title: Compliance With Referral Advice After Treatment With Prereferral Rectal Artesunate: A Study in 3 Sub-Saharan African Countries.
abstract: BACKGROUND
  Children aged <5 years were enrolled in a large study in 3 countries of sub-Saharan Africa because they had danger signs preventing them from being able to take oral medications. We examined compliance and factors associated with compliance with referral advice for those who were treated with rectal artesunate.
  
  
  METHODS
  Patient demographic data, speed of accessing treatment after danger signs were recognized, clinical symptoms, malaria microscopy, treatment-seeking behavior, and compliance with referral advice were obtained from case record forms of 179 children treated with prereferral rectal artesunate in a multicountry study. We held focus group discussions and key informant interviews with parents, community health workers (CHWs), and facility staff to understand the factors that deterred or facilitated compliance with referral advice.
  
  
  RESULTS
  There was a very high level of compliance (90%) among patients treated with prereferral rectal artesunate. Age, symptoms at baseline (prostration, impaired consciousness, convulsions, coma), and malaria status were not related to referral compliance in the analysis.
  
  
  CONCLUSIONS
  Teaching CHWs to diagnose and treat young children with prereferral rectal artesunate is feasible in remote communities of Africa, and high compliance with referral advice can be achieved.
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Department of Epidemiology and Medical Statistics, College of Medicine.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Department of Sociology, Faculty of Social Sciences.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000285:Administration, Rectal; D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage* / Q000627:therapeutic use*; D000077332:Artesunate; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D012017:Referral and Consultation
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
keywords: community health worker; compliance with referral advice; malaria; rapid diagnostic tests; rectal artesunate