Abstract
BackgroundIn Sub-Saharan Africa, both under-treatment and over-treatment of malaria are common since illnesses are often diagnosed and treated on the basis of symptoms. We investigate whether malaria treatment rates among febrile individuals correspond to observed patterns of malaria infection by age and by local prevalence.Methods and findingsWe use data on treatment of febrile illnesses from a household survey that was conducted between March and May 2012 in 92 villages in six districts in Eastern Uganda. All household members were also tested for malaria using a rapid diagnostic test. We show that both the age of the febrile individual and the village prevalence rate are strongly associated with the odds that a febrile patient was infected with malaria, but not with the odds of ACT treatment. Compared to individuals who were aged 15 or above, febrile individuals aged 5–14 had 3.21 times the odds of testing positive for malaria (95% CI: [2.36 4.37], P<0·001), and febrile individuals who were under age 5 had 2.66 times the odds of testing positive for malaria (95% CI: [1.99 3.56], P<0·001). However, ACT treatment rates for febrile illnesses were not significantly higher for either children ages 5–14 (Unadjusted OR: 1.19, 95% CI: [0.88 1.62], P = 0.255) or children under the age of 5 (Unadjusted OR: 1.24, 95% CI: [0.92 1.68], P = 0·154). A one standard deviation increase in the village malaria prevalence rate was associated with a 2.03 times higher odds that a febrile individual under the age of five tested positive for malaria (95% CI: [1.63 2.54], p<0·001), but was not significantly associated with the odds of ACT treatment (Un-adjusted OR: 0.83, 95% CI: [0.66 1.05], P = 0·113). We present some evidence that this discrepancy may be because caregivers do not suspect a higher likelihood of malaria infection, conditional on fever, in young children or in high-prevalence villages.ConclusionOur findings suggest that households have significant mis-perceptions about malaria likelihood that may contribute to the under-treatment of malaria. Policies are needed to encourage caregivers to seek immediate diagnostic testing and treatment for febrile illnesses, particularly among young children.
Highlights
Malaria continues to pose a large morbidity and mortality burden with an estimated 214 million cases in 2015 and nearly 440,000 deaths [1]
Our findings suggest that households have significant mis-perceptions about malaria likelihood that may contribute to the under-treatment of malaria
In this study we investigate whether artemisinin-based combination therapies (ACTs) treatment patterns for febrile illnesses correspond to patterns of malaria infection by patient age and by local prevalence
Summary
Malaria continues to pose a large morbidity and mortality burden with an estimated 214 million cases in 2015 and nearly 440,000 deaths [1]. A majority of these deaths occur in Sub-Saharan Africa, primarily among young children, and could likely be avoided with prompt treatment of the illness with artemisinin-based combination therapies (ACTs), the first-line treatment for uncomplicated malaria [1,2]. It is estimated that only 12–22% of malaria cases in children under age five were treated with ACTs in 2014 This low level of coverage with appropriate treatment is partly due to the fact that nearly 45% of children with fever (the primary symptom of malaria) either did not get any care outside the home or sought care in the informal private sector, where they are less likely to get ACTs than if they sought public sector treatment [1]. We investigate whether malaria treatment rates among febrile individuals correspond to observed patterns of malaria infection by age and by local prevalence
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
