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.
Highlights
Gaps remain in understanding the role of caregiver responses on time to seek appropriate care
Despite progress, a large number of African children continue to die of malaria, partly due to delays in seeking appropriate care [10]; defined as prompt diagnosis by microscopy or RDTs for suspected malaria cases followed by treatment with artemisinin-based combination therapy (ACT), if uncomplicated malaria is diagnosed, or parenteral artesunate and supportive care if severe malaria is diagnosed
Overall, staying at home was the most common response to illness by caregivers, followed by care seeking at a drug shop, which was more common among caregivers of children with severe malaria
Summary
Gaps remain in understanding the role of caregiver responses on time to seek appropriate care. Despite progress, a large number of African children continue to die of malaria, partly due to delays in seeking appropriate care [10]; defined as prompt diagnosis by microscopy or RDTs for suspected malaria cases followed by treatment with ACT, if uncomplicated malaria is diagnosed, or parenteral artesunate and supportive care if severe malaria is diagnosed. The proportion of children with confirmed malaria promptly receiving ACT is unacceptably low, ranging from 2 to 22% in 17 high burden countries in Africa [6]. Time taken to seek appropriate care by caregivers of sick children is influenced by two important decisions: when to respond to illness and where to seek care [13]. In sub-Saharan Africa, responses to seek care outside home are often delayed, and when a response is made, this response is often to seek care at a drug shop, rather than at a qualified health facility [14, 15]
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