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CAREGIVERS’ ACCEPTANCE OF USING ARTESUNATE SUPPOSITORIES FOR TREATING CHILDHOOD MALARIA IN PAPUA NEW GUINEA

Community-based interventions using artemisinin-derived suppositories may potentially reduce malaria-related childhood mortality. However, their sociocultural acceptability is unknown in Papua New Guinea and a formal examination of caregiver’s attitudes to rectal administration was needed to inform effective deployment strategies. Caregivers (n = 131) of children with uncomplicated malaria were questioned on their prior experience with, and attitudes to, rectal administration and then offered artesunate suppositories as treatment of their child. The 29% who refused this alternative were further questioned to determine their reasons for this refusal. Lack of spousal approval and fear of side effects were the most common reasons for refusal. Sixty-six percent of caregivers agreed to self-administer suppositories, which were perceived as effective (99%), safe (96%), and fast-acting (91%), but problematic to administer to a struggling child (56%). Shame, embarrassment, and hygiene were not significant concerns. Acceptability of rectal administration should be relatively high in Papua New Guinea. However, deployment must be accompanied by health education that addresses the practical aspects of administration, is appropriate for the illiterate, and is directed at fathers as well as mothers.

Received August 23, 2006. Accepted for publication November 23, 2006.

Acknowledgments: We thank the caregivers of the children for their participation in this study and the staff of the PNGIMR branches in Maprik and Madang and the clinics in Mugil and Kunjingini for assistance and support.

Financial support: This study was supported by the World Heath Organization Roll Back Malaria program, the Australian National Health and Medical Research Council, the Royal Australasian College of Physicians, and the Australian Agency for Overseas Development.

^* Address correspondence to Rachael L. Hinton, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea. E-mail: rachael.hinton{at}pngimr.org.pg

Authors’ addresses: Rachael L. Hinton, Alma Auwun, Grace Pongua, and Olive Oa, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea, Telephone: 675-732-1280, Fax: 675-732-1998, E-mail: rachael.hinton{at}pngimr.org.pg. Timothy M. E. Davis and Harin Karunajeewa, School of Medicine and Pharmacology, University of Western Australia, Perth 6009, Western Australia, Australia, Telephone: 61-8-9431-3229, Fax: 61-8-9431-2977. John C. Reeder, Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3001, Austalia, Telephone: 61-3-8506-2320, Fax: 61-3-9282-2144, E-mail: jreeder{at}burnet.edu.au.