Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study

Kassam, Rosemin; Sekiwunga, Richard; Macleod, D. M.; Tembe, Juliet; Liow, Eric

doi:10.1186/s12889-016-2813-7

Cited by 21 publications

(33 citation statements)

References 33 publications

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“…Our study found the practice of polypharmacy to be common, with one in three caregivers in Butaleja reporting using multiple antimalarials to manage malaria in their children, often in combination with non-antimalarials. This practice was confirmed in a follow-up study conducted in Butaleja, and has been reported in other regions of Uganda [15, 28–30]. The work by Rutebemberwa et al found a large majority of caregivers in Iganga District preferred combination therapy, but caregivers’ views about which antimalarials to start a child on varied considerably [28].…”

Section: Discussionmentioning

confidence: 59%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 59%

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

et al. 2016

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“…These findings confirm reports that private outlets continue to fill the gap between home management, CHWs and public facilities. Regular ACT stock-outs, frequent referrals to private vendors by public health providers to purchase anti-malarials, and poor service at public health facilities have been cited as common reasons for visiting private outlets in Butaleja [ 7 ]. Further, only a third of caregivers in Butaleja reported that ACT was easy to find in their community and one in six believed ACT was affordable.…”

Section: Discussionmentioning

confidence: 99%

“…Examples of such initiatives include the dissemination of first-line anti-malarial artemisinin-based combination therapy (ACT) cost-free from all public health facilities; the introduction of the Integrated Community Case Management Programme (iCCM) in mid-2010 to bring diagnostics and treatment closer to the community; the introduction of the Affordable Medicines Facility-Malaria (AMFm) in Spring 2011 to improve access to a range of ACT from licensed public and private outlets; the ban of resistant anti-malarials; the training of public providers; sensitization meetings with district-level leaders; and information, education and communication campaigns to improve household awareness [ 1 , 4 ]. Despite these initiatives, translating policy into practice to ensure universal access to ACT has been challenging in rural areas due to regular stock-outs of anti-malarials at public facilities, dispensing of non-first-line anti-malarial therapy at health facilities, and limited access to licensed private outlets supported by the AMFm scheme [ 5 – 7 ]. At the time of this study, it was also recognized that the delivery of iCCM was complex, requiring both providers and recipients of care to be fully engaged for desired outcomes to be achieved [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Kassam

Collins

Sekiwunga

2016

Malar J

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BackgroundDespite efforts to improve malaria management for children, a substantial gap remains between policy and practice in Uganda. The aim of this study was to create quantitative profiles of assets and challenges facing caregivers in Butaleja District when managing malaria in children aged 5 years and under. The objectives were: (1) to estimate caregivers’ assets and challenges during an acute episode; and, (2) to ascertain which caregiver attributes influenced receipt of an appropriate anti-malarial the most.MethodsData from a 2011 cross-sectional, household survey and ten psychometrically justified scales were used to estimate caregivers’ assets and challenges. The scales scores were simple counts across a series of items, for example, the number of times a caregiver answered a knowledge item correctly or the number of times a caregiver relied on a credible source for information. Since high scores on six of the scales reflected attributes that eased the burden of caregiving, these were labelled ‘caregiver assets’. Similarly, high scores on four of the measures signalled that a caregiver was having trouble managing the malaria episode, thereby reflecting deficits, and these were labelled ‘caregiver challenges’. ANOVAs were used to compare scale scores between caregivers of children who received an appropriate anti-malarial versus those who did not.ResultsOn the six asset scales, caregivers averaged highest on knowledge (65 %), followed by correct episode management (48 %), use of trustworthy information sources (40 %), ability to initiate or redirect their child’s treatment (37 %), and lowest on possible encounters with health professionals to assist in treatment decisions (33 %). Similarly, the average caregiver reported problems with 74 % of the issues they might encounter in accessing advice, and 56 % of the problems in obtaining the best anti-malarial. Caregivers whose children received an appropriate anti-malarial demonstrated greater assets and fewer challenges than those whose child did not, with important regional differences existing. Overall, no one region performed particularly well across all ten scales.ConclusionsFindings from this study suggest that the low use of artemisinin-based combination therapy (ACT) in Butaleja for children 5 years and under may result from caregivers’ high perceived barrier to accessing ACT and low perceived benefits from ACT.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1521-1) contains supplementary material, which is available to authorized users.

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“…Moreover, nearly half a million (429 000) deaths were caused by malaria, and more than 92% 0f these deaths have been happened in sub-Sahara African countries [2]. Consequently, malaria is still the leading public health problem in developing nations and it predominately affects pregnant mothers and under-ve children [3].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with malaria among under-five children in Ethiopia: A Systematic review and Meta-analysis Protocol

Tadesse¹,

Dessalegn²,

Birara³

et al. 2020

Preprint

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Background: The Sub-Saharan African countries have been carried 80% of the global burden of malaria. Consequently, malaria is still the leading cause of under-five mortality in developing nations. In Ethiopia, studies conducted regarding prevalence and associated factors of malaria among under five children are inconsistently reported and highly variable.Objective: to determine the pooled prevalence and associated factors of malaria among under five children in Ethiopia. Methods: The protocol for this review is registered at PROSPERO with registration number: CRD42020157886. A comprehensive search of the following electronic databases were made using: MEDLINE, EMBASE, CINAHL, Scopus, web science, HINARI, Cochrane library, Google Scholar and maternity & infant care databases as well as grey literature uploaded at Ethiopian Health Development Journal were searched until May 2020. The quality of studies will be assessed using Joanna Briggs Institute (JBI) checklist. All identified observational studies reporting the prevalence of malaria and associated factors among under five children in Ethiopia will be considered. Three reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. The analysis of data will be done using STATA 14.0 statistical software. We will determine the pooled prevalence and determinants of malaria among under five children using random effect model with effect size and 95% confidence interval. Heterogeneity among the included studies will be assessed through the Cochrane Q-test statistics and I2 test. Furthermore, publication bias will be checked using funnel plot and egger’s test. Finally, statistical significance level will be declared at a p-value less than 0.05. Discussion: The result from this systematic review will inform and guide health policy planners and researchers on the burden, and determinants of under five children malaria in Ethiopia. To our knowledge, this is the first systematic review in Ethiopia. We will synthesize the findings to generate up-to-date knowledge on malaria among under five children in Ethiopia.

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Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study

Cited by 21 publications

References 33 publications

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

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

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

Prevalence and factors associated with malaria among under-five children in Ethiopia: A Systematic review and Meta-analysis Protocol

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