Health-Seeking Behaviour for Childhood Malaria: Household Dynamics in Rural Senegal

Franckel, Aurélien; Lalou, Richard

doi:10.1017/s0021932008002885

Cited by 49 publications

(50 citation statements)

References 16 publications

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“…However, passive surveillance may miss clinical episodes that are treated or resolve spontaneously without presentation to health care facilities[14], [15], [16]. Cohorts under active surveillance often record higher rates of malaria episodes than those under passive surveillance [17], [18] which may be interpreted either as the inclusion of false-positives by the former, or an under-estimation of the true malaria burden by the latter [19], [20], [21].…”

Section: Introductionmentioning

confidence: 99%

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

et al. 2010

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BackgroundFebrile malaria is the most common clinical manifestation of P. falciparum infection, and is often the primary endpoint in clinical trials and epidemiological studies. Subjective and objective fevers are both used to define the endpoint, but have not been carefully compared, and the relative incidence of clinical malaria by active and passive case detection is unknown.MethodsWe analyzed data from cohorts under active and passive surveillance, including 19,462 presentations with fever and 5,551 blood tests for asymptomatic parasitaemia. A logistic regression model was used to calculate Malaria Attributable Fractions (MAFs) for various case definitions. Incidences of febrile malaria by active and passive surveillance were compared in a subset of children matched for age and location.ResultsActive surveillance identified three times the incidence of clinical malaria as passive surveillance in a subset of children matched for age and location. Objective fever (temperature≥37.5°C) gave consistently higher MAFs than case definitions based on subjective fever.ConclusionThe endpoints from active and passive surveillance have high specificity, but the incidence of endpoints is lower on passive surveillance. Subjective fever had low specificity and should not be used in primary endpoint. Passive surveillance will reduce the power of clinical trials but may cost-effectively deliver acceptable sensitivity in studies of large populations.

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Section: Introductionmentioning

confidence: 99%

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

et al. 2010

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“…Despite this, health education programmes in Malawi rarely seek to involve grandmothers [31]. Involving the wider community, including men and grandmothers in community-based education programmes in Malawi and elsewhere would ensure that all those involved in the treatment-seeking process are included [29, 31, 33, 34]. The role of older women should also be harnessed in behaviour change strategies [35]; involving grandmothers in health education programmes has been seen to lead to improvements in the education messages they give to mothers, and mothers’ health seeking behaviour [36].…”

Section: Discussionmentioning

confidence: 99%

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Ewing

Tolhurst

Kapinda

et al. 2016

Malar J

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BackgroundThis study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations. Qualitative data collection included 12 focus group discussions and 22 critical incident interviews conducted in the local language, with primary caregivers of children who had recently experienced a febrile episode.ResultsLow geographic accessibility to facilities inhibited care-seeking, sometimes by extending the ‘assessment period’ for a child’s illness episode, and led to delays in seeking formal treatment, particularly when the illness occurred at night. Although carers attempted to avoid incurring costs, cash was often needed for transport and food. Whilst in all communities fathers were normatively responsible for treatment costs, mothers generally had greater access to and control over resources and autonomy in decision-making in the matrilineal and matrilocal communities in the central part of the district, which were also closer to formal facilities.ConclusionsThis study illustrates the complex interplay between geographic access and gender dynamics in shaping decisions on whether and when formal treatment is sought for febrile children in Chikwawa District. Geographic marginality and cultural norms intersect in remote areas both to increase the logistical and anticipated financial barriers to utilising services and to reduce caretakers’ autonomy to act quickly once they recognize the need for formal care. Health education campaigns should be based within communities, engaging all involved in treatment-seeking decision-making, including men and grandmothers, and should aim to promote the ability of junior women to influence the treatment-seeking process. Both mothers’ financial autonomy and fathers financial contributions are important to enable timely access to effective healthcare for children with malaria.

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“…Studies of individual care-seeking in many LMICs suggests a complicated process according to a number of factors, including symptom [4, 33, 36], consultation with household members [37–39], relying on prior experiences [40], perceived severity of illness [41], quality of care, provider reputation [42, 43], cost [7, 38], location [44], and use of multiple, concurrent treatments [4, 45, 46]. Our study of care-seeking showed that PPMV customer behavior also varied by many of these factors.…”

Section: Discussionmentioning

confidence: 99%

Care-seeking at patent and proprietary medicine vendors in Nigeria

Prach

Treleaven

Isiguzo

et al. 2015

BMC Health Serv Res

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BackgroundTo achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms.MethodsIn Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop.ResultsMost customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs.ConclusionsBecause care-seeking behaviors vary by symptoms and the sick person’s age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving primary care need to target the places where most people access care, and equip PPMV workers with knowledge and tools to provide basic services.

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Health-Seeking Behaviour for Childhood Malaria: Household Dynamics in Rural Senegal

Cited by 49 publications

References 16 publications

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Care-seeking at patent and proprietary medicine vendors in Nigeria

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