Community health seeking practices for the management of malaria of the under-five in Bugiri District, Uganda.
OBJECTIVE
To obtain baseline information on health seeking practice of communities in management of the under-5 malaria fever that would indicate the outcome of introducing home management.


METHODS
A cross-sectional study conducted in Bugiri District interviewing 451 heads of households at random throughout the district of, 411,250 population using structured and open questionnaires on health seeking practice in the management of malaria of under-5 in the communities.


RESULTS
20.2% of the communities took prompt action to treat children, although 51.7% consulted health workers (HW). Sources of treatment were drug shops (48.1%), and health units (42.4%), and very few herbalists. Few cases (7.8%) were referred to higher level. In the health units HW treated 65.7% of ill children with anti-malarial. At home caretakers gave anti-malarial to only 39.4%. Were communities to follow WHO diagnosis guidelines in home management, caretakers would treat 95.6% of illnesses with anti-malarial; an excess of 29.9% over HW. Large proportions (56.4%) of caretakers gave anti-malarial for treating any fever. 36.8% recognized Chloroquine as anti-malarial. Correct Chloroquine dose was used in 6.7%. Nearest health unit was within 2-3 km radius accessible on foot. Cost of management was affordable at Ugx 1,000/=. Referral units were far (25 km).


CONCLUSIONS
Malaria is under-diagnosed, late and wrongly treated, with few referrals to higher levels. Home-based management will reduce morbidity and save more lives of malaria in under-5 but it will be like a mass treatment of children under-five in Bugiri District with the consequence of rapid introduction of drug resistance of the parasite, hence the need to improve on diagnosis to reduce unnecessary drug use.
Oryema-Lalobo
Michael
M
Makerere University, School of Public Health, Kampala, Uganda. mlalobo@musph.ac.ug
D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D009035:Mothers; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
D000962:Antimalarials