A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

Kaona, F. A. D.; Tuba, Mary

doi:10.1186/1471-2458-5-28

Cited by 20 publications

(19 citation statements)

References 14 publications

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“…Our findings reveal that the study communities were familiar with rectal application of medicine, mainly traditional medicine but also biomedical, an observation reported by Kaona and Tuba [11] from Zambia, arguing well for the potential acceptability of rectal artesunate.…”

Section: Discussionsupporting

confidence: 67%

“…We know far less through research about how families manage severe malaria which carries a higher mortality, except that convulsions tend to be perceived as a different disease with a separate aetiology [8]–[10]. Crucially, we know little, except for very recent work, about the nature and reason for delays involved between presentation of danger signs and arrival at hospital and/or provision of antimalarial treatment to children in Sub-Saharan Africa - an important basis for reducing this interval and improving child survival [11]–[13].…”

Section: Introductionmentioning

confidence: 99%

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Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral

et al. 2007

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ObjectivesPreparatory to a community trial investigating how best to deliver rectal artesunate as pre-referral treatment for severe malaria; local understanding, perceptions of signs/symptoms of severe malaria and treatment-seeking patterns for and barriers to seeking biomedical treatment were investigated.Methodology/Principal Findings19 key informant interviews, 12 in-depth interviews and 14 focus group discussions targeting care-givers, opinion leaders, and formal and informal health care providers were conducted. Monthly fever episodes and danger signs or symptoms associated with severe malaria among under-fives were recorded. Respondents recognized convulsions, altered consciousness and coma, and were aware of their risks if not treated. But, these symptoms were perceived to be caused by supernatural forces, and traditional healers were identified as primary care providers. With some delay, mothers eventually visited a health facility when convulsions were part of the illness, despite pressures against this. Although vomiting and failure to eat/suck/drink were associated with malaria, they were not considered as indicators of danger signs unless combined with another more severe symptom. Study communities were familiar with rectal application of medicines.Conclusions/SignificanceCommunities' recognition and awareness of major symptoms of severe malaria could encourage action, but perceptions of their causes and poor discrimination of other danger signs – vomiting and failure to feed – might impede early treatment. An effective health education targeting parents/guardians, decision-makers/advisors, and formal and informal care providers might be a prerequisite for successful introduction of rectal artemisinins as an emergency treatment. Role of traditional healers in delivering such medication to the community should be explored.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral

et al. 2007

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“…At the time of writing, only one other published study has addressed this issue. 18 The present study adds to preliminary qualitative ethnographic research of maternal perceptions and practices regarding childhood fever to provide a context with which to guide future implementation of this intervention. The findings of the preliminary research showed that mothers were adept at recognizing febrile illness, which was often managed expectantly with traditional home treatments.…”

Section: Discussionmentioning

confidence: 99%

Caregivers’ Acceptance of Using Artesunate Suppositories for Treating Childhood Malaria in Papua New Guinea

Hinton¹,

Auwun²,

Pongua³

et al. 2007

The American Journal of Tropical Medicine and Hygiene

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Community-based interventions using artemisinin-derived suppositories may potentially reduce malaria-related childhood mortality. However, their sociocultural acceptability is unknown in Papua New Guinea and a formal examination of caregiver's attitudes to rectal administration was needed to inform effective deployment strategies. Caregivers (n = 131) of children with uncomplicated malaria were questioned on their prior experience with, and attitudes to, rectal administration and then offered artesunate suppositories as treatment of their child. The 29% who refused this alternative were further questioned to determine their reasons for this refusal. Lack of spousal approval and fear of side effects were the most common reasons for refusal. Sixty-six percent of caregivers agreed to self-administer suppositories, which were perceived as effective (99%), safe (96%), and fast-acting (91%), but problematic to administer to a struggling child (56%). Shame, embarrassment, and hygiene were not significant concerns. Acceptability of rectal administration should be relatively high in Papua New Guinea. However, deployment must be accompanied by health education that addresses the practical aspects of administration, is appropriate for the illiterate, and is directed at fathers as well as mothers.

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“…The child's mother made the decision in only 7.4% of cases (Okoko & Yamuah, 2006). Less commonly, authors have reported that mothers have the autonomy to diagnose and treat malaria themselves, such as in a study in Zambia (Kaona & Tuba, 2005). A study of care-seeking in rural Senegal found that decision-making was collaborative in 71% of cases requiring treatment outside the home, with household roles divided according to gender norms, inter-generational relations and family characteristics (Frankel & Lalou, 2009).…”

Section: Introductionmentioning

confidence: 99%

Household Roles and Care-Seeking Behaviours in Response to Severe Childhood Illness in Mali

et al. 2013

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Malaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region.

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A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

Cited by 20 publications

References 14 publications

Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral

Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral

Caregivers’ Acceptance of Using Artesunate Suppositories for Treating Childhood Malaria in Papua New Guinea

Household Roles and Care-Seeking Behaviours in Response to Severe Childhood Illness in Mali

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