• 1.

    World Health Organization, 2017. World Malaria Report 2017. Geneva, Switzerland: WHO.

  • 2.

    World Health Organization Global Malaria Programme, 2015. Global Technical Strategy for Malaria 2016–2030. Geneva, Switzerland: WHO.

  • 3.

    World Health Organization, 2009. WHO Country Cooperation Strategy 2008–2013: Malawi. Brazzaville, Republic of Congo: WHO Regional Office for Africa.

    • Search Google Scholar
    • Export Citation
  • 4.

    Government of Malawi Ministry of Health, 2013. Guidelines for the Treatment of Malaria in Malawi, 4th edition. Lilongwe, Malawi: National Malaria Control Programme, Community Health Sciences Unit.

    • Search Google Scholar
    • Export Citation
  • 5.

    Malawi Ministry of Health, 2009. Malawi Standard Treatment Guidelines, 4th edition. Lilongwe, Malawi: Malawi Ministry of Health.

  • 6.

    Ewing VL, Lalloo DG, Phiri KS, Roca-Feltrer A, Mangham LJ, SanJoaquin MA, 2011. Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi. Malar J 10: 32.

    • Search Google Scholar
    • Export Citation
  • 7.

    Galactionova K, Tediosi F, De Savigny D, Smith T, Tanner M, 2015. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries. PLoS One 10: e0127818.

    • Search Google Scholar
    • Export Citation
  • 8.

    Johansson EW, Gething PW, Hildenwall H, Mappin B, Petzold M, Peterson SS, Selling KE, 2014. Diagnostic testing of pediatric fevers: meta-analysis of 13 national surveys assessing influences of malaria endemicity and source of care on test uptake for febrile children under five years. PLoS One 9: e95483.

    • Search Google Scholar
    • Export Citation
  • 9.

    Walldorf JA et al. 2015. School-age children are a reservoir of malaria infection in Malawi. PLoS One 10: e0134061.

  • 10.

    Buchwald A et al. 2016. Bed net use among school-aged children after a universal bed net campaign in Malawi. Malar J 15: 127.

  • 11.

    Coalson JE, Cohee LM, Buchwald AG, Nyambalo A, Kubale J, Seydel KB, Mathanga D, Taylor TE, Laufer MK, Wilson ML, 2018. Simulation models predict that school-age children are responsible for most human-to-mosquito P. falciparum transmission in southern Malawi. Malar J 17: 147.

    • Search Google Scholar
    • Export Citation
  • 12.

    Molyneux CS, Mung’ala-Odera V, Harpham T, Snow RW, 1999. Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya. Trop Med Int Health 4: 836845.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mujica Mota RE, Lara AM, Kunkwenzu ED, Lalloo DG, 2009. Health seeking behavior after fever onset in a malaria-endemic area of Malawi. Am J Trop Med Hyg 81: 935943.

    • Search Google Scholar
    • Export Citation
  • 14.

    Chuma J, Okungu V, Molyneux C, 2010. Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J 9: 144.

  • 15.

    Vialle-Valentin CE, LeCates RF, Zhang F, Ross-Degnan D, 2015. Treatment of febrile illness with artemisinin combination therapy: prevalence and predictors in five African household surveys. J Pharm Policy Pract 8: 1.

    • Search Google Scholar
    • Export Citation
  • 16.

    Guyatt HL, Snow RW, 2004. The management of fevers in Kenyan children and adults in an area of seasonal malaria transmission. Trans R Soc Trop Med Hyg 98: 111115.

    • Search Google Scholar
    • Export Citation
  • 17.

    Roll Back Malaria Monitoring and Evaluation Reference Group, World Health Organization, United Nations Children’s Fund, MEASURE DHS, MEASURE Evaluation, US Centers for Disease Control and Prevention, 2005. Malaria Indicator Survey: Basic Documentation for Survey Design and Implementation. Calverton, MD: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 18.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG, 2009. Research electronic data capture (REDCap)—a metadata driven methodology and workflow process for providing translational research informatict support. J Biomed Inform 42: 377381.

    • Search Google Scholar
    • Export Citation
  • 19.

    Filmer D, Pritchett L, 2001. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38: 115132.

    • Search Google Scholar
    • Export Citation
  • 20.

    Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, Bischoff EJ, Cameron S, Campbell H, 2014. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One 9: e93427.

    • Search Google Scholar
    • Export Citation
  • 21.

    Holtz TH, Kachur SP, Marum LH, Mkandala C, Chizani N, Roberts JM, Macheso A, Parise ME, 2003. Care seeking behaviour and treatment of febrile illness in children aged less than five years: a household survey in Blantyre District, Malawi. Trans R Soc Trop Med Hyg 97: 491497.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kazembe LN, Appleton CC, Kleinschmidt I, 2007. Choice of treatment for fever at household level in Malawi: examining spatial patterns. Malar J 6: 40.

    • Search Google Scholar
    • Export Citation
  • 23.

    Oyekale AS, 2015. Assessment of Malawian mothers’ malaria knowledge, healthcare preferences and timeliness of seeking fever treatments for children under five. Int J Environ Res Public Health 12: 521540.

    • Search Google Scholar
    • Export Citation
  • 24.

    Weil A, 2003. Home management of fever in children in Zomba, Malawi. Malawi Med J 15: 9598.

  • 25.

    Coalson JE et al. 2016. High prevalence of Plasmodium falciparum gametocyte infections in school-age children using sensitive molecular detection: patterns and predictors of risk from a cross-sectional study in southern Malawi. Malar J 15: 527.

    • Search Google Scholar
    • Export Citation
  • 26.

    Chen I, Clarke SE, Gosling R, Hamainza B, Killeen G, Magill A, O’Meara W, Price RN, Riley EM, 2016. “Asymptomatic” malaria: a chronic and debilitating infection that should be treated. PLoS Med 13: e1001942.

    • Search Google Scholar
    • Export Citation
  • 27.

    Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L, 2013. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 11: 623639.

    • Search Google Scholar
    • Export Citation
  • 28.

    Nankabirwa J, Brooker SJ, Clarke SE, Fernando D, Gitonga CW, Schellenberg D, Greenwood B, 2014. Malaria in school-age children in Africa: an increasingly important challenge. Trop Med Int Health 19: 12941309.

    • Search Google Scholar
    • Export Citation
  • 29.

    Gonçalves BP et al. 2017. Examining the human infectious reservoir for Plasmodium falciparum malaria in areas of differing transmission intensity. Nat Commun 8: 1133.

    • Search Google Scholar
    • Export Citation
  • 30.

    Jeffery GM, Eyles DE, 1954. The duration in the human host of infections with a Panama strain of Plasmodium falciparum. Am J Trop Med Hyg 3: 219224.

    • Search Google Scholar
    • Export Citation
  • 31.

    Abdel-Wahab A, Ali E, Suleiman S, Ahmed S, Walliker D, Babiker HA, 2002. Dynamics of gametocytes among Plasmodium falciparum clones in natural infections in an area of highly seasonal transmission. J Infect Dis 185: 18381842.

    • Search Google Scholar
    • Export Citation
  • 32.

    Nassir E, Abdel-Muhsin AM, Suliaman S, Kenyon F, Kheir A, Geha H, Ferguson HM, Walliker D, Babiker HA, 2005. Impact of genetic complexity on longevity and gametocytogenesis of Plasmodium falciparum during the dry and transmission-free season of eastern Sudan. Int J Parasitol 35: 4955.

    • Search Google Scholar
    • Export Citation
  • 33.

    Chuma J, Abuya T, Memusi D, Juma E, Akhwale W, Ntwiga J, Nyandigisi A, Tetteh G, Shretta R, Amin A, 2009. Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets. Malar J 8: 243.

    • Search Google Scholar
    • Export Citation
  • 34.

    Namuyinga RJ et al. 2017. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J 16: 114.

    • Search Google Scholar
    • Export Citation
  • 35.

    Opiyo N, Yamey G, Garner P, 2016. Subsidising artemisinin-based combination therapy in the private retail sector. Cochrane Database Syst Rev 3: CD009926.

    • Search Google Scholar
    • Export Citation
  • 36.

    Sabot OJ, Mwita A, Cohen JM, Ipuge Y, Gordon M, Bishop D, Odhiambo M, Ward L, Goodman C, 2009. Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. PLoS One 4: e6857.

    • Search Google Scholar
    • Export Citation
  • 37.

    Rutta E et al. 2011. Increasing access to subsidized artemisinin-based combination therapy through accredited drug dispensing outlets in Tanzania. Health Res Policy Syst 9: 22.

    • Search Google Scholar
    • Export Citation
  • 38.

    Morris A, Ward A, Moonen B, Sabot O, Cohen JM, 2015. Price subsidies increase the use of private sector ACTs: evidence from a systematic review. Health Policy Plan 30: 397405.

    • Search Google Scholar
    • Export Citation
  • 39.

    Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C, Clarke SE, 2015. A cluster randomised trial introducing rapid diagnostic tests into registered drug shops in Uganda: impact on appropriate treatment of malaria. PLoS One 10: e0129545.

    • Search Google Scholar
    • Export Citation
  • 40.

    Cohen JL, Yadav P, Moucheraud C, Alphs S, Larson PS, Arkedis J, Massaga J, Sabot O, 2013. Do price subsidies on artemisinin combination therapy for malaria increase household use? Evidence from a repeated cross-sectional study in remote regions of Tanzania. PLoS One 8: 110.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

Challenges in Treatment for Fever among School-Age Children and Adults in Malawi

View More View Less
  • 1 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan;
  • | 2 Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;
  • | 3 Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi;
  • | 4 College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

Prompt and effective treatment is key to malaria control and prevention, as it reduces disease morbidity and mortality and minimizes the number of transmission reservoirs. Transmission reduction may be particularly important among school-age children (SAC, 5–15 years old), who have the highest prevalence of Plasmodium falciparum infection in southern Malawi. We hypothesized that one factor contributing to this difference in prevalence is that SAC are less likely to seek appropriate treatment for fever than children younger than 5 years. In this study, we assessed treatment-seeking behaviors of people of all ages between 2012 and 2014 in Malawi. During each of the five cross-sectional surveys, all members of ∼900 households reported on fever and treatment-seeking in the previous 2 weeks. Multilevel logistic regression was used to analyze predictors of whether febrile people sought treatment and whether they did so at formal (government/private clinics) or informal sources (primarily shops). Twenty-two percent of participants (3,579/16,621) reported fever, and 2,715 of those (75.9%) sought treatment. Seeking treatment exclusively from local shops remains a common practice, although use of recommended diagnostic testing and antimalarial drugs was infrequently reported there. Although SAC were not significantly less likely than children aged < 5 years to seek treatment, SAC and adults (age ≥ 16 years) were significantly less likely to use formal sources. Our results indicate that encouraging treatment at government/private clinics and increasing retail access to appropriate antimalarial testing and treatment, especially among SAC, could help remedy inadequate treatment of symptomatic disease and potentially reduce Plasmodium transmission in Malawi.

    • Supplemental Materials (PDF 112 KB)
    • Supplemental Materials (PDF 583 KB)

Author Notes

Address correspondence to Jenna E. Coalson, University of Arizona, Drachman Hall, Office 206HH, 1295 N. Martin Ave., Tucson, AZ 85719. E-mail: jcoalson@gmail.com

Financial support: This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) [U19AI089683] and the National Institute of General Medical Sciences (NIGMS) [K12 GM000708] at the National Institutes of Health (NIH).

Authors’ addresses: Jenna E. Coalson, University of Arizona, Tucson, AZ, E-mail: jcoalson@gmail.com. Lauren M. Cohee, Jenny A. Walldorf, and Miriam K. Laufer, Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, E-mails: cohee@som.umaryland.edu, jwalldorf@cdc.gov, and mlaufer@som.umaryland.edu. Andrew Bauleni and Don P. Mathanga, Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi, E-mails: abauleni@mac.medcol.mw and dmathang@mac.medcol.mw. Terrie E. Taylor, Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, E-mail: ttmalawi@msu.edu. Mark L. Wilson, School of Public Health, University of Michigan, Ann Arbor, MI, E-mail: wilsonml@umich.edu.

Save