Caregiver responses and association with delayed care-seeking in children with uncomplicated and severe malaria

Abstract

BackgroundGaps remain in understanding the role of caregiver responses on time to seek appropriate care. The objective of this study was to describe caregiver responses to illness and the impact of these responses on time to seek appropriate care among children with malaria.MethodsA case–control study of 325 children with severe (cases) and 325 children with uncomplicated (controls) malaria was conducted in Jinja, Uganda. Caregivers’ responses to their children’s illnesses and time to seek appropriate care were documented. Responses included staying at home, seeking care at drug shops, and seeking care at public health facilities classified into two types: (1) health facilities where caregiver initially sought care before enrollment, and (2) health facilities where children were provided appropriate care and enrolled in the study. Weighted Cox regression was used to determine risk factors for delays in time to seek appropriate care within 24 h of illness onset.ResultsChildren staying home on self-medication was the most common initial response to illness among caregivers of controls (57.5%) and cases (42.4%, p < 0.001), followed by staying at home without medication (25.2%) and seeking care at drug shops (32.0%) for caregivers of controls and cases, respectively. Seeking care at drug shops was more common among caregivers of cases than of controls (32.0% vs. 12.3%; p < 0.001). However, compared to public health facilities, drug shops offered sub-optimal services with children less likely to have been examined (50.0% vs. 82.9%; p < 0.001) or referred to another facility (12.5% vs. 61.4%; p < 0.001). Upon adjustment for known risk factors for delay, initially seeking care at a drug shop (HR 0.37, p = 0.036) was associated with delay in seeking care at a health facility where appropriate care was provided. In contrast, those initially seeking care at public health facility before enrollment were more likely to subsequently seek care at another public health facility where appropriate care was provided (HR 5.55, p < 0.001).ConclusionCaregivers should be educated on the importance of promptly seeking care at a health facility where appropriate care can be provided. The role of drug shops in providing appropriate care to children with malaria needs to be reviewed.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2630-9) contains supplementary material, which is available to authorized users.

Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda

“…Performance levels were comparable across facility levels, types and age categories, with the exception of PFP facilities where only 50.7% (Table 2 ) of patients received appropriate malaria case management. Problems of PFP in Uganda have been described before including low testing rates [ 24 ] and use of non-recommended anti-malarials as first line treatment of uncomplicated malaria [ 46 ]; practices consistent with findings of this study. Prescription of non-recommended artemisinin-based combinations, such as DP, though a deviation from policy recommendation may be an acceptable practice in certain circumstances.…”

“…First, patients eligible for treatment with AL may not be able to afford the medicine. Second, failure to get medicines at the facility frustrates patients, promoting alternative care-seeking patterns for subsequent illness episodes, potentially delaying access to appropriate care [ 24 , 51 ]. While strengthening of the national supply chain has reduced the occurrence of stock-outs in public facilities, pockets of AL stock-outs persist [ 52 ].…”

The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis

“…This might indicate that seeking treatment outside the formal healthcare system, which may not be effective, delays appropriate treatment and increases the risk of SM. This is supported by studies in Uganda and Tanzania, which have shown that seeking care at a drug shop as a first response to illness was associated with delay in seeking care at a health facility where appropriate care was provided [24,28,71]. In addition, studies from Nigeria and Tanzania have shown evidence of progression to severe disease or SMA when not using a frontline antimalarial treatment in areas of high parasite resistance or when using suboptimal dosage [24,72].…”

Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort

“…Although we did not have data on severity or outcomes for children seeking care for these diagnoses, it is possible that care is sought later for children who live further from healthcare facilities, due to increased burden in accessing care. Early symptoms such as fever may be perceived as mild and not require care [ 16 , 17 ]. If care is sought later for children they may be more likely to develop severe disease and have worse outcomes.…”