Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data.

Jui A Shah,Yazoume Ye,Jacques B O Emina,Erin Eckert

doi:10.1186/s12936-015-0844-7

Abstract

BackgroundScaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment.MethodsThis study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.ResultsThe percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8–4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7–66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1–38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001).ConclusionsThis study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

Highlights

Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria
Treatment of fever among children under five Among children with fever, the proportion that received any anti-malarial treatment varied from 3.6 % in Ethiopia to 64.5 % in Uganda
The percentage of children with fever who received an artemisinin combination therapy (ACT) was below 10 % in nearly half of the countries included in the analysis

Summary

Introduction

Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment. Malaria burden remains high in sub-Saharan Africa (SSA) and affects mostly children under five years of age [1]. The World Health Organization (WHO) recommends prompt treatment, usually within 24 h of the onset of fever, with recommended anti-malarial medicines after confirmation of malaria through appropriate diagnostic tests [1]. Across SSA, only a small proportion of malaria patients, including children, receive prompt and effective treatment [1]. Potential reasons for low access to prompt and effective treatment among children revolve around affordability, acceptability, availability, and adequacy to meet expectations in quality of care [5,6,7,8,9]

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