Background
Methods
Study design
Data collection
Outcome variables and predictors
Data analysis
Ethical considerations
Results
Survey profile
Characteristics of households and their children
Variable | Categories | Under-five Households with fever (N = 1456) | Under-five Households without fever (N = 1199) | ||
---|---|---|---|---|---|
n(%) | 95% CI | n(%) | 95% CI | ||
Household | |||||
Location | Urban | 191 (12.4%) | 10.6–14.4% | 184 (14.8%) | 12.8–17.0% |
Rural | 1265 (87.6%) | 85.6–89.4% | 1015 (85.2%) | 83.0–87.2% | |
Region of Sierra Leone | North | 672 (46.9%) | 41.4–52.5% | 368 (30.6%) | 25.8–35.9% |
South | 371 (25.4%) | 21.1–30.3% | 427 (35.7%) | 30.4–41.4% | |
East | 291 (19.5%) | 15.7–24.1% | 236 (19.8%) | 15.9–24.5% | |
West | 122 (8.2%) | 5.8–11.3% | 168 (13.9%) | 10.6–18.0% | |
Number of household residents | 1–5 | 430 (29.3%%) | 26.5–32.2% | 440 (36.6%) | 33.6–39.8% |
6–10 | 795 (54.7%) | 51.8–57.5% | 602 (50.4%) | 47.3–53.5% | |
11+ | 231 (16.1%) | 13.9–18.5% | 157 (12.9%) | 11.0–15.2% | |
Religion | Christian | 284 (19.0%) | 16.2–22.2% | 261 (21.9%) | 18.9–25.4% |
Muslim | 1172 (81.0%) | 77.8–83.8% | 938 (78.1%) | 74.8–81.2% | |
Socio-economic status | 1 (poorest) | 508 (35.4%) | 31.9–39.0% | 400 (33.4%) | 30.0–37.1% |
2 | 532 (36.2%) | 33.3–39.1% | 410 (34.2%) | 31.2–37.4% | |
3 (least poor) | 416 (28.5%) | 25.2–31.9% | 389 (32.3%) | 28.6–36.3% | |
Ownership of bed nets | Own any net | 1272 (87.2%) | 10.1–15.1% | 1045 (86.9%) | 84.4–89.1% |
Net is an ITN | 1214 (83.1%) | 80.5–85.5% | 989 (82.2%) | 79.2–84.9% | |
Mean ITNs | 2.6 | 2.5–2.8 | 2.5 | 2.4–2.6 | |
Household adult respondents | |||||
Mean age (years) | 39.2 | 38.4–40.1 | 38.7 | 37.8–39.6 | |
Gender | Male | 684 (47.1%) | 44.0–50.2% | 577 (48.2%) | 45.0–51.5% |
Female | 772 (52.9%) | 49.8–56.0% | 622 (51.8%) | 48.5–55.0% | |
Education | None | 967 (66.8%) | 63.9–69.6% | 779 (64.7%) | 61.4–67.9% |
Primary | 173 (11.8%) | 10.1–13.8% | 124 (10.7%) | 8.9–12.7% | |
Secondary/highera | 279 (18.7%) | 16.4–21.2% | 277 (23.0%) | 20.3–25.9% | |
Arabic/Other | 37 (2.7%) | 1.9–3.8% | 19 (1.7%) | 1.0–2.8% | |
ITN use previous night | Respondent | 1129 (76.6%) | 73.7–79.3% | 913 (76.2%) | 72.9–79.2% |
Knowledge of malaria-related topics | |||||
Ever hear of the illness called “Malaria” | Yes | 1492 (98.1%) | 97.0–98.8% | 1167 (97.4%) | 96.1–98.3% |
At least one sign or symptom of malaria | Yes | 1374 (94.2%) | 92.5–95.6% | 1116 (93.0%) | 91.1–94.6% |
All are susceptible to malaria | Yes | 1065 (73.2%) | 70.3–75.9% | 884 (73.4%) | 70.3–76.3% |
At least one malaria protective measure | Yes | 1244 (85.2%) | 82.6–87.5% | 1026 (85.4%) | 82.7–87.8% |
ITNs can prevent malaria | Yes | 865 (59.6%) | 56.3–62.9% | 741 (60.9%) | 57.1–64.5% |
At least one antimalarial drug | Yes | 1268 (86.9%) | 84.7––88.8% | 1021 (85.1%) | 82.5–87.3% |
Recommended treatment with ACTs | Yes | 606 (41.8%) | 38.5–45.3% | 527 (43.7%) | 40.2–47.2% |
Treatment for children under‐five with fever
Observations | ||||
---|---|---|---|---|
n/N | % | Linearized SE | 95% CI | |
Treatment seeking for fever | ||||
Caregiver sought treatment | 1038/1641 | 63.4 % | 1.67% | 60.1–66.6% |
Caregiver sought prompt treatment (≤ 24 h) | 571/1038 | 55.9% | 1.87% | 52.2–59.6% |
First treatment sourcea | ||||
Public health facility | 854/1038 | 82.2% | 1.48% | 79.1–84.9% |
Otherb | 184/1038 | 17.8% | 1.48% | 15.1–20.9% |
Treatment of fever | ||||
Received any treatment | 982/1038 | 94.6% | 0.83% | 92.7–96.1% |
Type of treatment | ||||
Artemisinin combination therapy (ACT) | 469/982 | 47.6% | 2.11% | 43.4–51.7% |
Chloroquine | 472/982 | 48.7% | 2.19% | 44.5–53.1% |
Sulfadoxine-pyrimethamine (SP) | 153/982 | 15.0% | 1.37% | 12.5–17.9% |
Paracetamol | 770/982 | 78.4% | 1.67% | 74.3–80.9% |
Herbs | 141/982 | 14.4% | 1.36% | 11.6–17.0% |
Otherc | 136/982 | 13.5% | 1.32% | 11.1–16.3% |
ACT treatment timed | ||||
Received ACT same/next day ( within 24 h) | 314/469 | 67.8% | 2.33% | 63.0–72.2% |
Received ACT on day 2 | 93/469 | 19.4% | 2.00% | 15.8–23.7% |
Received ACT 3 + days | 29/469 | 6.0% | 1.07% | 4.2–8.5% |
ACT treatment time unknown | 33/469 | 6.8% | 1.21 | 4.8–9.6% |
ACT durationd | ||||
Took ACT for 3 days (correct duration) | 222/469 | 47.4% | 2.56% | 42.4–52.4% |
Did not take ACT for 3 days | 244/469 | 52.0% | 2.53% | 47.1–57.0% |
ACT duration unknown | 3/469 | 0.57% | 0.03% | 0.19–1.74% |
Mean duration of ACT treatment (days) | 3.62 | 0.80 | 3.47–3.78 | |
Prompt and effective treatment with ACTe | ||||
Children who received ACT < 24 h & Completed 3-day treatment course | 137/433 | 31.6% | 2.57% | 27.3–37.4% |
Factors associated with access
Variable | n/N | % | Unadjusted analysis | Adjusted analysis | ||
---|---|---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |||
Location | ||||||
Rural | 386/835 | 46.3% | Ref | 0.181 | Ref | 0.899 |
Urban | 83/147 | 54.9% | 1.41 (0.85–2.33) | 1.03 (0.63–1.69) | ||
Region | ||||||
West | 36/75 | 47.8% | Ref | 0.253 | Ref | 0.025 |
North | 203/452 | 45.0% | 0.89 (0.51–1.56) | 1.20 (0.64–2.26) | ||
South | 125/268 | 45.9% | 0.93 (0.51–1.70) | 1.48 (0.79–2.83) | ||
East | 105/187 | 56.4% | 1.41 (0.75–2.66) | 2.30 (1.20–4.44) | ||
Household size | ||||||
1–5 | 146/269 | 52.2% | Ref | 0.058 | Ref | 0. 178 |
6–10 | 257/548 | 47.6% | 0.83 (0.59–1.17) | 0.95 (0.68–1.33) | ||
11+ | 66/165 | 39.9% | 0.61 (0.41–0.91) | 0.69 (0.46–1.04) | ||
Household religion | ||||||
Muslim | 375/796 | 46.9% | Ref | 0.402 | Ref | 0.579 |
Christian | 94/186 | 50.7% | 1.17 (0.81–1.67) | 0.90 (0.62–1.30) | ||
Socio-economic status | ||||||
1 (poorest) | 131/317 | 41.0% | Ref | 0.001 | Ref | 0.237 |
2 | 175/382 | 46.1% | 1.23 (0.87–1.73) | 1.00 (0.68–1.47) | ||
3 (least poor) | 163/283 | 57.0% | 1.91 (1.31–2.77) | 1.41 (0.88–2.24) | ||
Respondent education | ||||||
None | 290/644 | 45.1% | Ref | 0.059 | Ref | 0.930 |
Primary | 63/123 | 51.2% | 1.28 (0.87–1.89) | 1.03 (0.68–1.58) | ||
Secondary or higher | 107/196 | 53.8% | 1.42 (0.99–2.03) | 1.00 ( 0.66–1.50) | ||
Arabic school or Other | 9/19 | 47.9% | 1.12 (0.44–2.87) | 1.41 (0.49–4.08) | ||
Everyone is at risk | ||||||
No | 120/250 | 47.4% | Ref | 0.948 | Ref | 0.380 |
Yes | 349/732 | 47.6 | 1.01 (0.73–1.39) | 0.85 (0.60–1.22) | ||
ITNs protect from malaria | ||||||
No | 129/370 | 35.0% | Ref | < 0.001 | Ref | 0.001 |
Yes | 340/612 | 55.2% | 2.29 (1.66–3.15) | 1.84 (1.29–2.63) | ||
Under 5 slept under ITN | ||||||
No | 119/287 | 40.2% | Ref | 0.009 | Ref | 0.061 |
Yes | 350/695 | 50.6% | 1.53 (1.11–2.10) | 1.41 (0.98–2.02) | ||
Knowledge of ACTs | ||||||
No | 187/537 | 34.7% | Ref | < 0.001 | Ref | < 0.001 |
Yes | 282/445 | 63.0% | 3.20 (2.36–4.35) | 2.78 (2.02–3.80) | ||
Child age (months) | ||||||
0–23 months | 136/321 | 42.6% | Ref | 0.047 | Ref | 0.016 |
24–59 months | 333/661 | 49.9% | 1.34 (1.00–1.79) | 1.45 (1.07–1.96) | ||
Prompt treatment (< 24 h) | ||||||
No | 209/440 | 47.2% | Ref | 0.842 | Ref | 0.866 |
Yes | 260/542 | 47.9% | 1.03 (0.77–1.37) | 1.03 (0.76–1.38) | ||
Public health facility | ||||||
No | 57/159 | 36.4% | Ref | 0.004 | Ref | 0.001 |
Yes | 412/823 | 49.7% | 1.73 (1.19–2.52) | 1.86 (1.27–2.72) |
Factors associated with adherence
Variable | n/N | % | Unadjusted analysis | Adjusted analysis | ||
---|---|---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |||
Location | ||||||
Rural | 178/385 | 46.2% | Ref | 0.233 | Ref | 0.245 |
Urban | 44/81 | 55.3% | 1.44 (0.79–2.64) | 1.49 (0.76–2.95) | ||
Region | ||||||
West | 11/35 | 30.1% | Ref | 0.355 | Ref | 0.211 |
North | 98/202 | 47.9% | 2.13 (0.83–5.50) | 2.58 (0.99–6.77) | ||
South | 60/124 | 49.3% | 2.26 (0.87–5.89) | 2.83 (1.04–7.68) | ||
East | 53/105 | 50.8% | 2.40 (0.91–6.32) | 2.76 (1.04–7.32) | ||
Household size | ||||||
1–5 | 63/144 | 45.3% | Ref | 0.487 | Ref | 0.620 |
6–10 | 122/256 | 47.3% | 1.08 (0.72–1.62) | 1.13 (0.73–1.73) | ||
11 + | 37/66 | 54.2% | 1.43 (0.79–2.59) | 1.35 (0.73–2.50) | ||
Household religion | ||||||
Muslim | 172/373 | 46.0% | Ref | 0.158 | Ref | 0.058 |
Christian | 50/93 | 54.7% | 1.42 (0.87–2.30) | 1.61 (0.98–2.65) | ||
Socio-economic status | ||||||
1 (poorest) | 62/131 | 46.5% | Ref | 0.883 | Ref | 0.930 |
2 | 83/175 | 47.0% | 1.02 (0.64–1.63) | 1.07 (0.66–1.75) | ||
3 (least poor) | 77/160 | 49.4% | 1.13 (0.68–1.86) | 1.12 (0.60–2.08) | ||
Respondent education | ||||||
None | 138/288 | 48.1% | Ref | 0.984 | Ref | 0.854 |
Primary | 30/63 | 48.5% | 1.02 (0.58–1.80) | 0.87 (0.46–1.64) | ||
Secondary or higher | 50/106 | 46.5% | 0.94 (0.57–1.54) | 0.80 (0.46–1.38) | ||
Arabic or other | 4/9 | 42.3% | 0.79 (0.18–3.49) | 0.74 (0.17–3.26) | ||
Know everyone is at risk | ||||||
No | 60/120 | 51.3% | Ref | 0.390 | Ref | 0.329 |
Yes | 162/346 | 46.4% | 0.82 (0.53–1.29) | 0.79 (0.49–1.27) | ||
Know ITNs protect | ||||||
No | 62/128 | 48.4% | Ref | 0.844 | Ref | 0.943 |
Yes | 160/338 | 47.4% | 0.96 (0.63–1.47) | 0.98 (0.63–1.54) | ||
U5 slept under ITN | ||||||
No | 58/118 | 48.8% | Ref | 0.779 | Ref | 0.829 |
Yes | 164/348 | 47.3% | 0.94 (0.61–1.44) | 0.95 (0.60–1.50) | ||
Knowledge ACTs | ||||||
No | 88/187 | 46.9% | Ref | 0.805 | Ref | 0.866 |
Yes | 134/279 | 48.2% | 1.05 (0.70–1.57) | 1.04 (0.67–1.60) | ||
Child age (months) | ||||||
0–23 months | 60/135 | 43.9% | Ref | 0.276 | Ref | 0.270 |
24–59 months | 162/331 | 49.2% | 1.24 (0.84–1.81) | 1.26 (0.83–1.90) | ||
Prompt treatment (< 24 h) | ||||||
No | 102/207 | 49.5% | Ref | 0.744 | Ref | 0.150 |
Yes | 119/258 | 45.9% | 1.05 (0.79–1.39) | 1.25 (0.92–1.70) | ||
Public health facility | ||||||
No | 28/57 | 48.3% | Ref | 0.926 | Ref | 0.951 |
Yes | 194/409 | 47.6% | 0.97 (0.55–1.74) | 0.98 (0.53–1.81) | ||
ACT within 24 h | ||||||
No | 85/154 | 55.0% | Ref | 0.047 | Ref | 0.015 |
Yes | 137/312 | 44.1% | 0.65 (0.42–0.99) | 0.55 (0.34–0.89) |