Caregivers’ treatment-seeking behaviors and practices in Uganda—A systematic review (Part II)

Kassam, Rosemin; Collins, John B.; Liow, Eric; Rasool, Nabeela

doi:10.1016/j.actatropica.2015.07.029

Cited by 22 publications

(13 citation statements)

References 16 publications

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“…Given that the use of home-stock medicines and visits to an unlicensed vendor remain common practice, only 43.2 % of those who visited a public health facility could be classified as having received an appropriate antimalarial. These findings confirm what has previously been reported for management of childhood malaria in Uganda: the use of public health facilities is limited, visits to a public facility does not ensure receipt of an ACT, and self-management practices with sub-optimal treatments at the household level remains a major obstacle to a child receiving an appropriate antimalarial treatment [34]. Accordingly, this study proposes a need for public health education to influence caregivers’ malaria management practices by educating them about ACTS, the importance of using only the first-line treatments, and to know where to quickly obtain these treatments when a child experiences fever.…”

Section: Discussionsupporting

confidence: 87%

Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

et al. 2016

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BackgroundThis study responds to a rural community’s concern that, despite national initiatives, malaria management in young children falls short of national guidelines in their district. This study aimed to: (1) describe caregivers’ treatment-seeking behaviors in the rural district of Butaleja, (2) estimate the percentage of children who received an appropriate antimalarial, and (3) determine factors that maximized the likelihood of receiving an appropriate antimalarial. Appropriate antimalarial in this study is defined as having received only the Uganda’s age-specific first-line malaria treatment for uncomplicated and severe malaria during the course of the febrile illness.MethodsA household survey design was used in 2011 to interview 424 caregivers with a child aged five and under who had fever within the two weeks preceding the survey. The survey evaluated factors that included: knowledge about malaria and its treatment, management practices, decision-making, and access to artemisinin combination therapy (ACT) and information sources. Bivariate analysis, followed by logistic regression, was used to determine predictors of the likelihood of receiving an appropriate antimalarial.ResultsHome management was the most common first action, with most children requiring a subsequent action to manage their fever. Overall, 20.9 % of children received a blood test, 68.4 % received an antimalarial, and 41.0 % received an ACT. But closer inspection showed that only 31.6 % received an appropriate antimalarial. These results confirm that ACT usage and receipt of an appropriate antimalarial in Butaleja remain well below the 2010/2015 target of 85 %. While nine survey items differentiated significantly whether a child had or had not received an appropriate antimalarial, our logistic regression model identified four items as independent predictors of likelihood that a child would receive an appropriate antimalarial: obtaining antimalarials from regulated outlets (OR = 14.99); keeping ACT in the home for future use (OR = 6.36); reporting they would select ACT given the choice (OR = 2.31); and child’s age older than four months (OR = 5.67).ConclusionsFew children in Butaleja received malaria treatment in accordance with national guidelines. This study highlighted the importance of engaging the full spectrum of stakeholders in the management of malaria in young children - including licensed and unlicensed providers, caregivers, and family members.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1815-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

et al. 2016

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“…The use of non-recommended modern medicines (paracetamol, chloloquine, quinine) alone or combined with another treatment was also very common. Paracetamol, especially popular, is an antipyretic, inexpensive, highly effective in decreasing fever, and easy to buy in informal structures like local markets [ 43 – 45 ]. The quinine drug is often perceived as the most effective treatment of malaria as it is recommended for severe malaria cases therefore, in cases of uncomplicated malaria, people seem to prefer the use of oral or intravenous quinine.…”

Section: Discussionmentioning

confidence: 99%

Low use of artemisinin-based combination therapy for febrile children under five and barriers to correct fever management in Benin: a decade after WHO recommendation

et al. 2018

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BackgroundArtemisinin-based combination therapy (ACT), used to treat uncomplicated malaria cases, is one of the main strategies of malaria control and elimination. One of the main objectives of the Benin National Malaria Control Program’s (NMCP) strategic plan is to ensure that at least 80% of uncomplicated malaria is treated with ACT within 24 h. Therefore, it was of great interest to measure whether the country case management of fever amongst children under five, adhered to the NMCP’s strategic plan and look into the barriers to the use of ACT.MethodsA cross-sectional survey based on a cluster and multi-stage sampling was conducted in two rural health districts in Benin. We recruited 768 and 594 children under five years were included in the northern and in the southern respectively. Data was collected on the general use of ACT and on the correct use of ACT that adheres to the NMCP’s strategy, as well as the barriers that prevent the proper management of fever amongst children. To assess the certain predictors of ACT usage, logistic regression was used, while taking into account the cluster random effect.ResultsAmong febrile children aged 6 to 59 months, 20.7% in the south and 33.9% in north received ACT. The correct use of ACT, was very low, 5.8% and in southern and 8.6% northern areas. Caregivers who received information on ACT were 3.13 time more likely in the south and 2.98 time more likely in the north to give ACT to their feverish child, PPR = 3.13[1.72–4.15] and PPR = 2.98 [2.72–3.11] respectively. Chloroquine and quinine, other malaria treatments not recommended by NMCP, were still being used in both areas: 12.3 and 3.3% in the south and 11.4 and 3.0% in the north.ConclusionIn Benin, the use and the correct use of ACT for febrile children remains low. The study also showed that having received information about the use of ACT is positively associated with the use of ACT. This point highlights the fact that efforts may not have been sufficiently integrated with social communication, which should be based on the behavioural determinants of populations.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5077-6) contains supplementary material, which is available to authorized users.

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“…While homebased treatment is a common first step for families, the diversity, adequacy and sequencing of home care is not well understood. Future studies should consider developing a standardized typology for the type of treatment provided that would enable comparisons across different contexts (40).…”

Section: Barriers To Seeking Care For Sick Children Outside the Homementioning

confidence: 99%

Understanding factors influencing care seeking for sick children in Ebonyi and Kogi states, Nigeria

Dougherty

Gilroy

Olayemi

et al. 2020

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Background : Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality. Methods : This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria’s Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al conceptual framework for household decision-making and pathways to care. These include (1) caregivers’ recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services. Results: Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist. Conclusion: We conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.

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Caregivers’ treatment-seeking behaviors and practices in Uganda—A systematic review (Part II)

Cited by 22 publications

References 16 publications

Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

Low use of artemisinin-based combination therapy for febrile children under five and barriers to correct fever management in Benin: a decade after WHO recommendation

Understanding factors influencing care seeking for sick children in Ebonyi and Kogi states, Nigeria

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