title: The Impact of a Community Awareness Strategy on Caregiver Treatment Seeking Behaviour and Use of Artemether-Lumefantrine for Febrile Children in Rural Kenya.
abstract: BACKGROUND
  Access to prompt and effective treatment is the cornerstone for malaria control. Population Services International in collaboration with the Ministry of Health launched a malaria behaviour change communication intervention in Nyanza province, Kenya. The initiative aimed to improve: symptom recognition and prompt access to government health facilities for febrile children; effective treatment with the recommended first-line drug artemether-lumefantrine (AL) in public health facilities and adherence to the AL regimen.
  
  
  METHODS
  Pre- and post-intervention cross-sectional household surveys were used to evaluate the impact of the intervention on prompt and correct use of AL for febrile children below five years of age. The primary outcome was the proportion of children below five years of age with fever in the last 14 days accessing AL within 48 hours of fever onset.
  
  
  RESULTS
  There was an increase from 62.8% pre-intervention to 79.4% post-intervention (95% CI: 11.1, 22.1) in caregivers who reported seeking formal treatment promptly (on the same day, or next day) for their febrile children. However, there was a decrease in the use of government health facilities in the post-intervention period. There was a small increase in the proportion of children accessing AL within 48 hours of fever onset [18.4% vs 23.5% (0.1-10.0)].
  
  
  CONCLUSIONS
  The findings of this evaluation demonstrate that interventions that target only one sector may have a limited impact on improvements in prompt and effective treatment where multiple sources of treatments are sought for febrile illness. Additionally, the context in which an intervention is implemented is likely to influence the process and outcomes.
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Wasunna
authors.affiliation: Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100 GPO, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, United Kingdom.
authors.forename: Emelda A
authors.initials: EA
authors.lastname: Okiro
authors.affiliation: Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), London, Keppel Street, WCIE 7HT, London, United Kingdom.
authors.forename: Jayne
authors.initials: J
authors.lastname: Webster
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, Keppel Street, WCIE 7HT, London, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Department of Public Health Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100 GPO, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, United Kingdom.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.affiliation: Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, United Kingdom; Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), London, Keppel Street, WCIE 7HT, London, United Kingdom; Health Systems and Social Science Research, Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMR-C), P.O. Box 230, Kilifi, Kenya.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jones
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use*; D001364:Awareness; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data; D003256:Community Participation / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004983:Ethanolamines / Q000627:therapeutic use*; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D000078102:Lumefantrine; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010342:Patient Acceptance of Health Care
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077549:Artemether; D000078102:Lumefantrine