Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

Abstract

BackgroundThis study responds to a rural community’s concern that, despite national initiatives, malaria management in young children falls short of national guidelines in their district. This study aimed to: (1) describe caregivers’ treatment-seeking behaviors in the rural district of Butaleja, (2) estimate the percentage of children who received an appropriate antimalarial, and (3) determine factors that maximized the likelihood of receiving an appropriate antimalarial. Appropriate antimalarial in this study is defined as having received only the Uganda’s age-specific first-line malaria treatment for uncomplicated and severe malaria during the course of the febrile illness.MethodsA household survey design was used in 2011 to interview 424 caregivers with a child aged five and under who had fever within the two weeks preceding the survey. The survey evaluated factors that included: knowledge about malaria and its treatment, management practices, decision-making, and access to artemisinin combination therapy (ACT) and information sources. Bivariate analysis, followed by logistic regression, was used to determine predictors of the likelihood of receiving an appropriate antimalarial.ResultsHome management was the most common first action, with most children requiring a subsequent action to manage their fever. Overall, 20.9 % of children received a blood test, 68.4 % received an antimalarial, and 41.0 % received an ACT. But closer inspection showed that only 31.6 % received an appropriate antimalarial. These results confirm that ACT usage and receipt of an appropriate antimalarial in Butaleja remain well below the 2010/2015 target of 85 %. While nine survey items differentiated significantly whether a child had or had not received an appropriate antimalarial, our logistic regression model identified four items as independent predictors of likelihood that a child would receive an appropriate antimalarial: obtaining antimalarials from regulated outlets (OR = 14.99); keeping ACT in the home for future use (OR = 6.36); reporting they would select ACT given the choice (OR = 2.31); and child’s age older than four months (OR = 5.67).ConclusionsFew children in Butaleja received malaria treatment in accordance with national guidelines. This study highlighted the importance of engaging the full spectrum of stakeholders in the management of malaria in young children - including licensed and unlicensed providers, caregivers, and family members.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1815-5) contains supplementary material, which is available to authorized users.

Assets and challenges facing caregivers when managing malaria in young children in rural Uganda

“…Data from a cross-sectional household survey conducted in 2011 and ten psychometrically justified scales were used to estimate assets and challenges facing caregivers when managing malaria in children 5 years and under in Butaleja District, Uganda [ 14 ]. Ethics approval for the project and written informed consent from participants was obtained prior to conducting the surveys.…”

“…A purposive, multi-step sampling process was used to ensure representation across all ten sub-counties and two town councils [ 14 ]. The sampling process considered size of villages, religious denominations, dominant tribes, and proximity to a government health centre.…”

“…The final printed survey encompassed interviewer instructions, research assistants’ post-interview remarks, and 160 questions collecting information on the seven educational and environmental factors, household identification, child’s disease presentation, demographics/socio-economic status. The development of the survey instrument, administration, and quality control measures are described in detail elsewhere [ 14 ].…”

“…As a first step, a household survey was conducted across Butaleja District in 2011 to describe caregivers’ treatment-seeking behaviour for malaria in children 5 years and under and to estimate the use of ACT and of appropriate anti-malarials in this age group. Analysis of the findings established a substantial gap between the national malaria policy and practices in Butaleja, with only 41 % of children with fever and presumed malaria reported to have received an ACT, 21 % received any blood test whatsoever, and 32 % received an appropriate anti-malarial [ 14 ]. Next, guided by the health belief model, a parallel study was carried out to operationalize caregivers’ assets and challenges with the management of malaria in young children and to conduct psychometrically analysis of the scales (Kassam et al, pers.…”

The challenge of rapid management of fever in children under 5 in Guinea

“…Some studies concluded that this decline in malaria-related care would threaten the control of the disease in Guinea [18][19][20]. This threat is reflected here by the still high recourse to traditional healers for the management of fever and by the no-recourse which, according to Kassam et al [21], would be associated with a tendency to self-medication and by non-confidence in traditional healers. Yet, the impact of economic and socio-cultural barriers on the decision to seek treatment should not be overlooked.…”