1
|
Arntson L, McLaughlin KR, Smit E. Factors influencing fever care-seeking for children under five years of age in The Gambia: a secondary analysis of 2019-20 DHS data. Malar J 2024; 23:124. [PMID: 38678245 PMCID: PMC11056064 DOI: 10.1186/s12936-024-04951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Malaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies. METHODS This cross-sectional analysis of The Gambia 2019-20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics. RESULTS Only 52.0% of mothers sought care from a trained healthcare provider for a child with fever-45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504-4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165-0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274-4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291-0.959). CONCLUSIONS Maintaining The Gambia's malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.
Collapse
Affiliation(s)
- Laura Arntson
- Oregon State University College of Health, 160 SW 26th St, Corvallis, OR, 97331, USA.
| | - Katherine R McLaughlin
- Department of Statistics, Oregon State University, 239 Weniger Hall, Corvallis, OR, 97331, USA
| | - Ellen Smit
- Oregon State University College of Health, 160 SW 26th St, Corvallis, OR, 97331, USA
| |
Collapse
|
2
|
Orish VN, Kyeremateng C, Appiah BP, Addei IB, Ayaba MA, Kwadzokpui PK, Marinkovic A, Prakash S, Okorie C, Izurieta R, Sanyaolu A. Knowledge and perception of asymptomatic malaria in the Volta region of Ghana. Trans R Soc Trop Med Hyg 2024; 118:33-43. [PMID: 37534813 DOI: 10.1093/trstmh/trad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The control of asymptomatic malaria is considered a key aspect of malaria control. This study aimed to assess the knowledge and perception of asymptomatic malaria among people in Ho municipality of the Volta region. METHODS A descriptive cross-sectional study involving questionnaire administration was conducted among randomly sampled residents of the Ho municipality of the Volta region of Ghana. Using SPSS version 25 statistical software, frequency distributions and proportions were computed for sociodemographic variables while knowledge and perception about asymptomatic malaria were computed into percentages and categorized into three levels based on Bloom's cut-off for further analysis. Findings with p-values <0.05 were considered statistically significant. RESULTS Among the 200 participants, 197 (98.5%) were aware of malaria. The majority (116 [58.0%]) of the study participants agreed to the possibility of asymptomatic infection, but most (133 [66.5%]) of the community members did not know that asymptomatic individuals can still transmit infections. The majority of the participants (184 [92.0%]) showed interest in getting further education on asymptomatic malaria and a significant majority (180 [90.0%]) expressed a willingness to take treatment after testing positive without showing any symptoms. CONCLUSIONS Asymptomatic malaria control can be achieved through a mass testing and treatment strategy, therefore improving the knowledge and perception about asymptomatic malaria might improve malaria control.
Collapse
Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Caleb Kyeremateng
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Baffoe P Appiah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Isaac B Addei
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Moses A Ayaba
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | | | | | - Chuku Okorie
- Department of Allied Health Sciences, Union College of Union County, Plainfield Campus, NJ, USA
| | - Ricardo Izurieta
- Department of Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adekunle Sanyaolu
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| |
Collapse
|
3
|
Adjei GO, Sulley AM, Goka BQ, Enweronu-Laryea C, Renner L, Alifrangis M, Kurtzhals JAL. Performance of an HRP-2 based (First Response®) and p-LDH-based (Optimal®) rapid diagnostic tests for diagnosis of malaria in paediatric sickle cell disease patients. Clin Infect Dis 2021; 75:435-441. [PMID: 34849647 DOI: 10.1093/cid/ciab977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) have been extensively evaluated and play an important role in malaria diagnosis. However, the accuracy of RDT for malaria diagnosis in patients with sickle cell disease (SCD) is unknown. METHODS We compared the performance of a histidine rich protein 2 (HRP-2) - based RDT (First Response®), and a lactate dehydrogenase (LDH) - based RDT (Optimal®) with routine microscopy as reference standard in 445 SCD children with an acute febrile illness in Accra, Ghana. RESULTS The overall sensitivity, specificity, positive and negative predictive values of the HRP-2 based RDT were, 100%, 95.7%, 73.8% and 100%, respectively. Comparable values for the LDH based RDT were, 91.7%, 99.5%, 95.7% and 99.0% respectively. A total of 423 results were true in both tests, one result was false in both tests, 16 results were false in the HRP-2 test only and 5 were false in the LDH test only (McNemar's test, p=0.03). At follow up, 73.7 % (28/38), 52.6 % (20/38), 48.6 % (17/35), and 13.2 % (5/38) of study participants were HRP-2 positive on days 14, 28, 35 and 42, respectively, compared to 0, 2.6 % (1/38), 2.9 % (1/35), and 2.6 % (1/38) for LDH. CONCLUSION The HRP2 based RDT fulfilled WHO criteria for malaria diagnosis in SCD patients and may provide diagnostic evidence for treatment to begin in cases where treatment would otherwise have begun presumptively based on symptoms, while LDH based RDT may be more suitable as a confirmatory test in low-parasitaemic sub-groups, such as SCD patients.
Collapse
Affiliation(s)
- George O Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana
| | - A M Sulley
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana
| | - B Q Goka
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - C Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - L Renner
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - M Alifrangis
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - J A L Kurtzhals
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| |
Collapse
|
4
|
Dalaba MA, Welaga P, Dalinjong PA, Chatio S, Immurana M, Alhassan RK, Klu D, Manyeh AK, Agorinya I, Oduro A, Adongo PB, Akweongo P. Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study. BMJ Open 2021; 11:e052224. [PMID: 34518274 PMCID: PMC8438825 DOI: 10.1136/bmjopen-2021-052224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the health-seeking behaviour and cost of fever treatment to households in Ghana. DESIGN Cross-sectional household survey conducted between July and September 2015. SETTING Kassena-Nankana East and West districts in Upper East region of Ghana. PARTICIPANTS Individuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents. RESULTS Out of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1-GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled. CONCLUSIONS Prompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.
Collapse
Affiliation(s)
| | - Paul Welaga
- School of Medicine, C K Tedam University of Technology and Applied Sciences, Navrongo, Upper East, Ghana
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Philip Ayizem Dalinjong
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Samuel Chatio
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Alfred Kwesi Manyeh
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Isaiah Agorinya
- School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Abraham Oduro
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | | | | |
Collapse
|
5
|
Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, Angus DC, West TE. The global burden of sepsis: barriers and potential solutions. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:232. [PMID: 30243300 PMCID: PMC6151187 DOI: 10.1186/s13054-018-2157-z] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.
Collapse
Affiliation(s)
- Kristina E Rudd
- International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St., Scaife Hall, #639, Pittsburgh, PA, USA.
| | - Niranjan Kissoon
- Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sotharith Bory
- Division of Infectious Diseases, Department of Medicine, Calmette Hospital, Phnom Penh, Cambodia
| | | | - Christopher W Seymour
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine and UPMC Health System, Pittsburgh, PA, USA
| | - T Eoin West
- International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|