Community Knowledge and Attitudes and Health Workers' Practices regarding Non-malaria Febrile Illnesses in Eastern Tanzania

Abstract

IntroductionAlthough malaria has been the leading cause of fever for many years, with improved control regimes malaria transmission, morbidity and mortality have decreased. Recent studies have increasingly demonstrated the importance of non-malaria fevers, which have significantly improved our understanding of etiologies of febrile illnesses. A number of non-malaria febrile illnesses including Rift Valley Fever, dengue fever, Chikungunya virus infection, leptospirosis, tick-borne relapsing fever and Q-fever have been reported in Tanzania. This study aimed at assessing the awareness of communities and practices of health workers on non-malaria febrile illnesses.MethodsTwelve focus group discussions with members of communities and 14 in-depth interviews with health workers were conducted in Kilosa district, Tanzania. Transcripts were coded into different groups using MaxQDA software and analyzed through thematic content analysis.ResultsThe study revealed that the awareness of the study participants on non-malaria febrile illnesses was low and many community members believed that most instances of fever are due to malaria. In addition, the majority had inappropriate beliefs about the possible causes of fever. In most cases, non-malaria febrile illnesses were considered following a negative Malaria Rapid Diagnostic Test (mRDT) result or persistent fevers after completion of anti-malaria dosage. Therefore, in the absence of mRDTs, there is over diagnosis of malaria and under diagnosis of non-malaria illnesses. Shortages of diagnostic facilities for febrile illnesses including mRDTs were repeatedly reported as a major barrier to proper diagnosis and treatment of febrile patients.ConclusionOur results emphasize the need for creating community awareness on other causes of fever apart from malaria. Based on our study, appropriate treatment of febrile patients will require inputs geared towards strengthening of diagnostic facilities, drugs availability and optimal staffing of health facilities.

Understanding the Role of Accredited Drug Dispensing Outlets in Tanzania’s Health System

“…Although most community members in Tanzania, even in low-transmission areas, still assume that fever is caused by malaria, malaria incidence is declining [23, 24]; the percentage of confirmed malaria cases has come down over 40% since 2005 [25]. Recent research showed that of 1,005 febrile children in Tanzania, only 9% had malaria [26].…”

Multiplex paper-based designs for point-of-care (POC) diagnostics

“…In this case, specific identification of febrile etiologies has proven to be a great challenge, forcing clinicians to resort to clinical diagnosis or symptomatic treatment or encouraging a trial-and-error sequential diagnosis of all possible causes of fever once malaria, the most common cause has been ruled out. 18 Simple diagnostic devices that can help differentiate between malarial and non-malarial fevers simultaneously will greatly facilitate timely management of patients with fever not due to malaria. Other areas of application include detection of antimicrobial residues in animalderived foods and detection of environmental contaminants in soil and water.…”

“…When the most common etiology of fever (malaria) is ruled out, identifying the exact cause of fever is usually done clinically in most cases, or if resources allow, through sequential testing of the likely fever etiologies to reach definitive diagnosis. 18 Designing multiplexed test devices is therefore very important for enhancing timely diagnosis as well as minimizing the cost that would otherwise be incurred if sequential testing was to be performed. 17 Using paper, various patterning methods have been described and tested in previous studies.…”

Challenges of malaria diagnosis in clinical settings and disease surveillance under reduced malaria burden in Tanzania

“…Out of the uncertainties on the aetiologic agents of non-malarial fevers, prescribers may resort to presumptive diagnosis and treatment of febrile cases based on their training in IMCI [54] as shown in Northeastern Tanzania [55]. In the study in Northeastern Tanzania, it was shown that of the 162 under-fives who received an antimalarial drug prescription, less than a quarter (21.6%) had positive mRDT results, implying that contrary to policy guidelines, more than three quarters (78.4%) received an antimalarial drug prescription despite having negative mRDT results [28].…”

“…Traditionally, patients have equated fever (hot body) to malarial illness [60]; thus when laboratory findings show no malaria, clients get disappointed and may opt to consult another laboratory, because quite often the reason for demanding a laboratory test for malaria is to get the assurance that the fever is due to malaria and thus a justification to take an antimalarial drug. Most community members in malaria endemic countries, including Tanzania lack the correct knowledge about the causes of febrile illnesses and most have the notion that fever and malaria are synonymous and quite often used interchangeably [30,54]; therefore even at a time that malaria has remarkably declined, malaria is still perceived to be a much more common cause of fever [12,13,61,62]. Due to lack of knowledge, most clients expect a positive malaria test and when given negative results, sometimes they may not accept them and would put pressure on the prescriber to consider a diagnosis of malaria [63], and if the prescriber do not concur they may resort to self-medication with antimalarial drugs [64,65].…”