Abstract
BackgroundHome-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6–59 months).MethodsA descriptive cross-sectional study carried out from June 2012–July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16.ResultsOf the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ2 = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (β = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (β = 1.87, OR 6.5, p = 0.02).ConclusionsThe expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality.
Highlights
Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver
The analysis showed that the Nagelkerke R 2 for severe malaria and mortality was 0.211 and 0.267 respectively indicating that the logistic model has no omitted variables if it fails to reject the null hypothesis
Concerning inappropriateness of home-based management of malaria (HMM), commencing HMM late was practiced by 124/219 (56.6%) caregivers, use of inappropriate anti-malarial drugs for HMM 187/219 (85.4%) caregivers and administration of HMM drugs at incorrect dosages was by 215/219 (98.2%) caregivers
Summary
Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The rate remains persistently high through the period of childhood [1, 2] It is a common cause of death especially in Nwaneri et al Malar J (2017) 16:187 and respond appropriately; community-based training programmes that provides caregivers with the knowledge and capacity to respond to malarial illness and creation of environment that enables the strategy to be implemented by making medicines available as near to the home as possible. This is aimed at delivering effective anti-malarial medicines by non-medical caregivers to individuals with suspected malaria as close as possible to their homes and work places [3]. Of note that is that, most of these researches were carried out during the era when chloroquine was the drug of choice for treatment of uncomplicated malaria
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