Care seeking behaviour and treatment of febrile illness in children aged less than five years: a household survey in Blantyre District, Malawi.
Malaria is a leading cause of death in children aged < 5 years in Malawi. As part of the Roll Back Malaria initiative, African heads of state have pledged that by 2005, 60% of children will receive an effective antimalarial drug within 24 h of developing fever. In 1993, Malawi switched from chloroquine to sulfadoxine-pyrimethamine (SP) in its recommendations of home treatment of febrile illness in children. To study care seeking behaviour and home treatment in Blantyre District, and provide valuable follow-up to the chloroquine to SP transition, we performed a 2-stage cluster-sample survey in February 2000. Our sample of 1080 households included 672 households with children aged < 5 years; 292 (32.2%, 95% CI 28.7-35.8%) of the 912 children in these households had completed a febrile episode within the past 14 d. Among recently febrile children, 210 (72.0%, 95% CI 67.0-77.1%) received medication at home during their illness, but only 36 (12.2%, 95% CI 8.4-16.0%) received an appropriate antimalarial drug. Overall, 111 (37.4%, 95% CI 30.9-43.9%) received prompt, appropriate treatment. Only rural location was statistically associated with failure to receive prompt appropriate treatment (risk ratio estimate 1.2, 95% CI 1.01-1.5). A greater effort to improve the quality of malaria home treatment or to expand health facility utilization will be necessary to achieve Roll Back Malaria goals before 2005 in Blantyre District. Current care seeking practices suggest interventions should stress promptness of health facility visits, improved access to appropriate drugs, and accurate dosing for home-based treatments.
Malaria Epidemiology Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tholtz@cdc.gov
Timothy H
TH
Holtz
S Patrick
SP
Kachur
Lawrence H
LH
Marum
Christopher
C
Mkandala
Nyson
N
Chizani
Jacquelin M
JM
Roberts
Allan
A
Macheso
Monica E
ME
Parise
D000553:Ambulatory Care / Q000706:statistics & numerical data; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006297:Health Services Accessibility; D006701:Home Nursing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy*; D008295:Malawi; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012423:Rural Health; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000962:Antimalarials