Treatment-seeking Paths in the Management of Severe Malaria in Children under 15 Years of Age Treated in Reference Hospitals of Kinshasa, Democratic Republic of Congo.
BACKGROUND
In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria.


METHODS
This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study.


RESULTS
Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher.


CONCLUSIONS
The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.
Institut Supérieur des Techniques Médicales de Kinshasa , RD Congo ; Université Libre de Bruxelles, School of Public Health, Research Centre in Epidemiology, Biostatistics and Clinical Research , Brussels, Belgium.
Félicien
F
Ilunga-Ilunga
Université Libre de Bruxelles, School of Public Health, Research Centre in Epidemiology, Biostatistics and Clinical Research , Brussels, Belgium.
Alain
A
Levêque
Université Notre-Dame de Tshiumbe, Democratic Republic of Congo.
Léon Okenge
LO
Ngongo
Université Libre de Bruxelles, School of Public Health, Health Policies & Systems Department , Brussels, Belgium.
Samia
S
Laokri
Université Libre de Bruxelles, School of Public Health, Research Centre in Epidemiology, Biostatistics and Clinical Research , Brussels, Belgium.
Michèle
M
Dramaix
Kinshasa (DRC); households; severe malaria; treatment-seeking path