Understanding caretakers' dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate

Daudi O Simba,Marian Warsame,Goran Tomson,Eva Johansson,Deodatus C Kakoko,Zul Premji,Melba F Gomes

doi:10.1186/1475-2875-9-123

Abstract

BackgroundMalaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate.MethodsFour focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis.ResultsThe theme "Caretakers dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate" depicts the challenge they face. Caretakers' understanding of the rationale for going to hospital after treatment - when and why they should adhere - influenced adherence. Caretakers, whose children did not improve, usually adhered to referral advice. If a child had noticeably improved with pre-referral treatment however, caretakers weighed whether they should proceed to the facility, balancing the child's improved condition against other competing priorities, difficulties in reaching the health facilities, and the perceived quality of care at the health facility. Some misinterpretation were found regarding the urgency and rationale for adherence among some caretakers of children who improved which were attributed to be possibly due to their prior understanding.ConclusionSome caretakers did not adhere when their children improved and some who adhered did so without understanding why they should proceed to the facility. Successful implementation of the rectal artesunate strategy depends upon effective communication regarding referral to clinic.

Highlights

IntroductionThis paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate
A recent multi-centre trial on rectal artesunate given as a pre-referral treatment to patients with suspected malaria who could not take oral drugs at the community level reported high adherence; between 5-12% in Ghana and Tanzania who survived for six hours never went to a clinic [6]
Results from the focus group discussions (FGDs) are discussed and supported by quotations to illuminate some of the findings from each subcategory that highlight the experiences and perceptions influencing the decision to adhere to referral advice

Summary

Introduction

This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate. A recent multi-centre trial on rectal artesunate given as a pre-referral treatment to patients with suspected malaria who could not take oral drugs at the community level reported high adherence; between 5-12% in Ghana and Tanzania who survived for six hours never went to a clinic [6]. Costs, use of referral cards and health workers communication skills have been shown to influence adherence to referral advice when patients presenting at primary health care facilities are advised to proceed to a secondary facility [8,9]. The factors that provoke non-adherence still remain an open question

Methods

Results

Discussion

Conclusion