Malaria Treatment Seeking Research Articles

Self-medication practice with antimalarials & the determinants of malaria treatment-seeking behavior among postpartum mothers in a rural community in Nigeria.

The majority of the population has inappropriate malaria treatment-seeking behavior and little is known about self-medication practice with antimalarials among postpartum mothers. The study, therefore, aims to determine the prevalence of self-treatment practice with antimalarials and identify factors that determine inappropriate treatment-seeking practice in this susceptible group. The study is a cross-sectional study that was conducted using a purposive sampling technique. In the study, 150 respondents were administered questionnaires by one-on-one interviews, and results were presented as frequencies and proportions. A chi-square test was done to determine the association between independent categorical variables and the dependent variable. In the study, 91 (60.7%) of the women claimed they did malaria screening tests in the laboratory/clinic before treatment, while only half of them sought professional care for treatment after the screening test. Additionally, most of the participants claimed they practice self-medication with antimalarials for themselves (64, 42.7%), and their newborn children (34, 22.7%). The experience of adverse effects (χ2 = 4.790, df = 1, p = .029) drug prescription by doctors (χ2 = 10.26, df = 1, p = .001) and the experience of malaria in the rainy season (χ2 = 4.86, df = 2, p = .027) was significantly related to receiving malaria treatment in the clinic/hospital. The study has shown that the practice of self-medication and inappropriate malaria treatment behavior is common in postpartum women in rural settings hence public health intervention that will develop standardized self-treatment guidelines for uncomplicated malaria will be useful in promoting appropriate self-treatment practice in this population. Highlights Self-medication practice with antimalarials among postpartum mothers both for themselves and their newborn child was 42.7% and 22.7% respectively One of the reasons adduced for such practice is that malaria is expensive to treat (37, 24.7%) Artemether/lumefantrine combination was the most commonly used drug for treatment (75.3%), and most of the participants preferred parenteral medication (68%) to oral drugs The experience of adverse effects was significantly related to receiving treatment in the clinic/hospital Of the 60.7% of women who claimed they did malaria screening test, only half of them sought professional care after the test.

Human mobility and urban malaria risk in the main transmission hotspot of Amazonian Brazil.

Malaria in the Amazon is often perceived as an exclusively rural disease, but transmission has been increasingly documented within and near urban centers. Here we explore patterns and causes of urban-to-rural mobility, which places travelers at risk of malaria in Mâncio Lima, the main malaria hotspot in northwestern Brazil. We also analyze rural-to-urban mobility caused by malaria treatment seeking, which poses an additional risk of infection to urban residents. We show that the rural localities most frequently visited by urban residents–typically farming settlements in the vicinity of the town–are those with the most intense malaria transmission and also the most frequent source localities of imported malaria cases diagnosed in the town. The most mobile urban residents are typically poor males 16 to 60-years old from multi-sited households who lack a formal job. Highly mobile residents represent a priority target for more intensive and effective malaria control interventions, that cannot be readily delivered to the entire community, in this and similar urbanized endemic settings across the Amazon.

Determinants of Delay in Seeking Malaria Treatment for Under-Five Children at Gambella Town, Southwest Ethiopia: A Case-Control Study.

Background Most of the malaria-related complications in children are due to delay in the treatment-seeking of caregivers. The objective of this study was to identify determinants of delay in seeking malaria treatment for under-five children in Gambella town, Ethiopia. Methods A case-control study was conducted in March 2017 among caregivers/parents consecutively included in the study. Data were collected by face-to-face interviews using a structured questionnaire. Descriptive statistics and logistic regression were, respectively, used for descriptive and analytical data analyses. Adjusted odds ratios and 95% CI were, respectively, calculated to assess the strength of association and statistical significance. Result A total of 153 cases and 153 control caregivers/parents participated in the study giving a response rate of 100%. The mean age of cases and controls was 29.4 years (SD ± 6.0 years) and 29.63 years (SD ± 7.8 years), respectively. Being housewife (AOR = 2.50; 95% CI: 1.47–4.22), having no history of child mortality (AOR = 3.70; 95% CI: 1.79–7.64), and chewing khat (AOR = 3.50; 95% CI: 1.57–7.68) were significantly associated with delay in seeking malaria treatment for under-five children among the caregivers. Conclusion and Recommendation. Comprehensive community-based malaria prevention and control education should be given for the caregivers in the town giving due emphasis to housewives, khat-chewers, and the caregivers with no story of child death to better promote early malaria treatment-seeking for under-five children.

A community-based survey of malaria and its prevention in Jazan, Saudi Arabia

ABSTRACTBackground: The fight against malaria has been effective globally and Saudi Arabia is in the stage of malaria pre-elimination to nearly complete elimination.Aim: The current study assesses the level of knowledge, attitudes and practices towards the prevention of malaria among the residents of the Jazan region of Saudi Arabia.Methods: This was a community-based cross-sectional survey using a structured questionnaire that was developed and distributed among 600 randomly selected households (≥18 years) from 11 sub-regions located in Jazan region of Saudi Arabia. The collected data were analyzed using Stata 15.Results: The majority of respondents were aware that malaria is a deadly disease transmitted by mosquito bites. They were familiar with malaria symptoms and common source of information. Indoor residual spraying (IRS) was the most popular preventive measure, practiced by 68.2% of respondents, followed by repellent and mosquito bed nets. Most respondents indicated that they would prefer to seek malaria treatment from healthcare facilities (80.3%) instead of pharmacy or other alternatives. The level of knowledge about malaria and its prevention differed significantly among various age and educational groups; however, no significant difference was observed across genders.Conclusions: There is appreciable knowledge about malaria symptoms, its transmission, and preventative methods among this Saudi Arabian population but there nevertheless remains a need for increased awareness of effective malaria prevention practices in certain areas. The outcome of the study highlights a growing need for generating innovative local strategies to improve preventative practices in order to meet malaria elimination goals.

Tracking spending on malaria by source in 106 countries, 2000–16: an economic modelling study

SummaryBackgroundSustaining achievements in malaria control and making progress toward malaria elimination requires coordinated funding. We estimated domestic malaria spending by source in 106 countries that were malaria-endemic in 2000–16 or became malaria-free after 2000.MethodsWe collected 36 038 datapoints reporting government, out-of-pocket (OOP), and prepaid private malaria spending, as well as malaria treatment-seeking, costs of patient care, and drug prices. We estimated government spending on patient care for malaria, which was added to government spending by national malaria control programmes. For OOP malaria spending, we used data reported in National Health Accounts and estimated OOP spending on treatment. Spatiotemporal Gaussian process regression was used to ensure estimates were complete and comparable across time and to generate uncertainty.FindingsIn 2016, US$4·3 billion (95% uncertainty interval [UI] 4·2–4·4) was spent on malaria worldwide, an 8·5% (95% UI 8·1–8·9) per year increase over spending in 2000. Since 2000, OOP spending increased 3·8% (3·3–4·2) per year, amounting to $556 million (487–634) or 13·0% (11·6–14·5) of all malaria spending in 2016. Governments spent $1·2 billion (1·1–1·3) or 28·2% (27·1–29·3) of all malaria spending in 2016, increasing 4·0% annually since 2000. The source of malaria spending varied depending on whether countries were in the malaria control or elimination stage.InterpretationTracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of $6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging.FundingThe Bill & Melinda Gates Foundation.

Determinants of delay in seeking treatment among malaria patients in Dera district, NorthWest Ethiopia: a case control study.

Prompt and effective treatment of malaria is critical because delays increase the risk for serious illness, disability and death. To assess determinants of delay in seeking treatment among malaria patients at Dera district, NorthWest Ethiopia. A case control study was conducted from September 01 to October 15, 2014. A total of 318 malaria patients diagnosed using microscopy or rapid diagnostic test, and who sought treatment in health centers were interviewed. Multivariable logistic regression was done to identify determinants of delay. Delay was high when a patient earned less than 25.0 USD [AOR=15.7, 95% CI: 4.8 - 51.2] and 9.6 times higher if he/she was not a member of community based health insurance [AOR= 9.6, 95% CI: 4.4 - 21.3]. Respondents who travelled for more than 30 minutes to get to a health facility [AOR= 4.4, 95% CI: 1.2 - 15.9] were more likely to be late in seeking treatment for malaria. Income, community based health insurance, previous history of malaria infection, decision making and distance were determinants of delay in seeking treatment for malaria. To reduce the delay, interventions should focus on outreach malaria services and increase enrollment to community based health insurance.

Community-based training of medical students is associated with malaria prevention and treatment seeking behaviour for children under 5\xa0years in Uganda: a study of MESAU-MEPI COBERS in Uganda

BackgroundFour university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda.MethodsA cross-sectional survey was done to compare communities around health facilities where medical students were placed at COBERS sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). We randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. We used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. We performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependant and independent variables.ResultsFive hundred twenty-three (66.8%) of the children under 5 years in COBERS communities slept under Insecticide Treated Nets (ITNs) the night before survey compared with 1451 (57.8%) in non-COBERS communities (AOR = 0.66, p = 0.017). 100 (60.0%) of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 (47.0%) in non-COBERS communities (AOR = 0.71, P = 0.009).ConclusionThe presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with other effects of COBERS.

Treatment Seeking Practices for Malaria: A Household Case of Uasin Gishu County, Kenya

Introduction: Malaria is among the leading cause of morbidity and mortality in Kenya. Malaria treatment seeking practices in epidemic areas in Africa such as Kenya are not well studied. The study aimed at assessing the treatment seeking practices in residents of Uasin-Gishu County following Malaria infection. Methods: Study was cross sectional study design. Stratified random sampling was used to identify 341 study participants. Principal component analysis was applied to compute the wealth index and the chisquare tests of association were carried out to determine factors associated with choice of treatment. Multivariate logistic regression determined predictors of treatment seeking practices. P<0.05 significance level was used during the study. Results: Fever was reported in 62.8% of all households; 94% sought treatment for the fever. Commonly assessed facility was government health facility (63%), chemists (15%), private clinics (12%) and traditional healers (2%). Educated persons’ were 8.7 fold more likely to seek care from a private hospital. Employed and business owners were 4.1 fold more likely to purchase medicines from chemists. There were significant negative associations between wealth index and education level and seeking care in a government health facility. Respondents in the middle and fourth quintile with tertiary education level rarely sought care from a government health facility respectively. Conclusion: Treatment practices among households were: through government health institutions, private/clinics and chemists. Wealth index, age category of household heads, education level and occupation influenced treatment seeking practice. Reccomendation: There is need for the government for the government to strength community-based interventions and health facilities

Factors associated with treatment-seeking for malaria in urban poor communities in Accra, Ghana

BackgroundIn Ghana, about 3.5 million cases of malaria are recorded each year. Urban poor residents particularly have a higher risk of malaria mainly due to poor housing, low socio-economic status and poor sanitation. Alternative treatment for malaria (mainly African traditional/herbal and/or self-medication) is further compounding efforts to control the incidence of malaria in urban poor communities. This study assesses factors associated with seeking alternative treatment as the first response to malaria, relative to orthodox treatment in three urban poor communities in Accra, Ghana.MethodsThis cross-sectional study was conducted in three urban poor localities in Accra, Ghana among individuals in their reproductive ages (15–59 years for men and 15–49 years for women). The analytic sample for the study was 707. A multinomial regression model was used to assess individual, interpersonal and structural level factors associated with treatment-seeking for malaria.ResultsOverall, 31% of the respondents sought orthodox treatment, 8% sought traditional/herbal treatment and 61% self-medicated as the first response to malaria. At the bivariate level, more males than females used traditional/herbal treatment and self-medicated for malaria. The results of the regression analysis showed that current health insurance status, perceived relative economic standing, level of social support, and locality of residence were associated with seeking alternative treatment for malaria relative to orthodox treatment.ConclusionsThe findings show that many urban poor residents in Accra self-medicate as the first response to malaria. Additionally, individuals who were not enrolled in a health insurance scheme, those who perceived they had a low economic standing, those with a high level of social support, and locality of residence were significantly associated with the use of alternative treatment for malaria. Multi-level strategies should be employed to address the use of alternative forms of treatment for malaria within the context of urban poverty.

Cost of malaria treatment and health seeking behaviour of children under-five years in the Upper West Region of Ghana.

BackgroundThere is limited knowledge on cost of treating malaria in children under-five years in northern Ghana which poses a challenge in determining whether interventions such as the National Health Insurance Scheme (NHIS) and Community-based Health Planning and Services (CHPS) have reduced the economic burden of malaria to households or not. This study examined the malaria care seeking and cost of treatment in children under-five years in the Upper West Region of Ghana.MethodsThe study used a cross-sectional, quantitative design and data were collected between July and August 2016 in three districts in the Upper West Region of Ghana. A total of 574 women who had under-five children were interviewed. Socio-demographic characteristics of respondents, malaria seeking patterns for under-five children with malaria as well as direct medical and non-medical costs associated with treating under-five children with malaria were collected from the patient perspective. Analysis was performed using STATA 12.ResultsOut of 574 women visited, about 63% (360) had children who had malaria and sought treatment. Most treatment was done at formal health facilities such as the health centres (37%) and the CHPS (35%) while 3% had self-treatment at home. The main reason for choice of place of treatment outside home was nearness to home (53%). The average direct medical and non-medical costs associated with treating an under-five child with malaria were US$4.13 and US$3.04 respectively. The average cost on transportation alone was US$2.64. Overall, the average direct medical and non-medical cost associated with treating an under-five child with malaria was US$4.91(range: minimum = US$0.13 –maximum = US$46.75). Children who were enrolled into the NHIS paid an average amount of US$4.76 compared with US$5.88 for those not enrolled, though the difference was not statistically significant (p-value = 0.15).ConclusionsThe average cost to households in treating an under-five child with malaria was US$4.91. This amount is considerably high given the poverty level in the area. Children not insured paid a little over one US dollar for malaria treatment compared to those insured. Efforts to improve enrolment into the NHIS may be needed to reduce the cost of malaria treatment to households. Construction of more health facilities near to community members and at hard to reach areas will improve access to health care and reduce direct non-medical cost such as transportation costs.

Determinants of Malaria Treatment Seeking Behaviour among Urban and Rural Households in North Central Nigeria

Determinants of Malaria Treatment Seeking Behaviour among Urban and Rural Households in North Central Nigeria

Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study

BackgroundMigration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting.MethodsA mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013–2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016–2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings.ResultsAmong others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap anti-malarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centres and voluntary health workers worsened the situation.ConclusionsMitigating key drivers that favour poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for the NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals. Further innovative out-reach programmes designed and implemented specific to the nature of mobile/migrant workers is crucial.

The Role of Health Extension Workers in Primary Health Care in AsgedeTsi'mbla District: A Case of Lim'at T'abya Health Post

Health Extension Workers are the health service providers to the community in delivering integrated preventive, promotive and basic curative health services. Hitherto no studies have been carried out in Lim ‘at T’abya health post focusing on the role of health extension workers. Thus the researcher has randomly selected 263 participants in order to achieve the intended objectives of the study. The researcher used both quantitative and qualitative approaches. The result of the study identified the major Health Extension Program services which are delivered by Health Extension Workers in the health post to seek malaria treatment, child immunization and Antenatal Care followed by Postnatal Care, family planning, referral for delivery, diarrhea treatment and health education. The challenges of Health Extension Workers hindering their performance for the unsuccessful health service provision identified as strong societal cultural beliefs, remoteness, poor relation with supervisors, communication system and road construction, low remuneration, lack of refresher courses and improper attention by Qebelle administrators to health agendas. Attitude of community towards Health Extension Workers communication skill, quality of service provision and social behaviors is over all positive but the following up of referred patients and the skill to diagnosing community health problems that Health Extension Workers need to work sensitively which are answered negatively by the respondents. To increase community’s health post utilization, health posts should be equipped with minimum essential medical equipment with particular focus on malaria treatments, family planning, deliver, treatment of common illnesses and immunization services in the study area.Int. J. Soc. Sc. Manage. Vol. 4, Issue-4: 248-266

Malaria prevalence, prevention and treatment seeking practices among nomadic pastoralists in northern Senegal

BackgroundMalaria transmission in Senegal is highly stratified, from low in the dry north to moderately high in the moist south. In northern Senegal, along the Senegal River Valley and in the Ferlo semi-desert region, annual incidence is less than five cases per 1000 inhabitants. Many nomadic pastoralists have permanent dwellings in the Ferlo Desert and Senegal River Valley, but spend dry season in the south with their herds, returning north when the rains start, leading to a concern that this population could contribute to ongoing transmission in the north.MethodsA modified snowball sampling survey was conducted at six sites in northern Senegal to determine the malaria prevention and treatment seeking practices and parasite prevalence among nomadic pastoralists in the Senegal River Valley and the Ferlo Desert. Nomadic pastoralists aged 6 months and older were surveyed during September and October 2014, and data regarding demographics, access to care and preventive measures were collected. Parasite infection was detected using rapid diagnostic tests (RDTs), microscopy (thin and thick smears) and polymerase chain reaction (PCR). Molecular barcodes were determined by high resolution melting (HRM).ResultsOf 1800 participants, 61% were male. Sixty-four percent had at least one bed net in the household, and 53% reported using a net the night before. Only 29% had received a net from a mass distribution campaign. Of the 8% (142) who reported having had fever in the last month, 55% sought care, 20% of whom received a diagnostic test, one-third of which (n = 5) were reported to be positive. Parasite prevalence was 0.44% by thick smear and 0.50% by PCR. None of the molecular barcodes identified among the nomadic pastoralists had been previously identified in Senegal.ConclusionsWhile access to and utilization of malaria control interventions among nomadic pastoralists was lower than the general population, parasite prevalence was lower than expected and sheds doubt on the perception that they are a source of ongoing transmission in the north. The National Malaria Control Program is making efforts to improve access to malaria prevention and case management for nomadic populations.

Factors associated with treatment seeking for malaria in Madhya Pradesh, India.

To determine household factors associated with treatment seeking for malaria. The study was carried out in four districts of Madhya Pradesh with different malaria endemicity. A total of 1470 households were interviewed in which at least one member suffered from microscopically confirmed malaria in the 3 months preceding the survey. Socio-demographic, economic, cultural characteristics, their health beliefs, knowledge and practices regarding malaria and choice of treatment seeking were explored. A total of 764 households were from high-endemic and 706 from low-endemic areas. More than half of household heads were illiterate; most are farmers. Approximately 46% sought treatment for malaria from unqualified informal providers; 19% from qualified private health practitioners and 35% from government health providers. Analysis revealed that household's area of residence, education, occupation, ethnicity, use of preventive measures, economic status, knowledge and practices, distance and delayed treatment seeking was strongly associated with the type of healthcare providers selected. Demand for formal health services among the poor, illiterate, tribal population living in remote areas is low. Accessible and affordable health services and a sensitisation programme to increase the demand for formal providers are needed.

Exploring the role of socioeconomic factors in the development and spread of anti-malarial drug resistance: a qualitative study

BackgroundMalaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world. Poverty contributes to the malaria burden as it has the ability to affect integral aspects of malaria control. There have been renewed efforts in the global malaria control, resulting in reductions in the global malaria burden over the last decade. However, the development of resistance to artemisinin-based combination therapy threatens the sustainability of the present success in malaria control. Anti-malarial drug use practices/behaviours remain very important drivers of drug resistance. This study adopted a social epidemiological stance in exploring the underlying socioeconomic factors that determine drug use behaviours promoting anti-malarial drug resistance.MethodsA qualitative approach, involving the use of interviews, was used in this inquiry to explore the existing anti-malarial drug use practices in the Nigerian population; and the different socioeconomic factors influencing the behaviours.ResultsThe significant malaria treatment behaviours influenced by socioeconomic factors in this study were the practice of ‘mixing’ drugs for malaria treatment, presumptive treatment, sharing of malaria treatment course, and the use of anti-malaria monotherapies. All the rural dwellers in this study reported they have mixed drugs for malaria treatment. When symptoms were experienced, socio-economic factors, like type of settlement, income level and occupation, tended to determine the treatment behaviour and, therefore, informed and determined the experience of the illness.DiscussionSocial and economic contexts can influence behaviours as they contribute in shaping norms and in creating opportunities that promote certain behaviours. As shown in this study, income level and type of settlement, as structural factors, affect the decision on where to seek malaria treatment and whether or not a malaria diagnostic test will be used prior to treatment. One of the dangers of using the mixed anti-malarial drugs is that it offers a safe route for the sale of expired and fake anti-malarial drugs as the mixed drugs are not sold or dispensed in their original packets.Conclusions and recommendationsPopulation-wide improvements in income, education, environmental and structural conditions of rural dwellers in malaria-endemic settings will encourage behavioural change on how anti-malarial drugs are used.

Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment

BackgroundTanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices.MethodsDispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing.Results and discussionA total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8–69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT.ConclusionsTrained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy.Trial registration ISRCTN ISRCTN14115509

Predicting Malaria Risk and Utilization of Health Care Services among the Population in Uganda

Background: Incidence rate is the most commonly used direct measure of disease occurrences in the population at risk. Predicting malaria risk and utilization of health care services among the population is important in explaining the dynamics of the disease. Objective: The objective of this study was to predict malaria risk and utilization of health care services among the population in Uganda. Methods: We used a retrospective longitudinal study design that involved a secondary analysis of data from Ministry of Health (MoH) and Uganda Bureau of statistics (UBOS).The predicting model was derived taking limiting distribution of the partial derivative with respect to time of the malaria predicting model at the health facilities. Results: Our findings revealed that some of the infected individuals are infectious within the first 2 months but the infectiousness decreases with increasing time implying the individuals become susceptible again. The monthly model predicted new cases of malaria were more than the observed new cases of malaria. This implies that not all cases are routinely diagnosed and not all infected individuals in the population are seeking treatment for malaria at the health facilities. The observed new cases of malaria at the government facilities account for about 39% of the malaria risk in the population. Furthermore 61% of the new cases of malaria either sought treatment from non-government facilities or never sought treatment at all. Conclusions: The proposed model can be used to predict both the intensity and expected number of new cases of malaria at health facility and population level in the next month. The model can further be used to assess the monthly intensity of malaria; evaluate the effectiveness of the interventions in reducing the risk in the general population, and to provide timely statistics for better monitoring and design of targeted interventions that will reduce malaria incidence in Uganda. Therefore the observed stagnation in malaria incidence in the country could be attributable to the failure to monitor the 61% of the incidence that do not seek treatment from government health facilities.

Determinants of Malaria Prevention and Treatment Seeking Behaviours of Pregnant Undergraduates Resident in University Hostels, South-East Nigeria.

This cross-sectional descriptive survey investigated determinants of malaria prevention and treatment seeking behaviours of pregnant undergraduates resident in university hostels, South-East Nigeria. Purposive sampling was used to enrol 121 accessible and consenting undergraduates with self-revealed and noticeable pregnancy residing in twenty-three female hostels of four university campuses in Enugu State, Nigeria. Structured interview guide developed based on reviewed literature and WHO-recommended malaria prevention and treatment measures was used to collect students' self-report data on malaria preventive health behaviours, sick role behaviours, and clinic use using mixed methods. The WHO-recommended malaria prevention measures were sparingly used. Some believed that pregnancy does not play any role in a woman's reaction to malaria infection. Only 41 (50.6%) visited a hospital for screening and treatment. Thirty-four (28.1%) used antimalaria medicine bought from chemist shop or over-the-counter medicines, while 33 (27.3%) used untreated net. The students were more likely to complete their antimalaria medicine when they were sick with malaria infection than for prevention (p = 0.0186). Knowledge, academic schedule, cultural influence on perception and decision-making, and accessibility of health facility were key determinants of the women's preventive and treatment seeking behaviours. Health education on malaria prevention and dangers of drug abuse should form part of orientation lectures for all freshmen. University health centres should be upgraded to provide basic antenatal care services.

Preventing Malaria among Under Five Children in Damot Gale Woreda, Wolayta Zone, Ethiopia: The Role of Parents Knowledge and Treatment Seeking

Background: Malaria is the leading public health problem in Ethiopia. Lack of malaria-specific knowledge has been commonly assumed to be an important barrier to engagement in behaviors that prevent malaria and prompt health seeking behavior.Objective: To assess parents’ knowledge, practice of prevention, treatment seeking and factors associated with malaria prevention among under-five children in Damot Gale Woreda.Methodology: A community based cross-sectional study was conducted among 419 households who had under five children. Data was collected from 4 rural kebeles (Smallest administrative villages). It was analyzed by using SPSS version 16.0. Logistic regression was used to identify the factors influencing the outcome. Odds ratios and the corresponding confidence intervals were used to identify potential predictors in logistic regression model.Results: Around 85% of parents correctly associated malaria transmission with the bite of infective mosquito. Regarding practice of prevention, 83.7% mentioned source reduction and 63.1% used bed nets. The prevalence of malaria was 38/419 (9.1%). Health care facilities were accessible for more than 90% of study population with a walking distance of less than 30 min but only 15% of sick children started anti-malarial treatment within 24 h. Being biological mother (AOR 2.42, 95% CI 1.42-4.12, P=0.03), knowledge of method of malaria prevention (AOR 1.59, 95% CI 1.126-2.242, P=0.002) and treatment seeking within 24 h for malaria (AOR 2.69, 95% CI 1.56-4.62, P=0.000) were significantly associated with practice of malaria prevention.Conclusion: Prevalence of malaria in children was 9.1%. Delay in treatment seeking within 24 h was high. So, health education on prevention methods and treatment seeking is required.