title: [Self-treatment of fever in the northern district of Dakar, Senegal].
abstract: Malaria is assimilated with its cardinal symptom, i.e., fever. Treatment of fever with antimalarial drugs is crucial to the prevention of malaria-related death in Senegal. The objective of this study was to analyze fever-treatment practices as a basis for making realistic recommendations for self-treatment in the northern health district of Dakar, Senegal. This cross-sectional study was conducted from March 1 to April 30, 2003. The population included all patients with body temperature higher or equal to 37.5 degrees C (99.5 degrees F) associated with at least one of the following symptoms: headache, shivering, vomiting and diarrhoea. Study endpoints included demographic data and fever treatment modalities including the nature, dosage, and duration of the drugs used. Malaria was suspected in 180 of the 271 patients enrolled in the study. Treatment had already been undertaken in 134 patients including 108 (81%) who had initiated self-treatment. Drugs included antipyretics, antibiotics, and/or antimalarials. Antimalarial drug dosage was incorrect in 84% of those who initiated self-treatment. Dosage errors involved number of daily doses (55%), duration of treatment (13%), or both (32%). Only 45% of patients fully completed treatment. Medical advice was sought in 30% of the cases and drugs were obtained over the counter in pharmacies in 59%. Patients under the age of 15 years were significantly more likely to initiate self-treatment (p=6.10-6), to treat symptoms early, and to use an antimalarial (p=4.10-6). Although self-treatment shortened the delay between onset of symptoms and initiation of treatment, it is likely that indiscriminate and incomplete treatment is responsible for development of resistance to chloroquine in the northern health district of Dakar. Strategies must be adapted to numerous local factors influencing self-treatment including the availability of health-care services and drugs of quality. Special attention must be given to the improvement of antimalarial drug packaging and of the awareness of people that provide self-treatment drugs.
authors.affiliation: Service de médecine préventive et santé publique, UCAD-DAKAR, BP 16 390, Dakar-Fann, Sénégal. pndiayempsp@yahoo.fr
authors.forename: P
authors.initials: P
authors.lastname: Ndiaye
authors.forename: A
authors.initials: A
authors.lastname: Tal-Dia
authors.forename: A
authors.initials: A
authors.lastname: Diedhiou
authors.forename: A
authors.initials: A
authors.lastname: Juergens-Behr
authors.forename: J P
authors.initials: JP
authors.lastname: Lemort
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012651:Self Medication / Q000706:statistics & numerical data*; D012675:Senegal
chemical_list: D000962:Antimalarials; D002738:Chloroquine