title: Concerns about covert HIV testing are associated with delayed presentation of suspected malaria in Ethiopian children: a cross-sectional study.
abstract: BACKGROUND
  Early diagnosis is important in preventing mortality from malaria. The hypothesis that guardians' fear of covert human immunodeficiency virus (HIV) testing delays presentation of children with suspected malaria was tested.
  
  
  METHODS
  The study design is a cross-sectional survey. The study population consisted of guardians of children with suspected malaria who presented to health centres in Oromia Region, Ethiopia. Data were collected on attitudes to HIV testing and the duration of children's symptoms using interview administered questionnaires.
  
  
  RESULTS
  Some 830 individuals provided data representing a response rate of 99% of eligible participants. Of these, 423 (51%) guardians perceived that HIV testing was routinely done on blood donated for malaria diagnosis, and 353 (43%) were aware of community members who delayed seeking medical advice because of these concerns. Children whose guardians suspected that blood was covertly tested for HIV had longer median delay to presentation for evaluation at health centres compared to those children whose guardians did not hold this belief (three days compared to two days, p < 0.001). Children whose guardians were concerned about covert HIV testing were at a higher odds of a prolonged delay before being seen at a health centre (odds ratio 1.73, 95% confidence intervals: 1.10 to 270 for a delay of ≥ 3 days compared to those seen in ≤ 2 days).
  
  
  CONCLUSIONS
  Children whose guardians believed that covert testing for HIV was routine clinical practice presented later for investigation of suspected malaria. This may account for up to 14% of the delay in presentation and represents a reversible risk factor for suboptimal management of malaria.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Haji
authors.affiliation: Department of Preventative Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa 6850, Ethiopia. deressaw@gmail.com.
authors.forename: Wakgari
authors.initials: W
authors.lastname: Deressa
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Fogarty
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000523:psychology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D057545:Social Stigma; D055815:Young Adult
references.citation: J Vector Borne Dis. 2004 Mar-Jun;41(1-2):27-31
references.pmid: 15332483
references.citation: Int J Nurs Stud. 2010 Apr;47(4):475-86
references.pmid: 19854440
references.citation: Malar J. 2010 Jul 13;9:203
references.pmid: 20626863
references.citation: Lancet. 2014 Feb 22;383(9918):723-35
references.pmid: 23953767
references.citation: Malar J. 2012 Jun 08;11:185
references.pmid: 22681850
references.citation: Trop Med Int Health. 2007 Oct;12(10):1148-56
references.pmid: 17956496
references.citation: Psychosoc Med. 2007 Jun 20;4:Doc07
references.pmid: 19742288
references.citation: Reprod Health. 2012 Jul 26;9:8
references.pmid: 22834566
references.citation: BMC Public Health. 2012 Dec 18;12:1089
references.pmid: 23249239
references.citation: Malar J. 2010 Apr 18;9:98
references.pmid: 20398416
references.citation: Trop Med Int Health. 2006 Jul;11(7):1022-31
references.pmid: 16827703
references.citation: Malar J. 2010 Nov 22;9:333
references.pmid: 21092176
references.citation: PLoS Med. 2005 Aug;2(8):e247
references.pmid: 16008508
references.citation: BMJ. 2014 Jan 24;348:f7450
references.pmid: 24464277
references.citation: Bull World Health Organ. 1999;77(3):263-6
references.pmid: 10212518
references.citation: Trop Med Int Health. 2009 May;14(5):491-8
references.pmid: 19222821
references.citation: PLoS One. 2012;7(7):e40244
references.pmid: 22815732
references.citation: Glob Health Action. 2009 Jan 13;2:
references.pmid: 20027277
references.citation: Malar J. 2009 Oct 28;8:243
references.pmid: 19863788
references.citation: Malar J. 2005 Jul 25;4:35
references.pmid: 16042793
references.citation: Malar J. 2010 Dec 21;9:367
references.pmid: 21176131
references.citation: Bull World Health Organ. 1999;77(4):310-4
references.pmid: 10327709
references.citation: AIDS Res Ther. 2011 Feb 28;8:8
references.pmid: 21356115
references.citation: Malar J. 2010 May 27;9:144
references.pmid: 20507555
references.citation: Int J Epidemiol. 1997 Feb;26(1):220-3
references.pmid: 9126523
references.citation: Malar J. 2010 Dec 30;9:377
references.pmid: 21192825