Abstract
BackgroundFever in under-five children (U5) is the commonest presenting complaint in general practice and mothers’ recognition is an entry point for fever treatment, including malaria. This study describes rural–urban disparity in fever prevalence in U5, mothers’ malaria knowledge, care-seeking, testing for malaria before anti-malarial medication and the associated factors.MethodsA cross-sectional survey was conducted among 630 mother–child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother–child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before anti-malarial use, and delayed care-seeking defined as care sought for fever > 48 h of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥ 75th, 50th–74th, and < 50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05.ResultsThe median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI 1.8–4.2, p < 0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times more likely to receive anti-malarial medications without testing for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI 1.6–9.9, p < 0.000).ConclusionsRural–urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than ‘one-size-fits-all’ approach.
Highlights
Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers’ recognition is an entry point for fever treatment, including malaria
Rural–urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication
Rural mothers were thrice more likely to delay care-seeking for fever in U5 children than urban mothers, but were 80% less likely to use anti-malarial medications without blood testing for malaria parasite in U5 children with fever
Summary
Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers’ recognition is an entry point for fever treatment, including malaria. In 2018, Nigeria was the first among the 11 countries with high malaria burden globally, accounting for 25% of cases and 24% of deaths globally [1]. The approach was aimed at redirecting the static global malaria control response with a focus on high malaria-burdened countries for impact. The pillar two of this approach emphasized the use of strategic information rather than one-size-fits-all approach to drive this impact This encouraged sub-national, evidence–based, strategic information and interventions to drive impact for improve malaria elimination [4]. This underscores localized effort with focus on high-burden settings where intensified malaria interventions are targeted at a drastic reduction in malaria cases and deaths
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