Treatment-seeking Paths in the Management of Severe Malaria in Children under 15 Years of Age Treated in Reference Hospitals of Kinshasa, Democratic Republic of Congo

Abstract

Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case–Control Study

“…Prior studies have shown inconsistent results regarding the impact of delayed care seeking on severe malaria risk. [6][7][8][9] These studies demonstrated association between longer duration of symptoms or arbitrarily set cut-offs defining duration of symptoms before admission and severe malaria, but they did not consider the standard WHO definition of delay and severe malaria risk. One study conducted in the Gambia showed lack of association between duration of symptoms and severe malaria, a finding attributed to difficulties in recollection of accurate historical information by distressed mothers.…”

“…4 This strategy is logical as progression to severe disease requires extensive parasite multiplication over time. 5 Support for delayed care seeking as a risk factor for severe malaria is largely based on results from cross-sectional studies demonstrating association between longer duration of symptoms and severe malaria [6][7][8][9] and demonstration of rapid progression of uncomplicated to severe malaria. 10,11 However, some studies have not shown an association between duration of symptoms and risk of severe malaria.…”

Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013

“…In the language of economics, these are constraints and preferences, respectively [ 53 ]. Inaccessibility to health facilities due to high costs, distance, and lack of transportation represents the most common constraint to formal healthcare seeking in both the northern and the southern regions of Nigeria [ 54 , 55 ]. On the other hand, the most frequent barriers (preferences) in this study were ignorance of the severity of the child’s illness and use of traditional care in lieu of formal care.…”

Treatment-seeking rates in malaria endemic countries

“…Potential covariates were identified for inclusion in a predictive model using a review of the literature for ‘treatment-seeking’ and ‘care-seeking’ for both ‘malaria’ and ‘fever’ in PubMed on 18 July 2015 [ 31 ]. The following have been reported as determinants of care-seeking rates: household wealth [ 15 , 17 , 19 , 20 , 22 , 32 – 38 ], care-giver education [ 15 , 19 , 32 , 34 , 39 ] and household location (rural or urban) or access to health facilities [ 15 , 20 – 22 , 32 , 33 , 40 – 45 ]. The World Bank provides freely available national-level indicator data [ 46 ], and several indicators that were in keeping with the themes identified by the literature were downloaded: access to electricity (as a proxy for wealth and access to health facilities), gross domestic product (GDP; current US$), GDP per capita, GDP growth (annual %), gross national income (GNI) per capita (current US$), total health expenditure (% of GDP), public health expenditure (% of total), primary education completion rate (% of relevant age group), and rural population (% of total population).…”