1921
Volume 100, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015–2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01–1.58 and aOR = 1.31, 95% CI = 1.02–1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58–0.96 and aOR = 0.67, 95% CI = 0.51–0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0900
2019-04-15
2020-06-05
Loading full text...

Full text loading...

/deliver/fulltext/14761645/100/6/tpmd180900.html?itemId=/content/journals/10.4269/ajtmh.18-0900&mimeType=html&fmt=ahah

References

  1. Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS, 2017. Fever in children: pearls and pitfalls. Children 4: 81.
    [Google Scholar]
  2. Olotu A, Fegan G, Williams TN, Sasi P, Ogada E, Bauni E, Wambua J, Marsh K, Borrmann S, Bejon P, 2010. Defining clinical malaria: the specificity and incidence of endpoints from active and passive surveillance of children in rural Kenya. PLoS One 5: e15569.
    [Google Scholar]
  3. Stauffer W, Fischer PR, 2003. Diagnosis and treatment of malaria in children. Clin Infect Dis 37: 13401348.
    [Google Scholar]
  4. Schumacher R-F, Spinelli E, 2012. Malaria in children. Mediterr J Hematol Infect Dis 4: e2012073.
    [Google Scholar]
  5. Tarimo DS, Lyimo EO, Moshiro C, 2014. Accuracy of fever and fraction of fevers attributable to malaria among under-fives under reduced malaria infection prevalence in district. Malar Chemother Control Elimin 3: 1.
    [Google Scholar]
  6. WHO, 2015. Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  7. Gething PW, Kirui VC, Alegana VA, Okiro EA, Noor AM, Snow RW, 2010. Estimating the number of paediatric fevers associated with malaria infection presenting to Africa’s public health sector in 2007. PLoS Med 7: e1000301.
    [Google Scholar]
  8. Okiro EA, Snow RW, 2010. The relationship between reported fever and Plasmodium falciparum infection in African children. Malar J 9: 99.
    [Google Scholar]
  9. WHO, 2017. World Malaria Report 2017. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  10. Mitiku I, Assefa A, 2017. Caregivers’ perception of malaria and treatment-seeking behaviour for under five children in Mandura district, west Ethiopia: a cross-sectional study. Malar J 16: 144.
    [Google Scholar]
  11. Salah MT, Adam I, Malik EM, 2007. Care-seeking behavior for fever in children under five years in an urban area in eastern Sudan. J Family Community Med 14: 2528.
    [Google Scholar]
  12. Sharma VR, 2008. When to seek health care: a duration analysis for malaria patients in Nepal. Soc Sci Med 66: 24862494.
    [Google Scholar]
  13. Department of Child and Adolescent Health and Development, World Health Organization, UNICEF, 2005. Handbook IMCI: Integrated Management of Childhood Illness. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  14. D’acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809817.
    [Google Scholar]
  15. Deressa W, Fantahun M, Ali A, 2007. Malaria-related mortality based on verbal autopsy in an area of low endemicity in a predominantly rural population in Ethiopia. Malar J 6: 128.
    [Google Scholar]
  16. Kamat VR, 2006. “I thought it was only ordinary fever!” cultural knowledge and the micropolitics of therapy seeking for childhood febrile illness in Tanzania. Soc Sci Med 62: 29452959.
    [Google Scholar]
  17. Malawi Ministry of Health, 2011. Malaria Strategic Plan 2011–2015 Towards Universal Access. Lilongwe, Malawi: National Malaria Control Programme Community Health Sciences Unit. Available at: https://www.medbox.org/malaria-strategic-plan-2011-2015/download.pdf. Accessed January 29, 2019.
  18. National Statistical Office (NSO)/Malawi, ORC Macro, 2005. Malawi Demographic and Health Survey 2004. Calverton, MD: NSO/Malawi and ORC Macro.
    [Google Scholar]
  19. National Statistical Office (NSO)/Malawi, ICF Macro, 2011. Malawi Demographic and Health Survey 2010. Zomba, Malawi: NSO/Malawi and ICF Macro.
    [Google Scholar]
  20. National Malaria Control Programme (NMCP)/Malawi, ICF International, 2012. Malawi Malaria Indicator Survey 2012. Lilongwe, Malawi: NMCP/Malawi and ICF International.
    [Google Scholar]
  21. National Malaria Control Programme (NMCP)/Malawi, ICF International, 2015. Malawi Malaria Indicator Survey 2014. Rockville, MD: NMCP/Malawi and ICF International.
    [Google Scholar]
  22. Hamooya BM, Chongwe G, Dambe R, Halwiindi H, 2016. Treatment-seeking behaviour for childhood fever among caretakers of Chivuna and Magoye rural communities of Mazabuka district, Zambia: a longitudinal study. BMC Public Health 16: 762.
    [Google Scholar]
  23. National Statistical Office (NSO) [Malawi] and ICF, 2017. Malawi Demographic and Health Survey 2015–16: Zomba, Malawi and Rockville, MD: NSO and ICF.
    [Google Scholar]
  24. Malawi Malaria Impact Evaluation Group, 2016. Evaluation of the Impact of Malaria Control Interventions on All-Cause Mortality in Children Under-Five in Malawi. Washington, DC: President’s Malaria Initiative.
  25. Awantang G, Babalola S, Koenker H, Fox K, Toso M, Lewicky N, Somah D, Koko V, 2018. Correlates of social behavior change communication on care-seeking behaviors for children with fever: an analysis of malaria household survey data from Liberia. Malar J 17: 105.
    [Google Scholar]
  26. Adinan J, Damian DJ, Mosha NR, Mboya IB, Mamseri R, Msuya SE, 2017. Individual and contextual factors associated with appropriate healthcare seeking behavior among febrile children in Tanzania. PLoS One 12: e0175446.
    [Google Scholar]
  27. Rutstein SO, Rojas G, 2006. Guide to DHS Statistics. Rockville, MD: ICF.
    [Google Scholar]
  28. Kassile T, Lokina R, Mujinja P, Mmbando BP, 2014. Determinants of delay in care seeking among children under five with fever in Dodoma region, central Tanzania: a cross-sectional study. Malar J 13: 348.
    [Google Scholar]
  29. Espino F, Manderson L, 2000. Treatment seeking for malaria in Morong, Bataan, the Philippines. Soc Sci Med 50: 13091316.
    [Google Scholar]
  30. Wiseman V, Scott A, Conteh L, McElroy B, Stevens W, 2008. Determinants of provider choice for malaria treatment: experiences from the Gambia. Soc Sci Med 67: 487496.
    [Google Scholar]
  31. Ntenda PAM, Chuang KY, Tiruneh FN, Chuang YC, 2017. Analysis of the effects of individual and community level factors on childhood immunization in Malawi. Vaccine 35: 19071917.
    [Google Scholar]
  32. Nkoka O, Chuang T-W, Chuang K-Y, Chen Y-H, 2018. Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis. Malar J 17: 372.
    [Google Scholar]
  33. Babalola S, Ricotta E, Awantang G, Lewicky N, Koenker H, Toso M, 2016. Correlates of intra-household ITN use in Liberia: a multilevel analysis of household survey data. PLoS One 11: e0158331.
    [Google Scholar]
  34. WHO, 2016. Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed January 29, 2019.
    [Google Scholar]
  35. Nkoka O, Chuang T-W, Chen Y-H, 2018. Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women. Malar J 17: 211.
    [Google Scholar]
  36. Robson K, Pevalin D, 2016. Multilevel Modeling in Plain Language. London, United Kingdom: Sage Publications.
    [Google Scholar]
  37. Gupta M et al., 2003. International differences in in-hospital revascularization and outcomes following acute myocardial infarction: a multilevel analysis of patients in ASSENT-2. Eur Heart J 24: 16401650.
    [Google Scholar]
  38. Ntenda PAM, Chuang Y-C, 2018. Analysis of individual-level and community-level effects on childhood undernutrition in Malawi. Pediatr Neonatol 59: 380389.
    [Google Scholar]
  39. Mayala B, Fish TD, Eitelberg D, Dontamsetti T, 2018. The DHS Program Geospatial Covariate Datasets Manual, 2nd edition. Rockville, MD: ICF.
    [Google Scholar]
  40. Altman DG, Bland JM, 1994. Statistics notes: quartiles, quintiles, centiles, and other quantiles. BMJ 309: 996.
    [Google Scholar]
  41. O’brien RM, 2007. A caution regarding rules of thumb for variance inflation factors. Qual Quant 41: 673690.
    [Google Scholar]
  42. Evans EA, Upchurch DM, Simpson T, Hamilton AB, Hoggatt KJ, 2017. Differences by veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders. Soc Psychiatry Psychiatr Epidemiol 53: 421435.
    [Google Scholar]
  43. Masangwi SJ, Ferguson N, Grimason A, Morse T, Kazembe L, 2010. Care-seeking behaviour and implications for malaria control in southern Malawi. South Afr J Epidemiol Infect 25: 2226.
    [Google Scholar]
  44. Kazembe LN, Appleton CC, Kleinschmidt I, 2007. Choice of treatment for fever at household level in Malawi: examining spatial patterns. Malar J 6: 40.
    [Google Scholar]
  45. Chinkhumba J, Skarbinski J, Chilima B, Campbell C, Ewing V, San Joaquin M, Sande J, Ali D, Mathanga D, 2010. Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi. Malar J 9: 209.
    [Google Scholar]
  46. Mathanga DP, Walker ED, Wilson ML, Ali D, Taylor TE, Laufer MK, 2012. Malaria control in Malawi: current status and directions for the future. Acta Trop 121: 212217.
    [Google Scholar]
  47. Ansari S, Soltero EG, Lorenzo E, Lee RE, 2017. The impact of religiosity on dietary habits and physical activity in minority women participating in the Health is Power (HIP) study. Prev Med Rep 5: 210213.
    [Google Scholar]
  48. Chege PM, Kimiywe JO, Ndungu ZW, 2015. Influence of culture on dietary practices of children under five years among Maasai pastoralists in Kajiado, Kenya. Int J Behav Nutr Phys Act 12: 131.
    [Google Scholar]
  49. Tan KL, 2011. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular Malaysia. Int Breastfeed J 6: 2.
    [Google Scholar]
  50. Kretchy I, Owusu-Daaku F, Danquah S, 2013. Spiritual and religious beliefs: do they matter in the medication adherence behaviour of hypertensive patients? Biopsychosoc Med 7: 15.
    [Google Scholar]
  51. Tegegne M, Sileshi S, Benti T, Teshome M, Woldie H, 2017. Factors associated with minimal meal frequency and dietary diversity practices among infants and young children in the predominantly agrarian society of Bale zone, southeast Ethiopia: a community based cross sectional study. Arch Public Health 75: 53.
    [Google Scholar]
  52. Pillai RK, Williams SV, Glick HA, Polsky D, Berlin JA, Lowe RA, 2003. Factors affecting decisions to seek treatment for sick children in Kerala, India. Soc Sci Med 57: 783790.
    [Google Scholar]
  53. WHO, 2013. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  54. Essomba NE, Kedy Koum DC, Adiogo D, Ngwe MI, Coppieters Y, 2015. Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala, Cameroon. Malawi Med J 27: 6064.
    [Google Scholar]
  55. Masangwi S, Ferguson N, Grimason A, Morse T, Kazembe L, 2016. Care-seeking for diarrhoea in southern Malawi: attitudes, practices and implications for diarrhoea control. Int J Environ Res Public Health 13: 1140.
    [Google Scholar]
  56. Ibrahim IR, Palaian S, Ibrahim MI, 2018. Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad, Iraq: a simulated patient study. Pharm Pract 16: 1313.
    [Google Scholar]
  57. Pemberton S, Humphris P, 2016 Locality, Neighbourhood and Health: A Literature Review, IRiS Working Paper Series, No. 13/2016 (UPWEB Working Paper Series, No. 2/2016). Birmingham, England: Institute for Research into Superdiversity.
  58. Evans CR, Williams DR, Onnela JP, Subramanian SV, 2018. A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Soc Sci Med 203: 6473.
    [Google Scholar]
  59. Menon MP, Njau JD, McFarland DA; Uganda Malaria Indicator Survey Technical Working Group, 2016. Cost and predictors of care-seeking behaviors among caregivers of febrile children-Uganda, 2009. Am J Trop Med Hyg 94: 932937.
    [Google Scholar]
  60. Kahabuka C, Kvale G, Hinderaker SG, 2013. Care-seeking and management of common childhood illnesses in Tanzania—results from the 2010 demographic and health survey. PLoS One 8: e58789.
    [Google Scholar]
  61. Hwang J, Graves PM, Jima D, Reithinger R, Kachur SP; the Ethiopia MISWG, 2010. Knowledge of malaria and its association with malaria-related behaviors—results from the malaria indicator survey, Ethiopia, 2007. PLoS One 5: e11692.
    [Google Scholar]
  62. Akbarinejad F, Soleymani M, Shahrzadi L, 2017. The relationship between media literacy and health literacy among pregnant women in health centers of Isfahan. J Educ Health Promot 6: 17.
    [Google Scholar]
  63. Zimmerman E, Woolf SH, 2014. Understanding the Relationship between Education and Health. Discussion Paper. Washington, DC: Institute of Medicine. Available at: https://nam.edu/wp-content/uploads/2015/06/BPH-UnderstandingTheRelationship1.pdf. Accessed January 29, 2019.
  64. Sabates R, Feinstein L, 2006. The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med 62: 29983010.
    [Google Scholar]
  65. Baumann E, Czerwinski F, Reifegerste D, 2017. Gender-specific determinants and patterns of online health information seeking: results from a representative German health survey. J Med Internet Res 19: e92.
    [Google Scholar]
  66. Sridharan S, Dey A, Seth A, Chandurkar D, Singh K, Hay K, Gibson R, 2017. Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India. Glob Health Action 10: 1287493.
    [Google Scholar]
  67. Chibwana AI, Mathanga DP, Chinkhumba J, Campbell CH, 2009. Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi. Malar J 8: 219.
    [Google Scholar]
  68. Anselmi L, Lagarde M, Hanson K, 2015. Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique. Health Econ Rev 5: 26.
    [Google Scholar]
  69. Kenny A et al., 2015. Remoteness and maternal and child health service utilization in rural Liberia: a population-based survey. J Glob Health 5: 020401.
    [Google Scholar]
  70. Sonkong K, Chaiklieng S, Neave P, Suggaravetsiri P, 2015. Factors affecting delay in seeking treatment among malaria patients along Thailand-Myanmar border in Tak Province, Thailand. Malar J 14: 3.
    [Google Scholar]
  71. Robert SA, 1998. Community-level socioeconomic status effects on adult health. J Health Soc Behav 39: 1837.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0900
Loading
/content/journals/10.4269/ajtmh.18-0900
Loading

Data & Media loading...

  • Received : 12 Nov 2018
  • Accepted : 04 Mar 2019
  • Published online : 15 Apr 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error