1
|
Rahimi A, Kassam R, Dang Z, Sekiwunga R. Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study. Pharm Pract (Granada) 2019; 17:1622. [PMID: 31897260 PMCID: PMC6935545 DOI: 10.18549/pharmpract.2019.4.1622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: A qualitative study was conducted to gain insight into challenges reported by
Butaleja households during a previous household survey. Specifically, this
paper discusses heads of households’ and caregivers’
perceptions of challenges they face when seeking care for their very young
children with fever presumed to be malaria. Methods: Eleven focus groups (FGs) were carried out with household members (five with
heads of households and six with household caregivers) residing in five
sub-counties located across the district. Purposive sampling was used to
ensure the sample represented the religious diversity and geographical
distance from the peri-urban center of the district. Each FG consisted of
five to six participants. The FGs were conducted at a community centre by
two pairs of researchers residing in the district and who were fluent in
both English and the local dialect of Lunyole. The discussions were
recorded, translated, and transcribed. Transcripts were reviewed and coded
with the assistance of QDA Miner (version 4.0) qualitative data management
software, and analyzed using thematic content analysis. Results: The FG discussions identified four major areas of challenges when managing
acute febrile illness in their child under the age of five with presumed
malaria (1) difficulties with getting to public health facilities due to
long geographical distances and lack of affordable transportation; (2) poor
service once at a public health facility, including denial of care, delay in
treatment, and negative experiences with the staff; (3) difficulties with
managing the child’s illness at home, including challenges with
keeping home-stock medicines and administering medicines as prescribed; and
(4) constrained to use private outlets despite their shortcomings. Conclusions: Future interventions may need to look beyond the public health system to
improve case management of childhood malaria at the community level in rural
districts such as Butaleja. Given the difficulties with accessing quality
private health outlets, there is a need to partner with the private sector
to explore feasible models of community-based health insurance programs and
expand the role of informal private providers.
Collapse
Affiliation(s)
- Asa Rahimi
- BSc (Hons). Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Rosemin Kassam
- BSc Pharm, ACPR, PharmD, PhD. Professor. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Zhong Dang
- BSc MBIM. Research Assistant. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Richard Sekiwunga
- MSc PRH. Scientist. Child Health and Development Centre, School of Medicine, Makerere University, Kampala (Uganda).
| |
Collapse
|
2
|
Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study. J Trop Med 2018; 2018:6987435. [PMID: 29623095 PMCID: PMC5830015 DOI: 10.1155/2018/6987435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
This study investigated unlicensed drug outlets' practices for the management of malaria in the rural district of Butaleja, Uganda. A qualitative design using semistructured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education, but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy (ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed vendors to improve the management of childhood malaria.
Collapse
|
3
|
Quakyi IA, Adjei GO, Sullivan DJ, Stephens JK, Laar A, Ama Aubyn VN, Owusu R, Sakyi KS, Coleman N, Krampa FD, Vanotoo L, Tuakli J, Bortei BB, Essuman E, Sorvor F, Boateng IA, Bart-Plange C, Addison EA, Winch P, Adjei AA. Targeted community based interventions improved malaria management competencies in rural Ghana. Glob Health Res Policy 2017; 2:29. [PMID: 29202097 PMCID: PMC5683319 DOI: 10.1186/s41256-017-0048-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is one of the most challenging public health concerns in the developing world. To address its impact in endemic regions, several interventions are implemented by stakeholders. The Affordable Medicine Facility-malaria (AMFm) is an example of such interventions. Its activities include communication interventions to enhance the knowledge of caregivers of children under five years, licensed chemical sellers (LCS) and prescribers on malaria management with artemisinin-based combination therapy (ACT). This study was conducted to evaluate the effectiveness of the AMFm activities on malaria among targeted groups in two rural communities in Ghana. Methods A communication intervention study was conducted in the Asante-Akim North and South Districts of Ghana. Repeated cross-sectional pre and post surveys were deployed. Relevant malaria messages were designed and used to develop the information, education and communication (IEC) tools for the intervention. With the aid of posters and flipcharts developed by our study, community health workers (CHWs), prescribers, and licenced chemical sellers provided proper counselling to clients on malaria management. Trained CHWs and community based volunteers educated caregivers of children under five years on malaria management at their homes and at public gatherings such as churches, mosques, schools. Chi-square tests and logistic regression were run to determine associations and control for demographic differences respectively. Results There was significantly high exposure to malaria/ACT interventions in the intervention district than in the comparison district (OR = 16.02; 95% CI = 7.88–32.55) and same for malaria/ACT-related knowledge (OR = 3.63; 95% CI = 2.52–5.23). The participants in the intervention district were also more knowledgeable about correct administration of dispersible drug for children <5 years than their counterparts in the unexposed district. Conclusion Our data show that targeted interventions improve malaria based competences in rural community settings. The availability of subsidized ACTs and the intensity of the communication campaigns contributed to the AMFm-related awareness, improved knowledge on malaria/ACTs and management practices.
Collapse
Affiliation(s)
- Isabella A Quakyi
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - George O Adjei
- Office of Research, Innovation and Development, University of Ghana, Legon, Accra, Ghana
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Judith K Stephens
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Amos Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Richmond Owusu
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwame S Sakyi
- Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Nathaniel Coleman
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Francis D Krampa
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Linda Vanotoo
- Regional Health Directorate, Ghana Health Services, Accra, Ghana
| | | | - Bernard B Bortei
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Edward Essuman
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Felix Sorvor
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Isaac A Boateng
- Asante-Akim Central Municipal Health Directorate, Ghana Health Services, Konongo, Ghana
| | - Constance Bart-Plange
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Ebenezer A Addison
- Kpone Katamanso District Health Directorate, Ghana Health Services, Kpone, Tema, Ghana
| | - Peter Winch
- Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Andrew A Adjei
- Worldwide Universities Network, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| |
Collapse
|
4
|
Liow E, Kassam R, Sekiwunga R. Investigating unlicensed retail drug vendors' preparedness and knowledge about malaria: An exploratory study in rural Uganda. Acta Trop 2017; 174:9-18. [PMID: 28606818 DOI: 10.1016/j.actatropica.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/07/2017] [Accepted: 06/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite major efforts to increase the uptake of preventive measures and timely use of the first line antimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors' (1) training related to malaria case management for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options. METHODS A qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. RESULTS About half of the 75 vendors interviewed had received some sort of formal training on malaria at a post-secondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two-fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government's first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection. CONCLUSION Findings from this study confirm significant gaps in unlicensed vendors' knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet.
Collapse
Affiliation(s)
- Eric Liow
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Rosemin Kassam
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Richard Sekiwunga
- Child Health and Development Centre, School of Medicine, Makerere University, Kampala, P.O. Box 6717, Uganda.
| |
Collapse
|