title: Home-based management of fever and malaria treatment practices in Uganda.
abstract: The Home-Based Management of Fever/Malaria (HBMF) strategy in rural Uganda was evaluated in a quasi-experimental study. The intervention consisted of volunteers educating mothers and providing a 3-day course of pre-packaged chloroquine plus sulfadoxine/pyrimethamine tablets (HOMAPAK), free of charge, for the treatment of under-five fevers. Using a structured questionnaire, information was obtained on care-seeking and treatment practices before (n=498) and 18 months after the introduction of HBMF (n=587). Assessment of the intervention effect indicated 13.5% improvement in the accumulated proportion of patients (1) treated, (2) treated within 24h of illness onset, (3) treated with the recommended antimalarials, (4) treated at an adequate dosage and (5) treated for the correct duration. Combining this with the antimalarial drug efficacy resulted in a 10.4% improvement in the community effectiveness of malaria treatment. HOMAPAK use was reported in 25% of 156 febrile children; 23% in the most poor compared with 50% in the least poor. Using HOMAPAK instead of other allopathic antimalarials increased the likelihood of completing all steps (odds ratio 37, 95% CI 4.8-286). Similar to other large-scale public health interventions, this study demonstrates modest practice changes at the population level. However, practices improved markedly among HOMAPAK users, suggesting that intensifying implementation efforts to increase HOMAPAK use, especially among the poorest, would be beneficial.
authors.affiliation: Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda. jsabiiti@infocom.co.ug
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: George
authors.initials: G
authors.lastname: Pariyo
authors.forename: Jasper
authors.initials: J
authors.lastname: Ogwal-Okeng
authors.forename: Max G
authors.initials: MG
authors.lastname: Petzold
authors.forename: Goran
authors.initials: G
authors.lastname: Tomson
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use; D003153:Community Health Services; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006701:Home Nursing; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D009035:Mothers / Q000193:education; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D012423:Rural Health; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014454:Uganda
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine