title: Introducing the concept of a new pre-referral treatment for severely ill febrile children at community level: a sociological approach in Guinea-Bissau.
abstract: BACKGROUND
  Innovative strategies are needed to tackle childhood mortality in the rural tropics. Artesunate suppositories were developed to bring emergency treatment closer to severely ill children with malaria in rural areas where injectable treatment is not possible for several hours. Adding an antibacterial rectal drug would extend this strategy to treat non-malarial febrile illness as well. The objective of these studies was to assess acceptability of such a new pre-referral strategy by healthcare providers and likely uptake by the population.
  
  
  METHODS
  Two qualitative studies were conducted between May and July 2009. Study 1 investigated the acceptability of introducing a combined antimalarial-antibacterial suppository by interviewing 27 representatives of the three administrative levels (central government, regional, local) of the health sector; Study 2 investigated treatment-seeking behaviour and acceptability of this intervention at community level by interviewing 74 mothers in 2 villages.
  
  
  CONCLUSIONS
  Up to 92% of health representatives were in favour of introducing a new pre-referral strategy to tackle both malaria and non-malaria related severe illnesses in Guinea-Bissau, provided it was endorsed by international health authorities. The main obstacles to implementation were the very limited human and financial resources. In the two villages surveyed, 44% of the mothers associated severe illness with fever only, or fever plus one additional symptom. Mothers' judgement of severity and ensuing decisions were not specific for serious illness, indicating that initial training to recognize signs of severe disease and treatment availability for non-severe, fever-associated symptoms will be required to prevent overuse of a new intervention designed as a pre-referral treatment for severely ill children. Level C health centres were the first resort in both villages (50% and 87% of respondents respectively). This information is encouraging for the implementation of a pre-referral treatment.
authors: Audrey
authors: A
authors: Vermeersch
authors: Anaëlle
authors: A
authors: Libaud-Moal
authors: Amabelia
authors: A
authors: Rodrigues
authors: Nicholas J
authors: NJ
authors: White
authors: Piero
authors: P
authors: Olliaro
authors: Melba
authors: M
authors: Gomes
authors: Elizabeth A
authors: EA
authors: Ashley
authors: EA 4575 Développements Analytiques et Pharmaceutiques appliqués aux Maladies Négligées et aux Contrefaçons, Université Bordeaux Segalen, Bordeaux, France. pascalmillet1@gmail.com.
authors: Pascal
authors: P
authors: Millet
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D004338:Drug Combinations; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000469:parasitology; D006169:Guinea-Bissau; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy* / Q000469:parasitology; D009035:Mothers; D036301:Qualitative Research; D012017:Referral and Consultation; D012424:Rural Population; D013488:Suppositories; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D013488:Suppositories; D000077332:Artesunate