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Konate D, Diawara SI, Sogoba N, Shaffer J, Keita B, Cisse A, Sanogo I, Dicko I, Guindo MDA, Balam S, Traore A, Kante S, Dembele A, Kasse F, Denou L, Diakite SA, Traore K, M'Baye Thiam S, Sanogo V, Toure M, Diarra A, Agak GW, Doumbia S, Diakite M. Effect of a fifth round of seasonal malaria chemoprevention in children aged 5-14 years in Dangassa, an area of long transmission in Mali. Parasite Epidemiol Control 2023; 20:e00283. [PMID: 36704118 PMCID: PMC9871299 DOI: 10.1016/j.parepi.2022.e00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
Despite a significant reduction in the burden of malaria in children under five years-old, the efficient implementation of seasonal malaria chemoprevention (SMC) at large scale remains a major concern in areas with long malaria transmission. Low coverage rate in the unattainable areas during the rainy season, a shift in the risk of malaria to older children and the rebound in malaria incidence after stopping drug administration are mainly reported in these areas. These gaps represent a major challenge in the efficient implementation of SMC measures. An open randomized study was conducted to assess the effect of a fifth additional round to current regime of SMC in older children living in Dangassa, a rural malaria endemic area. Poisson regression Model was used to estimate the reduction in malaria incidence in the intervention group compared to the control group including age groups (5-9 and 10-14 years) and the use of long-lasting insecticidal nets (LLINs; Yes or No) with a threshold at 5%. Overall, a downward trend in participation rate was observed from August (94.3%) to November (87.2%). In November (round 4), the risk of malaria incidence was similar in both groups (IRR = 0.66, 95%CI [0.35-1.22]). In December (round 5), a decrease of 51% in malaria incidence was observed in intervention group compared to control group adjusted for age groups and the use of LLINs (IRR = 0.49, 95%CI [0.26-0.94]), of which 17% of reduction is attributable to the 5th round in the intervention group. An additional fifth round of SMC resulted in a significant reduction of malaria incidence in the intervention group. The number of SMC rounds could be adapted to the local condition of malaria transmission.
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Affiliation(s)
- Drissa Konate
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- Corresponding author.
| | - Sory I. Diawara
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Nafomon Sogoba
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Jeff Shaffer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Bourama Keita
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdourhamane Cisse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Ibrahim Sanogo
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ilo Dicko
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Merepen dite Agnes Guindo
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Saidou Balam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdouramane Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Salimata Kante
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Assitan Dembele
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Fatoumata Kasse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Larissa Denou
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seidina A.S. Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Karim Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sidibe M'Baye Thiam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Vincent Sanogo
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | - Mahamoudou Toure
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ayouba Diarra
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - George W. Agak
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Seydou Doumbia
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Scott S, Camara BS, Hill M, Lama EK, Barry L, Ogouyemi-Hounto A, Houndjo W, Tougri G, Yacouba N, Achu D, Ateba M, Diar MSI, Malm KL, Adomako K, Djata P, Da Silva W, Cissé I, Sanogo V, Jackou H, Ogbulafor N, Adu BM, Nikau J, Gaye S, Gueye AB, Kandeh B, Kolley O, Atcha-Oubou T, Tchadjobo T, Loua KM, Tchouatieu AM, Mbaye I, Lima-Parra MA, Poku-Awuku A, Ndiaye JL, Merle C, Thomas L, Milligan P. The use of video job-aids to improve the quality of seasonal malaria chemoprevention delivery. PLOS Digit Health 2022; 1:e0000165. [PMID: 36812625 PMCID: PMC9931299 DOI: 10.1371/journal.pdig.0000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/16/2022] [Indexed: 06/18/2023]
Abstract
Mobile phones are increasingly used in community health programmes, but the use of video job-aids that can be displayed on smart phones has not been widely exploited. We investigated the use of video job-aids to support the delivery of seasonal malaria chemoprevention (SMC) in countries in West and Central Africa. The study was prompted by the need for training tools that could be used in a socially distanced manner during the COVID-19 pandemic. Animated videos were developed in English, French, Portuguese, Fula and Hausa, illustrating key steps for administering SMC safely, including wearing masks, washing hands, and social distancing. Through a consultative process with the national malaria programmes of countries using SMC, successive versions of the script and videos were reviewed to ensure accurate and relevant content. Online workshops were held with programme managers to plan how to use the videos in SMC staff training and supervision, and the use of the videos was evaluated in Guinea through focus groups and in-depth interviews with drug distributors and other staff involved in SMC delivery and through direct observations of SMC administration. Programme managers found the videos useful as they reinforce messages, can be viewed at any time and repeatedly, and when used during training sessions, provide a focus of discussion and support for trainers and help retain messages. Managers requested that local specificities of SMC delivery in their setting be included in tailored versions of the video for their country, and videos were required to be narrated in a variety of local languages. In Guinea, SMC drug distributors found the video covered the all the essential steps and found the video easy to understand. However, not all key messages were followed as some of the safety measures, social distancing and wearing masks, were perceived by some as creating mistrust amongst communities. Video job-aids can potentially provide an efficient means of reaching large numbers of drug distributors with guidance for safe and effective distribution of SMC. Not all distributors use android phones, but SMC programmes are increasingly providing drug distributors with android devices to track delivery, and personal ownership of smartphones in sub-Saharan Africa is growing. The use of video job-aids for community health workers to improve the quality delivery of SMC, or of other primary health care interventions, should be more widely evaluated.
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Affiliation(s)
- Susana Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Michael Hill
- Centre for Excellence in Learning and Teaching, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eugène Kaman Lama
- National Control Malaria Programme, Ministry of Health, Conakry, Guinea
| | - Lansana Barry
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | - William Houndjo
- National Malaria Control Programme, Ministry of Health, Cotonou, Benin
| | - Gauthier Tougri
- National Malaria Control Programme, Ministry of Health, Ouagadougou, Burkina Faso
| | - Nombre Yacouba
- National Malaria Control Programme, Ministry of Health, Ouagadougou, Burkina Faso
| | - Dorothy Achu
- National Malaria Control Programme, Ministry of Health, Yaoundé, Cameroon
| | - Marcellin Ateba
- National Malaria Control Programme, Ministry of Health, Yaoundé, Cameroon
| | | | - Keziah L. Malm
- National Malaria Control Programme, Ministry of Health, Accra, Ghana
| | - Kofi Adomako
- National Malaria Control Programme, Ministry of Health, Accra, Ghana
| | - Paolo Djata
- National Malaria Control Programme, Ministry of Health, Bissau, Guinea Bissau
| | - Wica Da Silva
- National Malaria Control Programme, Ministry of Health, Bissau, Guinea Bissau
| | - Idrissa Cissé
- National Malaria Control Programme, Ministry of Health, Bamako, Mali
| | - Vincent Sanogo
- National Malaria Control Programme, Ministry of Health, Bamako, Mali
| | - Hadiza Jackou
- National Malaria Control Programme, Ministry of Health, Niamey, Niger
| | - Nnenna Ogbulafor
- National Malaria Elimination Programme, Ministry of Health, Abuja, Nigeria
| | - Bala M. Adu
- National Malaria Elimination Programme, Ministry of Health, Abuja, Nigeria
| | - Jamilu Nikau
- National Malaria Elimination Programme, Ministry of Health, Abuja, Nigeria
| | - Seynabou Gaye
- National Malaria Control Programme, Ministry of Health, Dakar, Senegal
| | | | - Balla Kandeh
- National Malaria Control Programme, Ministry of Health, Banjul, The Gambia
| | - Olimatou Kolley
- National Malaria Control Programme, Ministry of Health, Banjul, The Gambia
| | | | | | | | | | | | | | | | | | - Corinne Merle
- UNDP/UNICEF/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)/ World Health Organization (WHO), Geneva, Switzerland
| | - Liz Thomas
- University of York, York, United Kingdom
| | - Paul Milligan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Doumbia S, Toure M, Sogoba N, Alifrangis M, Diakite M, Diarra A, Keita M, Konaté D, Diawara SI, Thiam SM, Keita S, Tounkara M, Cissé I, Sanogo V, Magassa MH, Barry AE, Winch PJ, Marker HC, Shaffer JG, Traoré SF, Müller GC, Cui L, Beier JC, Mihigo J. The West Africa ICEMR Partnerships for Guiding Policy to Improve the Malaria Prevention and Control. Am J Trop Med Hyg 2022; 107:84-89. [PMID: 36228908 PMCID: PMC9662222 DOI: 10.4269/ajtmh.21-1330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 12/01/2022] Open
Abstract
The Mali National Malaria Control Program (NMCP) recently established a phased set of goals for eliminating malaria in Mali by 2030. Over the past decade, the scale-up of NMCP-led malaria control interventions has led to considerable progress, as evidenced by multiple malariometric indicators. The West Africa International Center of Excellence in Malaria Research (WA-ICEMR) is a multidisciplinary research program that works closely with the NMCP and its partners to address critical research needs for malaria control. This coordinated effort includes assessing the effectiveness of control interventions based on key malaria research topics, including immune status, parasite genetic diversity, insecticide and drug resistance, diagnostic accuracy, malaria vector populations and biting behaviors, and vectorial capacity. Several signature accomplishments of the WA-ICEMR include identifying changing malaria age demographic profiles, testing innovative approaches to improve control strategies, and providing regular reporting on drug and insecticide resistance status. The NMCP and WA-ICEMR partnership between the WA-ICEMR and the NMCP offers a comprehensive research platform that informs the design and implementation of malaria prevention and control research programs. These efforts build local expertise and capacity for the next generation of malaria researchers and guide local policy, which is crucial in sustaining efforts toward eliminating malaria in West Africa.
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Affiliation(s)
- Seydou Doumbia
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamoudou Toure
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nafomon Sogoba
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Mahamadou Diakite
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ayouba Diarra
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moussa Keita
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Drissa Konaté
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sory I. Diawara
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidibé M’Baye Thiam
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Soumba Keita
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moctar Tounkara
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Idrissa Cissé
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | - Vincent Sanogo
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | | | | | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hannah C. Marker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeffrey G. Shaffer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Sékou F. Traoré
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Günter C. Müller
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Liwang Cui
- Division of Infectious Diseases and Internal Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - John C. Beier
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jules Mihigo
- U.S. President’s Malaria Initiative, United States Agency for International Development Office, Bamako, Mali
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Cissoko M, Sagara I, Landier J, Guindo A, Sanogo V, Coulibaly OY, Dembélé P, Dieng S, Bationo CS, Diarra I, Magassa MH, Berthé I, Katilé A, Traoré D, Dessay N, Gaudart J. Sub-national tailoring of seasonal malaria chemoprevention in Mali based on malaria surveillance and rainfall data. Parasit Vectors 2022; 15:278. [PMID: 35927679 PMCID: PMC9351140 DOI: 10.1186/s13071-022-05379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background In malaria endemic countries, seasonal malaria chemoprevention (SMC) interventions are performed during the high malaria transmission in accordance with epidemiological surveillance data. In this study we propose a predictive approach for tailoring the timing and number of cycles of SMC in all health districts of Mali based on sub-national epidemiological surveillance and rainfall data. Our primary objective was to select the best of two approaches for predicting the onset of the high transmission season at the operational scale. Our secondary objective was to evaluate the number of malaria cases, hospitalisations and deaths in children under 5 years of age that would be prevented annually and the additional cost that would be incurred using the best approach. Methods For each of the 75 health districts of Mali over the study period (2014–2019), we determined (1) the onset of the rainy season period based on weekly rainfall data; (ii) the onset and duration of the high transmission season using change point analysis of weekly incidence data; and (iii) the lag between the onset of the rainy season and the onset of the high transmission. Two approaches for predicting the onset of the high transmission season in 2019 were evaluated. Results In the study period (2014–2019), the onset of the rainy season ranged from week (W) 17 (W17; April) to W34 (August). The onset of the high transmission season ranged from W25 (June) to W40 (September). The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best of the two approaches predicted the onset of the high transmission season in 2019 to be in June in two districts, in July in 46 districts, in August in 21 districts and in September in six districts. Using our proposed approach would prevent 43,819 cases, 1943 hospitalisations and 70 deaths in children under 5 years of age annually for a minimal additional cost. Our analysis shows that the number of cycles of SMC should be changed in 36 health districts. Conclusion Adapting the timing of SMC interventions using our proposed approach could improve the prevention of malaria cases and decrease hospitalisations and deaths. Future studies should be conducted to validate this approach. Graphical Abstract ![]()
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Affiliation(s)
- Mady Cissoko
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali. .,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France. .,Direction Régionale de la Santé de Tombouctou, 59, Tombouctou, Mali.
| | - Issaka Sagara
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Jordi Landier
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Abdoulaye Guindo
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Vincent Sanogo
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Oumou Yacouba Coulibaly
- Direction Générale de la Santé et Hygiène Publique, Sous-Direction Lutte Contre la Maladie (DGSHP-SDLM), 233, Bamako, Mali
| | - Pascal Dembélé
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Sokhna Dieng
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | | | - Issa Diarra
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Mahamadou H Magassa
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Ibrahima Berthé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Abdoulaye Katilé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Diahara Traoré
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Nadine Dessay
- ESPACE-DEV, UMR228, IRD/UM/UR/UG/UA, Institut de Recherche Pour le Développement (IRD) France, 34093, Montpellier, France
| | - Jean Gaudart
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,APHM, INSERM, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistic & ICT, Aix-Marseille University, 13005, Marseille, France
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5
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Treleaven E, Whidden C, Cole F, Kayentao K, Traoré MB, Diakité D, Sidibé S, Lin TK, Boettiger D, Cissouma S, Sanogo V, Padian N, Johnson A, Liu J. Relationship between symptoms, barriers to care and healthcare utilisation among children under five in rural Mali. Trop Med Int Health 2021; 26:943-952. [PMID: 33866656 PMCID: PMC9291065 DOI: 10.1111/tmi.13592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives To identify social and structural barriers to timely utilisation of qualified providers among children under five years in a high‐mortality setting, rural Mali and to analyse how utilisation varies by symptom manifestation. Methods Using baseline household survey data from a cluster‐randomised trial, we assessed symptom patterns and healthcare trajectories of 5117 children whose mothers reported fever, diarrhoea, bloody stools, cough and/or fast breathing in the preceding two weeks. We examine associations between socio‐demographic factors, symptoms and utilisation outcomes in mixed‐effect logistic regressions. Results Almost half of recently ill children reported multiple symptoms (46.2%). Over half (55.9%) received any treatment, while less than one‐quarter (21.7%) received care from a doctor, nurse, midwife, trained community health worker or pharmacist within 24 h of symptom onset. Distance to primary health facility, household wealth and maternal education were consistently associated with better utilisation outcomes. While children with potentially more severe symptoms such as fever and cough with fast breathing or diarrhoea with bloody stools were more likely to receive any care, they were no more likely than children with fever to receive timely care with a qualified provider. Conclusions Even distances as short as 2–5 km significantly reduced children’s likelihood of utilising healthcare relative to those within 2 km of a facility. While children with symptoms indicative of pneumonia and malaria were more likely to receive any care, suggesting mothers and caregivers recognised potentially severe illness, multiple barriers to care contributed to delays and low utilisation of qualified providers, illustrating the need for improved consideration of barriers.
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Affiliation(s)
- Emily Treleaven
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Whidden
- Muso, Bamako, Mali.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Faith Cole
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kassoum Kayentao
- Muso, Bamako, Mali.,Malaria Research & Training Centre, University of Bamako, Bamako, Mali
| | | | | | | | - Tracy Kuo Lin
- Institute for Health & Aging, University of California, San Francisco, CA, USA
| | - David Boettiger
- Institute for Health & Aging, University of California, San Francisco, CA, USA.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Vincent Sanogo
- Division of Prevention and Case Management, National Malaria Control Programme, Bamako, Mali
| | - Nancy Padian
- Institute for Health & Aging, University of California, San Francisco, CA, USA
| | - Ari Johnson
- Muso, Bamako, Mali.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Jenny Liu
- Institute for Health & Aging, University of California, San Francisco, CA, USA
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