title: Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study.
abstract: BACKGROUND
  The vast majority of malaria deaths in Uganda occur in children five and under and in rural areas. This study's exploratory case study approach captured unique situations to illustrate special attributes and aspects of treatment-seeking during a malaria episode.
  
  
  METHODS
  During August 2010, a qualitative exploratory study was conducted in seven of Butaleja District's 12 sub-counties. Multiple case study methodology consisting of loosely-structured interviews were carried out with eight caregivers of children five and under in the local dialect. Caregivers were geographically distant and not known to each other. Interviews were translated into English and transcribed the same day. Data were analyzed using content analysis.
  
  
  RESULTS
  Of the eight cases, children recovered fully in three instances, survived but with deficits in three, and died in two. Common to all outcomes were (1) triggers to illness recognition, (2) similar treatment sequences and practices, (3) factors which influenced caregivers' treatment-seeking decisions, (4) challenges encountered while seeking care at public health facilities, (5) cost burdens associated with managing malaria, (6) life burdens resulting from negative outcomes from malaria, (7) variations in caregiver knowledge about artemisinin combination therapy, and (8) varying perspectives how malaria management could be improved.
  
  
  CONCLUSIONS
  Despite the reality that caregivers in Butaleja District generally share similar practices, experiences and challenges, very few children ever receive treatment in accordance with the Uganda's national guidelines. To bring national practice into conformance with policy, three advances must occur: (1) All key stakeholders (those affiliated with the formal health system--public facilities and licensed private outlets, unlicensed drug vendors, and caregivers of young children) must concur on the need and the means to improve malaria management, (2) all health providers (formal and unlicensed) need to be engaged in training and certification to improve timely access to affordable treatment irrespective of a region's remoteness or low population density, and (3) future public health interventions need to improve caregivers' capacity to take the necessary actions to best manage malaria in young children.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. rosemin.kassam@ubc.ca.
authors.forename: Rosemin
authors.initials: R
authors.lastname: Kassam
authors.affiliation: Child Health and Development Centre, School of Medicine, Makerere University, Kampala, P.O.Box 7062, Uganda. sekiwunga@yahoo.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Sekiwunga
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. macleod.d@hotmail.com.
authors.forename: Duncan
authors.initials: D
authors.lastname: MacLeod
authors.affiliation: The Islamic University, Mbale, Uganda. tembehirome02@gmail.com.
authors.forename: Juliet
authors.initials: J
authors.lastname: Tembe
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. ericliow@alumni.ubc.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Liow
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D017028:Caregivers; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D015438:Health Behavior; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010290:Parents; D010342:Patient Acceptance of Health Care; D011156:Population Density; D036301:Qualitative Research; D014454:Uganda; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin