Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria

Knowledge, attitudes and practices regarding malaria prevention and control in communities in the Eastern Region, Ghana, 2020

BACKGROUND

In sub-Saharan Africa countries including Ghana, the malaria burden remains unacceptably high and still a serious health challenge. Evaluating a community's level of knowledge, attitude, and practice (KAP) regarding malaria is essential to enabling appropriate preventive and control measures. This study aimed to evaluate knowledge of malaria, attitudes toward the disease, and adoption of control and prevention practices in some communities across the Eastern Region of Ghana.

METHODS

A cross‑sectional based study was carried out in 13 communities across 8 districts from January -June, 2020. Complete data on socio-demographic characteristics and KAP were obtained from 316 randomly selected household respondents by a structured pre-tested questionnaire. Associations between KAP scores and socio-demographic profiles were tested by Chi-square and binary logistic regression. Data analysis was done with SPSS version 26.0.

RESULTS

Most respondents (85.4%) had good knowledge score about malaria. Preferred choice of treatment seeking place (50.6%) was the health center/clinic. All respondents indicated they would seek treatment within 24 hours. Mosquito coils were the preferred choice (58.9%) against mosquito bites. Majority of households (58.5%) had no bed nets and bed net usage was poor (10.1%). Nearly half of the respondents (49.4%) had a positive attitude toward malaria and 40.5% showed good practices. Chi-square analysis showed significant associations for gender and attitude scores (p = 0.033), and educational status and practice scores (p = 0.023). Binary logistic regression analysis showed that 51-60 year-olds were less likely to have good knowledge (OR = 0.20, p = 0.04) than 15-20 year-olds. Respondents with complete basic schooling were less likely to have good knowledge (OR = 0.33, p = 0.04) than those with no formal schooling. A positive attitude was less likely in men (OR = 0.61, p = 0.04). Good malaria prevention practice was lower (OR = 0.30, p = 0.01) in participants with incomplete basic school education compared to those with no formal schooling.

CONCLUSION

Overall scores for respondents' knowledge, though good, was not reflected in attitudes and levels of practice regarding malaria control and prevention. Behavioral change communication, preferably on radio, should be aimed at attitudes and practice toward the disease.

Influence of MAMA decoction, an Herbal Antimalarial, on the Pharmacokinetics of Amodiaquine in Mice

BACKGROUND AND OBJECTIVE

MAMA decoction (MD) is an antimalarial product prepared from the leaves of Mangifera indica L. (Anacardiaceae), Alstonia boonei De Wild (Apocynaceae), Morinda lucida Benth (Rubiaceae) and Azadirachta indica A. Juss (Meliaceae). A previous report showed that MD enhanced the efficacy of amodiaquine (AQ) in malaria-infected mice, thus suggesting a herb-drug interaction. The present study hence evaluated the effect of MD on the disposition of AQ in mice with a view to investigating a possible pharmacokinetic interaction.

METHODS

In a 3-period study design, three groups of mice (n = 72) were administered oral doses of AQ (10 mg/kg/day) alone, concurrently with MD (120 mg/kg/day), and in the 3rd period, mice were given AQ after a 3-day pre-treatment with MD. Blood samples were collected between 0 and 96 h for quantification of AQ and its major metabolite, desethylamodiaquine, by a validated high-performance liquid chromatography method.

RESULTS

Maximum concentrations of AQ increased by 12% with the concurrent dosing of MD and by 85% in the group of mice pre-treated with MD. The exposure and half-life of desethylamodiaquine increased by approximately 11% and 21%, respectively, with concurrent administration. Corresponding increases of approximately 20% and 33% of desethylamodiaquine were also observed in mice pre-treated with MD.

CONCLUSION

MD influenced the pharmacokinetics of AQ and desethylamodiaquine, its major metabolite. The increase in the half-life and systemic exposure of AQ following its co-administration with MD may provide a basis for the enhanced pharmacological effect of the combination in an earlier study in Plasmodium-infected mice.

Evaluation of herbal antimalarial MAMA decoction-amodiaquine combination in murine malaria model

CONTEXT

Co-administration of amodiaquine with MAMA decoction (MD), an herbal antimalarial drug comprising the leaves of Mangifera indica L. (Anacardiaceae), Alstonia boonei De Wild (Apocynaceae), Morinda lucida Benth (Rubiaceae) and Azadirachta indica A. Juss (Meliaceae) was investigated. The practice of concurrent administration of herbal medicines with orthodox drugs is currently on the increase globally.

OBJECTIVE

The study was designed to investigate the possible enhancement of the antimalarial potency as well as possible herb-drug interaction resulting from concurrent administration of MAMA decoction with amodiaquine (AQ).

MATERIALS AND METHODS

Combinations of MD with AQ were investigated in chloroquine (CQ)-sensitive Plasmodium berghei NK 65 in varying oral doses (mg/kg) at: sub-therapeutic [MD30 + AQ1.25], therapeutic [MD120 + AQ10] and median effective [MD40 + AQ3.8], using chemosuppressive and curative antimalarial test models. Secondly, P. berghei ANKA (CQ-resistant)-infected mice were orally treated with MD 120, 240, [MD120 + AQ10] and [MD240 + AQ10] mg/kg, using both models. The survival times of mice were monitored for 28 d.

RESULTS

ED50 values of MD and AQ were 48.8 and 4.1 mg/kg, respectively. A total parasite clearance of CQ-sensitive P. berghei NK65 was obtained with the therapeutic combination dose in the curative test giving an enhanced survival time. In CQ-resistant P. berghei ANKA-infected mice, [MD120 + AQ10] and [MD240 + AQ10] mg/kg gave comparable activities with AQ (10 mg/kg) in both models.

CONCLUSION

The therapeutic combination dose gave total parasite clearance of CQ-sensitive P. berghei NK65, whereas none of the doses tested showed notable activity against CQ-resistant P. berghei ANKA.

Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State

BACKGROUND

Malaria is one of the most severe global public health problems worldwide, particularly in Africa, where Nigeria has the greatest number of malaria cases. This community-based study was designed to investigate the prevalence and risk factors of malaria and to evaluate the knowledge, attitudes, and practices (KAP) regarding malaria among rural Hausa communities in Kano State, Nigeria.

METHODS

A cross-sectional community-based study was conducted on 551 participants from five local government areas in Kano State. Blood samples were collected and examined for the presence of Plasmodium species by rapid diagnostic test (RDT), Giemsa-stained thin and thick blood films, and PCR. Moreover, demographic, socioeconomic, and environmental information as well as KAP data were collected using a pre-tested questionnaire.

RESULTS

A total of 334 (60.6 %) participants were found positive for Plasmodium falciparum. The prevalence differed significantly by age group (p < 0.01), but not by gender or location. A multivariate analysis showed that malaria was associated significantly with being aged 12 years or older, having a low household family income, not using insecticide treated nets (ITNs), and having no toilets in the house. Overall, 95.6 % of the respondents had prior knowledge about malaria, and 79.7, 87.6 and 95.7 % of them knew about the transmission, symptoms, and prevention of malaria, respectively. The majority (93.4 %) of the respondents considered malaria a serious disease. Although 79.5 % of the respondents had at least one ITN in their household, utilization rate of ITNs was 49.5 %. Significant associations between the respondents' knowledge concerning malaria and their age, gender, education, and household monthly income were reported.

CONCLUSIONS

Malaria is still highly prevalent among rural Hausa communities in Nigeria. Despite high levels of knowledge and attitudes in the study area, significant gaps persist in appropriate preventive practices, particularly the use of ITNs. Innovative and Integrated control measures to reduce the burden of malaria should be identified and implemented in these communities. Community mobilization and health education regarding the importance of using ITNs to prevent malaria and save lives should be considered.

Mothers' understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control

INTRODUCTION

Regular evaluations of communities' understanding of malaria-related practices are essential for control of the disease in endemic areas. This study was aimed at investigating the perceptions, prevention and treatments practices for childhood malaria by mothers in rural communities.

MATERIALS AND METHODS

We conducted a community-based cross-sectional study at rural communities of Ise-Orun local Government area, Nigeria. We randomly sampled 422 mothers of children less than 5 years and administered a validated questionnaire to assess their perceptions and practices relating to childhood malaria. We used a 10-point scale to assess perception and classified it as good (≥5) or poor (<5). Predictive factors for poor perceptions were identified using logistic regression.

RESULTS

Approximately 51% of the mothers had poor perception and 14.2% ascribed malaria illness to mosquito bite only. Majority (85.8%) of the mothers practiced malaria preventive measures, including: Insecticide treated nets (70.0%), chemoprophylaxis (20.1%) and environmental sanitation (44.8%). Of the 200 mothers whose children had malaria fever within the 3 months prior to the study visits, home treatment was adopted by 87.5%. Local herbal remedies were combined with orthodox medicine in the treatments of malaria for 91.5% of the children. The main reasons for not seeking medical treatment at existing formal health facilities were "high cost", "challenges of access to facilities" and "mothers' preference for herbal remedies". Lack of formal education was the only independent predictor of poor malaria perceptions among mothers (OR = 1.91, 95% CI = 1.18, 3.12).

CONCLUSIONS

Considerable misconceptions about malaria exist among mothers in the rural communities. The implications for malaria control in holoendemic areas are highlighted.

Understanding careseeking for child illness in sub-Saharan Africa: a systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria

Diarrhoea, pneumonia and malaria are the largest contributors to childhood mortality in sub-Saharan Africa. While supply side efforts to deliver effective and affordable interventions are being scaled up, ensuring timely and appropriate use by caregivers remains a challenge. This systematic review synthesises qualitative evidence on the factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. For this review, we searched six electronic databases, hand searched 12 journals from 1980 to 2010 using key search terms, and solicited expert review. We identified 5104 possible studies and included 112. Study quality was appraised using the Critical Appraisal Skills Program (CASP) tool. We followed a meta-ethnographic approach to synthesise findings according to three main themes: how households understand these illnesses, how social relationships affect recognition and response, and how households act to prevent and treat these illnesses. We synthesise these findings into a conceptual model for understanding household pathways to care and decision making. Factors that influence household careseeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location, gender, household income and cost of treatment. Several studies also emphasise the importance of experimentation, previous experience with health services and habit in shaping household choices. Moving beyond well-known barriers to careseeking and linear models of pathways to care, the review suggests that treatment decision making is a dynamic process characterised by uncertainty and debate, experimentation with multiple and simultaneous treatments, and shifting interpretations of the illness and treatment options, with household decision making hinging on social negotiations with a broad variety of actors and influenced by control over financial resources. The review concludes with research recommendations for tackling remaining gaps in knowledge.

Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use

OBJECTIVE

To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city).

METHODS

A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities.

RESULTS

The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities.

CONCLUSIONS

The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND

Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services.

METHODS

This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings.

RESULTS

A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers.

CONCLUSION

This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly.

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND

Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services.

METHODS

This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings.

RESULTS

A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers.

CONCLUSION

This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly.

Knowledge and Misconceptions about Malaria among Pregnant Women in a Post-Conflict Internally Displaced Persons' Camps in Gulu District, Northern Uganda

Background. In Uganda Malaria continues to be a major public health problem accounting for about 30–50% of all outpatient consultations and 35% of hospital admissions and a leading cause of mortality and morbidity. Pregnant women and their unborn children are vulnerable to malaria. Methods. A cross-sectional survey was conducted in 20 postconflict IDP camps of Gulu district selected randomly as clusters. 769 pregnant women were interviewed. Results. The majority of the respondents 85% have ever heard about malaria. Most (80%) 571 respondent attributed malaria to be transmitted by mosquito bites, 15 said cold weather, 53 said dirt, and 35 said not sleeping under net. Most (91%) 683 respondents mentioned that malaria was caused by mosquito, 28 mentioned cold food, 3 mentioned playing in the rain, 19 mentioned cold weather, and 6 mentioned eating mangos. Conclusion. Most pregnant women in the post conflict IDP camps have relatively high knowledge about malaria transmission, signs, symptoms, and consequences during pregnancy. However, majority of respondents had misconception about the cause of malaria while a few had misconception about the mode of malaria transmission.

Resistance-mediating polymorphisms of Plasmodium falciparum among isolates from children with severe malaria in kumasi, ghana

BACKGROUND

Antimalarial drug resistance has been a major contributor to the failure of the battle against malaria in many developing countries. The P. falciparum genes, pfcrt and pfmdr-1, have been implicated in chloroquine resistance. The objective of this study was to determine the presence of mutant alleles of these chloroquine resistance genes among isolates of P. falciparum from children presenting with severe malaria in Ghana.

METHODS

Venous blood samples were taken from patients, and plasma chloroquine levels measured. P. falciparum chromosomal DNA was isolated from the blood samples, and subjected to PCR, restriction digestion and sequencing. Resulting data were analysed using the STATA statistical software.

RESULTS

Of 140 children recruited into the study, 109 (77.9%) had detectable pre-treatment chloroquine levels. PCR and restriction digestion analysis of the pfcrt gene indicated that 124 (88.6%) had the mutant T76 gene, and that this correlated with higher chloroquine levels. Sequence analysis of these showed consistent genetic sequences for chloroquine resistant and sensitive parasites with respect to Pfcrt codons 72 through 76.The Pfcrt T76 mutation was found in 88.4% of isolates having the Pfmdr-1Y86 mutation. The Pfmdr-1 Y86 mutation was found in 67.6% of isolates having the Pfcrt T76 mutation.

CONCLUSION

The study affirms Pfcrt as a better chloroquine resistance marker. Both mutations are independently selected by chloroquine levels and that one mutation (Y86) might modify/increase the effect of the other (T76). This study also depicts the much-overlooked antimalarial drug resistance situation in the area and emphasizes the need for a proper treatment strategy.

Knowledge, attitudes and practices about malaria among communities: comparing epidemic and non-epidemic prone communities of Muleba district, North-western Tanzania

BACKGROUND

Muleba district in North-western Tanzania has experienced malaria epidemics in recent years. Community knowledge, attitudes and practices are important in enhancing disease control interventions. This study investigated determinants of malaria epidemics in the study area in relation to household knowledge, attitudes and practice on malaria.

METHODS

A community based cross-sectional survey involving 504 study participants was conducted between April and June 2007 using a structured questionnaire focusing on knowledge, attitudes and practices of community members in epidemic and non-epidemic villages about malaria transmission, signs and symptoms, treatment, prevention and control. Multivariate logistic regression analysis was used to assess determinants of malaria epidemics.

RESULTS

A total of 504 respondents (males = 36.9%) were interviewed. Overall, 453 (90.1%) mentioned malaria as the most important disease in the area. Four hundred and sixty four respondents (92.1%) knew that malaria is transmitted through mosquito bite. A total of 436 (86.7%), 306 (60.8%) and 162 (32.1%) mentioned fever, vomiting and loss of appetite as major symptoms/signs of malaria, respectively. Of those interviewed 328 (65.1%) remembered the recent outbreak of 2006. Of the 504 respondents interviewed, 296 (58.7%) reported that their households owned at least one mosquito net. Three hundred and ninety seven respondents (78.8%) knew insecticides used to impregnate bed nets. About two thirds (63.3%) of the respondents had at least a household member who suffered from malaria during the recent epidemic. During the 2006 outbreak, 278 people (87.2%) sought treatment from health facilities while 27 (8.5%) obtained drugs from drug shops and 10 (3.1%) used local herbs. Logistic regression analysis showed that household location and level of knowledge of cause of malaria were significant predictors of a household being affected by epidemic.

CONCLUSIONS

Residents of Muleba district have high level of knowledge on malaria. However, this knowledge has not been fully translated into appropriate use of available malaria interventions. Our findings suggest that household location, ineffective usage of insecticide treated nets and knowledge gaps on malaria transmission, signs and symptoms, prevention and control predisposed communities in the district to malaria epidemics. It is important that health education packages are developed to address the identified knowledge gaps.

Geographic inequities in provision and utilization of malaria treatment services in southeast Nigeria: diagnosis, providers and drugs

OBJECTIVES

To examine the levels of geographic inequities in households' choice of providers, mode of diagnosis and drugs for the treatment of malaria.

METHODS

Interviewer-administered questionnaire was used to collect information from 2250 randomly selected respondents from six malaria-endemic communities in southeast Nigeria. A comparison of data between urban and rural areas was used to examine geographic inequities in treatment seeking.

FINDINGS

There were geographic inequities in the use of different providers and drugs for the treatment of malaria. The urbanites used more of private hospitals/clinics and specialist hospital, while the rural dwellers used more of drug sellers (patent medicine dealers (PMD) and pharmacy shops (PS)). The rural dwellers were prescribed the cheaper drugs whilst the urbanites were prescribed the more costly drugs.

CONCLUSION

The geographic inequities in malaria treatment are skewed against the rural people. Everybody is seeking care from the private sector for treatment of malaria but the rural dwellers are using mostly the informal healthcare providers.

Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria

BACKGROUND

Agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria - a disease which seriously impacts on agricultural productivity. Unfortunately information relating to agricultural practices and farmers' behavioural antecedent factors that could assist malaria programmers plan and implement interventions to reduce risk of infections among farmers is scanty. Farmers' knowledge about malaria and agricultural practices which favour the breeding of mosquitoes in Fashola and Soku, two rural farming communities in Oyo State were therefore assessed in two rural farming communities in Oyo State.

METHODS

This descriptive cross-sectional study involved the collection of data through the use of eight Focus Group Discussions (FGDs) and the interview of 403 randomly selected farmers using semi-structured questionnaires. These sets of information were supplemented with observations of agricultural practices made in 40 randomly selected farms. The FGD data were recorded on audio-tapes, transcribed and subjected to content analysis while the quantitative data were analyzed using descriptive and inferential statistics.

RESULTS

Most respondents in the two communities had low level of knowledge of malaria causation as only 12.4% stated that mosquito bite could transmit the disease. Less than half (46.7%) correctly mentioned the signs and symptoms of malaria as high body temperature, body pains, headache, body weakness and cold/fever. The reported main methods for preventing mosquito bites in the farming communities included removal of heaps of cassava tuber peelings (62.3%), bush burning/clearing (54.6%) and clearing of ditches (33.7%). The dumping of cassava tuber peelings which allows the collection of pools of water in the farms storage of peeled cassava tubers soaked in water in uncovered plastic containers, digging of trenches, irrigation of farms and the presence of fish ponds were the observed major agricultural practices that favoured mosquito breeding on the farms. A significant association was observed between respondents' knowledge about malaria and agricultural practices which promote mosquito breeding. Respondents' wealth quintile level was also seen to be associated with respondents' knowledge about malaria and agricultural practices which promote mosquito breeding.

CONCLUSION

Farmers' knowledge of malaria causation and signs and symptoms was low, while agricultural practices which favour mosquito breeding in the farming communities were common. There is an urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favour mosquito breeding. Multiple intervention strategies are needed to tackle the factors related to malaria prevalence and mosquito abundance in the communities.

Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies

BACKGROUND

In Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries.

METHODS

We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention.

RESULTS

The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39).

CONCLUSION

These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.

Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi

Background

Prompt access to effective treatment for malaria is unacceptably low in Malawi. Less than 20% of children under the age of five with fever receive appropriate anti-malarial treatment within 24 hours of fever onset. This study assessed socio-cultural factors associated with delayed treatment of children with fever in Mwanza district, Malawi.

Methodology

It was a qualitative study using focus group discussions and key informant interviews.

Results

A total of 151 caregivers and 46 health workers participated in the focus group discussions. The majority of caregivers were able to recognize fever and link it to malaria. Despite high knowledge of malaria, prompt treatment and health-seeking behaviour were poor, with the majority of children first being managed at home with treatment regimens other than effective anti-malarials. Traditional beliefs about causes of fever, unavailability of anti-malarial drugs within the community, barriers to accessing the formal health care system, and trust in traditional medicine were all associated with delays in seeking appropriate treatment for fever.

Conclusion

The study has demonstrated important social cultural factors that negatively influence for caregivers of children under five. To facilitate prompt and appropriate health-seeking behaviour, behavioral change messages must address the prevailing local beliefs about causes of fever and the socio-economic barriers to accessing health care.