Abstract
ObjectivesPreparatory to a community trial investigating how best to deliver rectal artesunate as pre-referral treatment for severe malaria; local understanding, perceptions of signs/symptoms of severe malaria and treatment-seeking patterns for and barriers to seeking biomedical treatment were investigated.Methodology/Principal Findings19 key informant interviews, 12 in-depth interviews and 14 focus group discussions targeting care-givers, opinion leaders, and formal and informal health care providers were conducted. Monthly fever episodes and danger signs or symptoms associated with severe malaria among under-fives were recorded. Respondents recognized convulsions, altered consciousness and coma, and were aware of their risks if not treated. But, these symptoms were perceived to be caused by supernatural forces, and traditional healers were identified as primary care providers. With some delay, mothers eventually visited a health facility when convulsions were part of the illness, despite pressures against this. Although vomiting and failure to eat/suck/drink were associated with malaria, they were not considered as indicators of danger signs unless combined with another more severe symptom. Study communities were familiar with rectal application of medicines.Conclusions/SignificanceCommunities' recognition and awareness of major symptoms of severe malaria could encourage action, but perceptions of their causes and poor discrimination of other danger signs – vomiting and failure to feed – might impede early treatment. An effective health education targeting parents/guardians, decision-makers/advisors, and formal and informal care providers might be a prerequisite for successful introduction of rectal artemisinins as an emergency treatment. Role of traditional healers in delivering such medication to the community should be explored.
Highlights
Most malaria deaths occur in children in rural areas of sub-Saharan Africa [1]
We know little, except for very recent work, about the nature and reason for delays involved between presentation of danger signs and arrival at hospital and/ or provision of antimalarial treatment to children in Sub-Saharan Africa - an important basis for reducing this interval and improving child survival [11,12,13]
One of four traditional healers interviewed (TH from Msakala) listed malaria among the diseases leading to death of children
Summary
Most malaria deaths occur in children in rural areas of sub-Saharan Africa [1]. A major cause is lack of access to prompt effective treatment Those that present with severe malaria have short histories of illness, emphasizing the speed of disease progression if not treated promptly and effectively [2]. For those children who manage to reach health facilities, hospital based data indicates that the episode commences with a febrile illness 1–3 days prior to admission, and neurological manifestations within 12 hours of admission [3,4]. We know little, except for very recent work, about the nature and reason for delays involved between presentation of danger signs and arrival at hospital and/ or provision of antimalarial treatment to children in Sub-Saharan Africa - an important basis for reducing this interval and improving child survival [11,12,13]
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.
