Why most Togolese people do not seek care for malaria in health care facilities: A theory-driven inventory of reasons

Dassa, Kolou Simliwa; Mullet, Étienne

doi:10.1080/13548500902890095

Cited by 18 publications

(17 citation statements)

References 7 publications

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“…More than 80% of patients with fever in the intervention and control arms in both transmission settings consulted CHWs for treatment within 24 h after onset of symptoms, which is much higher than has previously been observed at health facilities in Uganda [11] and elsewhere [26]. These data show that CHWs provide an opportunity for improving the speed of treatment seeking for febrile illnesses in rural areas, where poor access to health facilities, lack of drugs, perceived high cost and unfriendly attitude of health workers often result in delayed treatment [27][28][29][30][31][32] and illustrate the role of community-based treatment programmes in increasing access to prompt effective treatment of malaria.…”

Section: Discussionmentioning

confidence: 83%

Appropriate targeting of artemisinin‐based combination therapy by community health workers using malaria rapid diagnostic tests: findings from randomized trials in two contrasting areas of high and low malaria transmission in south‐western Uganda

Ndyomugyenyi

Magnussen

Lal

et al. 2016

Tropical Med Int Health

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ObjectiveTo compare the impact of malaria rapid diagnostic tests (mRDTs), used by community health workers (CHWs), on the proportion of children <5 years of age receiving appropriately targeted treatment with artemisinin‐based combination therapy (ACT), vs. presumptive treatment.MethodsCluster‐randomized trials were conducted in two contrasting areas of moderate‐to‐high and low malaria transmission in rural Uganda. Each trial examined the effectiveness of mRDTs in the management of malaria and targeting of ACTs by CHWs comparing two diagnostic approaches: (i) presumptive clinical diagnosis of malaria [control arm] and (ii) confirmatory diagnosis with mRDTs followed by ACT treatment for positive patients [intervention arm], with village as the unit of randomisation. Treatment decisions by CHWs were validated by microscopy on a reference blood slide collected at the time of consultation, to compare the proportion of children <5 years receiving appropriately targeted ACT treatment, defined as patients with microscopically‐confirmed presence of parasites in a peripheral blood smear receiving artemether‐lumefantrine or rectal artesunate, and patients with no malaria parasites not given ACT.ResultsIn the moderate‐to‐high transmission area, ACT treatment was appropriately targeted in 79.3% (520/656) of children seen by CHWs using mRDTs to diagnose malaria, vs. 30.8% (215/699) of children seen by CHWs using presumptive diagnosis (P < 0.001). In the low transmission area, 90.1% (363/403) children seen by CHWs using mRDTs received appropriately targeted ACT treatment vs. 7.8% (64/817) seen by CHWs using presumptive diagnosis (P < 0.001). Low mRDT sensitivity in children with low‐density parasitaemia (<200 parasites/μl) was identified as a potential concern.ConclusionWhen equipped with mRDTs, ACT treatments delivered by CHWs are more accurately targeted to children with malaria parasites. mRDT use could play an important role in reducing overdiagnosis of malaria and improving fever case management within iCCM, in both moderate‐to‐high and low transmission areas. Nonetheless, missed treatments due to the low sensitivity of current mRDTs in patients with low parasite density are a concern. For community‐based treatment in areas of low transmission and/or non‐immune populations, presumptive treatment of all fevers as malaria may be advisable, until more sensitive diagnostic assays, suitable for routine use by CHWs in remote settings, become available.

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Section: Discussionmentioning

confidence: 83%

Appropriate targeting of artemisinin‐based combination therapy by community health workers using malaria rapid diagnostic tests: findings from randomized trials in two contrasting areas of high and low malaria transmission in south‐western Uganda

Ndyomugyenyi

Magnussen

Lal

et al. 2016

Tropical Med Int Health

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“…This study reveals that respondents who took non-prescribed anti-malarials, a higher proportion 56.1% took non-ACT, such as chloroquine, artemether, amodiaquine, quinine and sulphadoxine-pyrimethamine. This situation can be attributed to the lack of knowledge of chemical sellers about the effective treatment for malaria and are dispensing both ACT and non-ACT anti-malarial drugs to clients to treat malaria [4,6,17,18]. The study also found that children under five years of age were more likely to receive non-prescribed anti-malarials if others influenced their carer’s decision.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for using non-prescribed anti-malaria drugs include lack of access to health facilities, cost of treatment in health facilities and social distance of health workers from patients [6]. Several sociocultural factors, including people’s beliefs, perceptions and knowledge about malaria and influence of peers on people’s choice of malaria treatment [4,7] have been cited to influence use of non-prescribed anti-malarials.…”

Section: Introductionmentioning

confidence: 99%

The use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga municipality, northern Ghana

Aborah

Akweongo

Adjuik

et al. 2013

Malar J

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BackgroundThe use of non-prescribed anti-malarial drugs can lead to treatment failure and development of drug-resistant parasites. This study investigated the use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga Municipality of northern Ghana.MethodsThis was a cross-sectional survey of a random sample of 392 adults and children with episodes of malaria in the last four weeks prior to the study.ResultsMajority of survey respondents 96.9% (380) knew the symptoms of malaria, 75% (294) knew the causes of malaria and 93.1% (365) were aware of mode of transmission of malaria. The use of non-prescribed anti-malarial drugs was 16.8% (95% CI: 13.3-21.0) among the respondents. About 56% (95% CI: 43.3-68.3) of the respondents who took non-prescribed anti-malaria drugs took non-artemisinin-based combination therapy (chloroquine, artemether, amodiaquine and sulphadoxine-pyrimethamine). Respondents above five years of age were more likely to use non-prescribed anti-malarial drugs than those below five years of age [P < 0.001]; respondents who knew the right source of malaria treatment were less likely to use non-prescribed anti-malarial drugs than those who did not [P = 0.002]. Respondents using non-prescribed anti-malarials were influenced by people around them who used non-prescribed anti-malarials. Thus, these respondents were more likely to use non-prescribed anti-malarials than those who were not influenced [P = 0.004].ConclusionsRespondents’ knowledge of malaria treatment and the influence of people using non-prescribed anti-malarials are factors affecting use of non-prescribed anti-malarials. The study concludes that there is high use of non-prescribed anti-malarial drugs in the municipality and most of the non-prescribed anti-malarias were non-artemisinin-based combination therapy. The study recommends education of the general public and chemical sellers to reduce the use of non-prescribe anti-malaria drugs.

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“…Thus, one of the strategies of the Roll Back Malaria (RBM) programme is to reduce mortality in U5 through early diagnosis and treatment within 24 hours of the onset of symptoms [ 5 ]. However, poor physical access to health facilities is an obstacle to early diagnostic and curative services in rural areas in Low- and Middle-Income Countries (LMICs) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study

et al. 2015

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BackgroundHome management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver’s ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana.MethodsA cross-sectional household survey was conducted among 811 caregivers recruited through multistage sampling. A caregiver was reported to have practiced appropriate HMM if an antimalarial drug was administered to a febrile child in the recommended regimen (correct dose and duration for the child’s age). Binary logistic regression was used to determine factors associated with appropriate HMM.ResultsOf the 811 caregivers, 87% recognised the symptoms of uncomplicated malaria in U5, and 49% (n = 395) used antimalarial drugs for the HMM. Fifty percent (n = 197) of caregivers who administered antimalarial drugs used the appropriate regimen. In the multivariate logistic regression, caregivers with secondary (OR = 1.71, 95% CI: 1.03, 2.83) and tertiary (OR = 3.58, 95% CI: 1.08, 11.87) education had increased odds of practicing appropriate HMM compared with those with no formal education. Those who sought treatment in the hospital for previous febrile illness in U5 had increased odds of practicing appropriate HMM (OR = 2.24, 95% CI: 1.12, 4.60) compared with those who visited the health centres.ConclusionsHalf of caregivers who used antimalarial drugs practiced appropriate HMM. Educational status and utilisation of hospitals in previous illness were associated with appropriate HMM. Health education programmes that promote the use of the current first line antimalarial drugs in the appropriate regimen should be targeted at caregivers with no education in order to improve HMM in communities where parasitological diagnosis of malaria may not be feasible.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1777-3) contains supplementary material, which is available to authorized users.

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Why most Togolese people do not seek care for malaria in health care facilities: A theory-driven inventory of reasons

Cited by 18 publications

References 7 publications

Appropriate targeting of artemisinin‐based combination therapy by community health workers using malaria rapid diagnostic tests: findings from randomized trials in two contrasting areas of high and low malaria transmission in south‐western Uganda

Appropriate targeting of artemisinin‐based combination therapy by community health workers using malaria rapid diagnostic tests: findings from randomized trials in two contrasting areas of high and low malaria transmission in south‐western Uganda

The use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga municipality, northern Ghana

Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study

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