Abstract
BackgroundMild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. However, treatment is complicated and expensive, and mortality is higher when children present to the hospital with severe forms of these illnesses. We studied how care seeking behaviours and other factors contributed to severity of malaria, pneumonia and diarrhoea among children less than five years in rural Tanzania.MethodsWe interviewed consecutive care-takers of children diagnosed with malaria, pneumonia and/or diarrhea at Korogwe and Muheza district hospitals, in north-eastern Tanzania, between July 2009 and January 2010, and compared characteristics of children presenting with severe and those with non-severe disease.ResultsA total of 293 children with severe and 190 with non-severe disease were studied. We found persistent associations between severity of disease and caretaker’s lack of formal education (OR 6.6; 95% confidence interval (CI) 2.7-15.8) compared to those with post-primary education, middle compared to high socio-economic status (OR 1.9; 95% CI 1.2-3.2), having 4 or more children compared to having one child (OR 2.5; 95% CI 1.4-4.5), having utilized a nearer primary health care (PHC) facility for the same illness compared to having not (OR 5.2; 95% CI 3.0-9.1), and having purchased the first treatment other than paracetamol from local or drug shops compared to when the treatment was obtained from the public hospitals for the first time (OR 3.2; 95% CI 1.9-5.2). The old officially abandoned first line anti-malaria drug Sulfadoxin-pyrimethamine (SP) was found to still be in use for the treatment of malaria and was significantly associated with childrens’ presentation to the hospital with severe malaria (OR 12.5; 95% CI 1.6-108.0).ConclusionsOur results indicate that caretakers with no formal education, with lower SES and with many children can be target groups for interventions in order to further reduce child mortality from treatable illnesses. Furthermore, the quality of the available drug shops and PHC facilities need to be closely monitored.
Highlights
Mild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs
In this study from rural Tanzania, we found that children had a higher probability of presenting at the district hospital with severe disease if they had utilized primary health care (PHC) facilities for the same illness, had obtained the first treatment other than paracetamol from local sources and drug shops, and if they had received SP as the only treatment for malaria
Our study has identified some factors that are associated with severity of disease from malaria, pneumonia and diarrhea
Summary
Pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. Pneumonia and diarrhea are treatable with complete recovery from the widely available and inexpensive first line drugs. There have been many efforts to prevent infections in children through vaccination programmes and other community interventions, some with success. Primary prevention of infectious diseases is still difficult to achieve for children in poor families who are continuously exposed to health risks and other hazards typical in poor communities. Many children from poor families are undernourished, making them less resistant to infections. This makes early disease detection and timely management crucial in preventing deaths of these children from treatable illnesses
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