Abstract

BackgroundIn 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. Implementation is through community drug distributors (CDDs) who distribute pre-packaged chloroquine plus sulfadoxine-pyrimethamine (HOMAPAK®) free of charge to caretakers of febrile children. Adherence of caretakers to this regimen has not been studied.MethodsA questionnaire-based survey combined with inspection of blister packaging was conducted to investigate caretakers' adherence to HOMAPAK®. The population surveyed consisted of internally displaced people (IDPs) from eight camps.ResultsA total of 241 caretakers were interviewed. 95.0% (CI: 93.3% – 98.4%) of their children had received the correct dose for their age and 52.3% of caretakers had retained the blister pack. Assuming correct self-reporting, the overall adherence was 96.3% (CI: 93.9% – 98.7%). The nine caretakers who had not adhered had done so because the child had improved, had vomited, did not like the taste of the tablets, or because they forgot to administer the treatment. For 85.5% of cases treatment had been sought within 24 hours. Blister packaging was considered useful by virtually all respondents, mainly because it kept the drugs clean and dry. Information provided on, and inside, the package was of limited use, because most respondents were illiterate. However, CDDs had often told caretakers how to administer the treatment. For 39.4% of respondents consultation with the CDD was their reported first action when their child has fever and 52.7% stated that they consult her/him if the child does not get better.ConclusionIn IDP camps, the HBMF strategy forms an important component of medical care for young children. In case of febrile illness, most caretakers obtain prompt and adequate antimalarial treatment, and adhere to it. A large proportion of malaria episodes are thus likely to be treated before complications can arise. Implementation in the IDP camps now needs to focus on improving monitoring, supervision and general support to CDDs, as well as on targeting them and caretakers with educational messages. The national treatment policy for uncomplicated malaria has recently been changed to artemether-lumefantrine. Discussions on a suitable replacement combination for HBMF are well advanced, and have raised new questions about adherence.

Highlights

  • In 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years

  • Summary of study population From 12 to 19 September 2005, 243 caretakers were approached in eight internally displaced persons (IDP) camps, none of whom refused to take part in the study

  • The present study shows that community drug distributors (CDDs) play an important role in the control of malaria in IDP camps, some of them providing presumptive malaria treatment for febrile illness to more than 60 children per month

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Summary

Introduction

In 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. From the moment a patient experiences the first symptoms of malaria to the point when the disease has been cured, many potential barriers have to be overcome These include delays in recognition of symptoms and treatment seeking, and nonadherence to the drug regimen. Helping caretakers of young children to overcome these and other barriers to prompt and effective treatment is of particular importance in sub-Saharan Africa. In this malaria endemic region, severe malaria is the most common cause of death of young children. The greatest proportion of these deaths is due to the lack of early recognition of malaria symptoms (which overlap with those of other fatal febrile illnesses in early childhood) and their management with prompt and effective treatment within 24 hours of onset of symptoms [1,2,3,4,5]

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