Measuring malaria diagnosis and treatment coverage in population-based surveys: a recall validation study in Mali among caregivers of febrile children under 5 years

Abstract

BackgroundNationally-representative household surveys are the standard approach to monitor access to and treatment with artemisinin-based combination therapy (ACT) among children under 5 years (U5), however these indicators are dependent on caregivers’ recall of the treatment received.MethodsA prospective case–control study was performed in Mali to validate caregivers’ recall of treatment received by U5s when seeking care for fever from rural and urban public health facilities, community health workers and urban private facilities. Clinician-recorded consultation details were the gold standard. Consenting caregivers were followed-up for interview at home within 2 weeks using standard questions from Demographic and Health Surveys and Malaria Indicator Surveys.ResultsAmong 1602 caregivers, sensitivity of recalling that the child received a finger/heel prick was 91.5%, with specificity 85.7%. Caregivers’ recall of a positive malaria test result had sensitivity 96.2% with specificity 59.7%. Irrespective of diagnostic test result, the sensitivity and specificity of caregivers’ recalling a malaria diagnosis made by the health worker were 74.3% and 74.9%, respectively. Caregivers’ recall of ACT being given had sensitivity of 43.2% and specificity 90.2%, while recall that any anti-malarial was given had sensitivity 59.0% and specificity 82.7%. Correcting caregivers’ response of treatment received using a combination of a visual aid with photographs of common drugs for fever, prescription documents and retained packaging changed ACT recall sensitivity and specificity to 91.5% and 71.1%, respectively.ConclusionsThese findings indicate that caregivers’ responses during household surveys are valid when assessing if a child received a finger/heel prick during a consultation in the previous 2 weeks, and if the malaria test result was positive. Recall of ACT treatment received by U5s was poor when based on interview response only, but was substantially improved when incorporating visual aids, prescriptions and drug packaging review.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2636-3) contains supplementary material, which is available to authorized users.

Factors associated with access and adherence to artemisinin‐based combination therapy (ACT) for children under five: a secondary analysis of a national survey in Sierra Leone

“…Ashton et al. recently found that caregiver recall surrounding testing and diagnosis to be valid; therefore, the recommendation regarding confirmed malaria cases may need to be reviewed [ 44 ].…”

Quality of clinical management of children diagnosed with malaria: A cross-sectional assessment in 9 sub-Saharan African countries between 2007–2018

“…Our results are consistent with prior evidence from population-representative household surveys suggesting important gaps in diagnostic testing and ACT taking for children with malaria [ 22 , 25 , 65 ]. While these studies have the advantage of capturing children who are not brought for formal care, household surveys may be subject to recall bias and misunderstanding of clinical actions [ 66 , 67 ]. Our results underscore concerns about insufficient treatment for malaria and highlight the fact that even children who are brought to formal providers often receive inadequate care.…”

Management of uncomplicated malaria among children under five years at public and private sector facilities in Mali

“…Four types of health facility were included in the study: two urban private facilities, two urban public facilities, two rural public facilities and nine CHWs. Full details of site selection are detailed elsewhere [ 27 ].…”

“…Ethics approval and consent to participate Approval was obtained from the Ethics Committee of the Malian National Institute for Public Health Research (L'Institut National de Recherche en Santé Publique, INRSP) and from the Tulane University Biomedical Institutional Review Board. Full details of recruitment and consent procedures are available in [27]. Briefly, verbal consent to be contacted for a follow up interview was collected from caregivers at the facility, with full written consent collected during the follow-up visit at their home.…”

“…This paper reports malaria case management practices recorded during a treatment recall validation study in a high transmission setting in Mali, including public health facilities in urban and rural areas, CHW sites, and private health facilities in urban areas [ 27 ]. The aim was to conduct secondary analysis of existing data collected from different types of health provider and locations for a treatment recall validation study to describe malaria testing and treatment practices among febrile U5s.…”