographic and Health Survey, 2015–2016

“…It suggests the need for intensified social and behaviour change communication strategies to improve care-seeking efforts. The results are similar to what was reported in previous studies from Senegal and Mozambique, in which around onethird of children with fever did not receive any treatment or medical advice [29,30].…”

Satisfaction with malaria care among pregnant women and mothers of under-five years children in Ibadan, Southwest Nigeria

“…Moving on, this study nding on satisfaction with communication and interpersonal manner of care by the health providers supports the evidence that good communication between physicians and patients has a positive impact on patient satisfaction, thereby leading to improved compliance to treatment, decreased anxiety, increased recall and understanding of healthcare [33]. Also, the ndings of this study on the impact of socio-economic status on malaria satisfaction are consistent with the report from a nationwide study in Zambia, which showed some socio-economic status indices such as education, income and place of residence [34], as predictors of satisfaction with malaria care which contributed to the mothers' health-seeking behaviour [35].…”

The economic burden of malaria on households and the health system in a high transmission district of Mozambique

“…In Mozambique, malaria is the leading cause of care-seeking, accounting for 45% of outpatient consultations and 24% of hospital admissions in 2015 [7]. The Mozambican Ministry of Health provides free diagnosis and treatment services for malaria at public health facilities [8], but these services require considerable human resource and health systems investment. Scarcity of resources and weak health system financing force the country to rely on international donors for the provision of RDTs and anti-malarial medicines, the majority of which are purchased by the US President’s Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria.…”