Background
Methods
Study design
Responses
Itinerary of events data
Analysis
Results
Care-seeking characteristics
Variable | Caregivers of children with uncomplicated malaria | Caregivers of children with severe malaria | p value |
---|---|---|---|
Total number of caregivers, N | 325 | 325 | |
Median time in days taken to seek appropriate treatment; (IQR) | 1.70 (0.91–2.87) | 2.45 (1.62–3.81) | < 0.001 |
Median number of actions taken before seeking appropriate treatment; (IQR) | 3 (2–4) | 4 (3–6) | < 0.001 |
Stayed home not on medication | 82 (25.2%) | 67 (20.6%) | 0.169 |
Stayed home on medication | 186 (57.2%) | 137 (42.1%) | < 0.001 |
Drug shop | 40 (12.3%) | 104 (32.0%) | < 0.001 |
Non-biomedical provider | 2 (0.62) % | 1 (0.3%) | 0.563 |
Private clinic | 0 | 1 (0.3%) | * |
Initial response-type by caregivers, n (%)a | |||
Health centre II | 0 | 5 ((1.5%) | 0.020 |
Initial health centre III/IV | 0 | 6 (1.8%) | 0.014 |
Enrolling health centre III/IV | 11 (3.3%) | 0 | < 0.001 |
Initial public hospital | 0 | 2 (0.6%) | 0.157 |
Enrolling public hospital | 4 (1.2%) | 2 (0.6%) | 0.414 |
Total number of responses taken by caregivers, N | 1172 | 1551 | |
Stayed home not on medication | 254 (21.7%) | 276 (17.8%) | 0.010 |
Stayed home on medication | 497 (42.4%) | 403 (26.0%) | < 0.001 |
Drug shop | 80 (6.8%) | 284 (18.3%) | < 0.001 |
Non-biomedical provider | 8 (0.7%) | 7 (0.5%) | 0.478 |
Total number of types of responses by caregivers, n (%)d | |||
Private clinic | 0 | 47 (3.0%) | < 0.001 |
Health centre II | 0 | 19 (1.2%) | < 0.001 |
Initial health centre III/IVb | 7 (0.6%) | 96 (6.2%) | < 0.001 |
Enrolling health centre III/IV | 258 (22.0%) | 0 | NA |
Initial public hospitalb | 1 (0.1%) | 94 (6.1%) | < 0.001 |
Enrolling public hospitalc | 67 (5.7%) | 325 (21.0%) | NA |
Health services provided to children at facilities before enrolment with severe malaria
Facility | Number of children examined by provider n/N (%) | Number of children offered a malaria test n/N (%) | Number of children offered a haemoglobin test n/N (%) | Number of children provided an anti-malarial n/N (%) | Number of children who were referred to another facility n/N (%) |
---|---|---|---|---|---|
Drug shop | 140/280 (50.0%) | 25/280 (8.9%) | 0/280 (0) | 176/280 (62.9%) | 35/280 (12.5%) |
Private clinic | 39/50 (78.0%) | 21/50 (42.0%) | 14/50 (28.0%) | 14/50 (26.9%) | 31/50 (62.0%) |
Public health centre II | 13/17 (76.5%) | 5/17 (29.4%) | 1/17 (5.9%) | 8/17 (47.1%) | 9/17 (52.9%) |
Public health centre III | 25/33 (75.8%) | 12/33 (36.4%) | 2/33 (6.1%) | 8/33 (24.2%) | 21/33 (63.6%) |
Public health centre IV | 54/63 (85.7%) | 26/63 (41.3%) | 12/63 (19.0%) | 21/63 (33.3%) | 31/63 (49.2%) |
Public hospital | 78/92 (84.8%) | 40/92 (43.5%) | 40/92 (43.5%) | 14/92 (15.2%) | 66/92 (61.7%) |
All public facilitiesa | 170/205 (82.9%) | 83/205 (40.5%) | 35/205 (26.8%) | 51/205 (24.8%) | 127/205 (62.0%) |
Factors associated with care-seeking at a drug shop as the initial response to illness
Variables | All children (N = 325 pairs) | |
---|---|---|
Univariate | Multivariable | |
OR (95% CI); p-value | OR (95% CI); p-value | |
Mother took decision on first day | 0.76 (0.35, 1.61); 0.478 | 0.38 (0.16, 0.89); 0.026 |
Child | ||
Age in years | 0.87 (0.67, 1.13); 0.319 | |
Female | 0.69 (0.36, 1.32); 0.273 | |
Danger symptoms on day 1 | 1.26 (0.37, 4.23); 0.704 | |
Exclusively breast feed for 6 months | 1.59 (0.76, 3.33); 0.211 | |
Sleeps under a net | 2.00 (0.71, 5.61); 0.188 | 2.01 (0.69, 5.80); 0.195 |
Caregiver | ||
Age in years | 0.97 (0.93, 1.01); 0.146 | 0.95 (0.91, 0.99); 0.043 |
Mother of child | 0.77 (0.32, 1.86); 0.569 | |
Post primary education | 0.49 (0.06, 3.56); 0.482 | |
Employed | 1.64 (0.85, 3.18); 0.137 | 2.33 (1.16, 4.69); 0.017 |
Polygamous relationship | 0.93 (0.42, 2.03); 0.859 | |
Head of home | ||
Age in years | 0.96 (0.93, 0.98); 0.007 | |
Post primary education | 1.46 (0.72, 2.97); 0.288 | |
Employed | 1.54 (0.37, 0.58); 0.379 | |
≥ 3 children under 5 years of age in the home, n (%) | 1.39 (0.59, 3.24); 0.751 | |
Socioeconomic position | ||
1 (lowest) | Referent | |
2 | 0.68 (0.25, 1.85); 0.461 | |
3 | 1.36 (0.58, 3.21); 0.475 | |
4 (highest) | 0.90 (0.35, 2.31); 0.840 |
Time to seeking appropriate care
Interval in days | Caregivers of children with uncomplicated malaria, N = 325 | Caregivers of children with severe malaria, N = 325 | ||||||
---|---|---|---|---|---|---|---|---|
Number of caregivers responding to illness | Number of children who accessed appropriate care | Cumulative probability of accessing appropriate care | Hazard (95%) | Number of caregivers responding to illness | Number of children who accessed appropriate care | Cumulative probability of accessing appropriate care | Hazard (95%) | |
0 to < 1 | 325 | 99 | 0.304 | 0.35 (0.28, 0.42) | 325 | 38 | 0.116 | 0.12 (0.08, 0.16) |
1 to < 2 | 226 | 96 | 0.600 | 0.53 (0.43, 0.64) | 287 | 77 | 0.353 | 0.30 (0.24, 0.37) |
2 to < 3 | 130 | 55 | 0.769 | 0.53 (0.40, 0.67) | 210 | 90 | 0.630 | 0.54 (0.43, 0.65) |
3 to < 4 | 75 | 26 | 0.849 | 0.41 (0.26, 0.57) | 120 | 46 | 0.772 | 0.47 (0.34, 0.60) |
4 to < 5 | 49 | 15 | 0.895 | 0.36 (0.18, 0.54) | 74 | 23 | 0.843 | 0.36 (0.22, 0.51) |
5 to < 6 | 34 | 9 | 0.923 | 0.30 (0.10, 0.50) | 51 | 19 | 0.901 | 0.45 (0.25, 0.65) |
6 to < 7 | 25 | 6 | 0.941 | 0.27 (0.05, 0.48) | 32 | 14 | 0.944 | 0.56 (0.27, 0.84) |
7 to < 8 | 19 | 8 | 0.966 | 0.53 (0.17, 0.88) | 18 | 10 | 0.975 | 0.76 (0.32, 1.20) |
8 to < 9 | 11 | 6 | 0.984 | 0.75 (0.19, 1.30) | 8 | 5 | 0.990 | 0.90 (0.19, 1.61) |
9 to < 10 | 5 | 3 | 0.993 | 0.85 (0.00, 1.73) | 3 | 1 | 0.993 | 0.40 (0.00, 1.16) |
11 to < 12 | 2 | 2 | 1.00 | 2.00 (2.00, 2.00) | 2 | 1 | 0.996 | 0.66 (0.00, 1.89) |
12 to < 13 | 1 | 1 | 1 | 2.00 (2.00, 2.00) |
Impact of care-seeking responses on time to seek appropriate care
Variable | Hazard Ratio; (95% CI) | p-value |
---|---|---|
Initial response | ||
Stayed home; not on medication | Referent | Referent |
Stayed home; on medication | 0.68; (0.40, 1.17) | 0.168 |
Went to a drug shop | 0.37; (0.14, 0.93) | 0.036 |
Initial public hospital (not enrolled) | 5.55; (2.12, 14.5) | 0.000 |
Care taker post primary education | 2.65; (1.37, 5.76) | 0.007 |
Mother took decision on first day | 1.53; (0.74, 3.13) | 0.243 |
Head of household employed | 1.62; (0.73, 4.08) | 0.237 |
Socioeconomic position | ||
1st (lowest) | Referent | Referent |
2nd | 1.07; (0.51, 2.24) | 0.853 |
3rd | 1.61; (0.78, 3.35) | 0.196 |
4th (highest) | 1.35; (0.65, 2.78) | 0.411 |