Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study.

Soter Ameh,Wilfred Ndifon,Caroline W Kabiru,Angela Oyo-Ita,Paul Welaga,Bassey Ikpeme,Emmanuel Nsan

doi:10.1186/s12889-015-1777-3

Abstract

BackgroundHome management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver’s ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana.MethodsA cross-sectional household survey was conducted among 811 caregivers recruited through multistage sampling. A caregiver was reported to have practiced appropriate HMM if an antimalarial drug was administered to a febrile child in the recommended regimen (correct dose and duration for the child’s age). Binary logistic regression was used to determine factors associated with appropriate HMM.ResultsOf the 811 caregivers, 87% recognised the symptoms of uncomplicated malaria in U5, and 49% (n = 395) used antimalarial drugs for the HMM. Fifty percent (n = 197) of caregivers who administered antimalarial drugs used the appropriate regimen. In the multivariate logistic regression, caregivers with secondary (OR = 1.71, 95% CI: 1.03, 2.83) and tertiary (OR = 3.58, 95% CI: 1.08, 11.87) education had increased odds of practicing appropriate HMM compared with those with no formal education. Those who sought treatment in the hospital for previous febrile illness in U5 had increased odds of practicing appropriate HMM (OR = 2.24, 95% CI: 1.12, 4.60) compared with those who visited the health centres.ConclusionsHalf of caregivers who used antimalarial drugs practiced appropriate HMM. Educational status and utilisation of hospitals in previous illness were associated with appropriate HMM. Health education programmes that promote the use of the current first line antimalarial drugs in the appropriate regimen should be targeted at caregivers with no education in order to improve HMM in communities where parasitological diagnosis of malaria may not be feasible.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1777-3) contains supplementary material, which is available to authorized users.

Highlights

Home management of uncomplicated malaria (HMM) is integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment
We reported knowledge of malaria, the appropriate regimen of antimalarial drugs used for the HMM in Children under 5 years of age (U5), barriers to uptake of HMM, and factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana
Knowledge of uncomplicated malaria and actions taken during onset of fever in U5 About 87% (708/811) of the respondents recognised the symptoms of uncomplicated malaria in U5 (Figure 1)

Summary

Introduction

Home management of uncomplicated malaria (HMM) is integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver’s ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana. Malaria-related deaths in U5 occur within 48 hours of onset of illness [4]. One of the strategies of the Roll Back Malaria (RBM) programme is to reduce mortality in U5 through early diagnosis and treatment within 24 hours of the onset of symptoms [5]. Poor physical access to health facilities is an obstacle to early diagnostic and curative services in rural areas in Lowand Middle-Income Countries (LMICs) [6,7]

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Results

Conclusion