Introduction
Methods
Study area
Study design
Data collection
Community entry
Data collection team
Household survey
In-depth interviews with OTCMS
Data analysis
Results
Socio-demographic characteristics of study OTCMS and caregivers
Characteristics | n(%) | Attendant n(%) | Owner n(%) |
---|---|---|---|
14 (100) | 7 (50) | 7 (50) | |
Gender | |||
Male | 12 (85.71) | 5 (71.43) | 7 (100) |
Female | 2 (14.29) | 2 (28.57) | 0 (0) |
Age (years) | |||
≤ 50 | 8 (57.14) | 7 (100) | 2 (28.57) |
> 50 | 6 (42.86) | 0 (0) | 5 (71.43) |
Years of experience | |||
< 10 | 7 (50) | 7 (100) | 0 (0) |
≥ 10 | 7 (50) | 0 (0) | 7 (100) |
Marital Status | |||
Single | 6 (42.86) | 6 (85.71) | 0 (0) |
Married | 8 (57.14) | 1 (14.29) | 7 (100) |
Level of education | |||
Junior High School | 1 (7.14) | 0 (0) | 1 (14.29) |
Senior high school | 11 (78.57) | 7 (100) | 4 (57.14) |
Tertiary | 2 (14.29) | 0 (0) | 2 (28.57) |
Religion | |||
Christianity | 13 (92.86) | 7 (100) | 6 (85.71) |
Islam | 1 (7.14) | 0 (0) | 1 (14.29) |
Additional occupation | |||
None | 4 (28.57) | 3 (42.86) | 1 (14.29) |
Farming/fishing | 9 (64.29) | 3 (42.86) | 6 (85.71) |
Petty trader | 1 (7.14) | 1 (14.29) | 0 (0) |
Characteristics | n(%) | Asirebuso n(%) | Ahomamu n(%) | Dominase n(%) | Dedeso n(%) |
---|---|---|---|---|---|
254 (100) | 38 (14.96) | 91 (35.83) | 72 (28.35) | 53 (20.87) | |
Gender | |||||
Male | 7 (2.76) | 1 (2.63) | 6 (6.59) | 0 (0) | 0 (0) |
Female | 247 (97.24) | 37 (97.37) | 85 (93.41) | 72 (100) | 53 (100) |
Age (years) | |||||
16–25 | 52 (20.47) | 3 (7.89) | 23 (25.27) | 12 (16.67) | 14 (26.42) |
26–35 | 94 (37.01) | 16 (42.11) | 35 (38.46) | 22 (30.56) | 21 (39.62) |
36–45 | 66 (26.98) | 11 (28.95) | 25 (27.47) | 18 (25.00) | 12 (22.64) |
46–55 | 27 (10.63) | 4 (10.53) | 7 (7.69) | 12 (16.67) | 4 (7.55) |
> 55 | 11 (4.33) | 2 (5.26) | 1 (1.10) | 7 (9.72) | 1 (1.89) |
unknown | 4 (1.57) | 2 (5.26) | 0 (0) | 1 (1.39) | 1 (1.89) |
Marital Status | |||||
Single | 32 (12.59) | 4 (10.53) | 17 (18.68) | 5 (6.94) | 6 (11.32) |
Married | 204 (80.31) | 33 (86.84) | 71 (78.02) | 57 (79.17) | 43 (81.13) |
Separated | 6 (2.36) | 0 (0) | 1 (1.1) | 3 (4.17) | 2 (3.77) |
Widowed | 10 (3.94) | 0 (0) | 2 (2.20) | 6 (8.33) | 2 (3.77) |
No response | 2 (0.79) | 1 (2.63) | 0 (0) | 1 (1.39) | 0 (0) |
Level of education | |||||
No education | 75 (29.53) | 14 (36.84) | 21 (23.08) | 19 (26.39) | 21 (39.62) |
Primary school | 70 (27.56) | 10 (26.32) | 24 (26.37) | 28 (38.89) | 8 (15.09) |
Junior High School | 85 (33.46) | 11 (28.95) | 32 (35.16) | 21 (29.17) | 21 (39.62) |
Senior high school | 15 (5.91) | 2 (5.26) | 10 (10.99) | 1 (1.39) | 2 (3.77) |
Tertiary | 7 (2.76) | 0 (0) | 4 (4.40) | 2 (2.78) | 1 (1.89) |
No response | 2 (0.79) | 1 (2.63) | 0 (0) | 1 (1.39) | 0 (0) |
Religion | |||||
None | 3 (1.18) | 1 (2.63) | 2 (2.20) | 0 (0) | 0 (0) |
Christianity | 232 (91.34) | 32 (84.21) | 87 (95.60) | 70 (97.22) | 43 (81.13) |
Islam | 16 (6.30) | 4 (10.53) | 2 (2.20) | 0 (0) | 10 (18.87) |
Others | 1 (0.39) | 0 (0) | 0 (0) | 1 (1.39) | 0 (0) |
No response | 2 (0.79) | 1 (2.63) | 0 (0) | 1 (1.39) | 0 (0) |
Primary occupation | |||||
Unemployed | 27 (10.62) | 0 (0) | 17 (18.68) | 3 (4.17) | 7 (13.21) |
Farming/fishing | 126 (49.61) | 23 (60.53) | 42 (46.15) | 39 (54.17) | 22 (41.51) |
Petty trader | 66 (25.98) | 12 (31.58) | 16 (17.58) | 23 (31.94) | 15 (28.30) |
Civil servant | 7 (2.76) | 0 (0) | 3 (3.30) | 2 (2.78) | 2 (3.77) |
Artisan | 16 (6.30) | 0 (0) | 12 (13.19) | 1 (1.39) | 3 (5.66) |
others | 10 (3.94) | 2 (5.26) | 1 (1.10) | 3 (4.17) | 4 (7.55) |
No response | 2 (0.79) | 1 (2.63) | 0 (0) | 1 (1.39) | 0 (0) |
n(%) | Asirebuso n(%) | Ahomamu n(%) | Dominase n(%) | Dedeso n(%) | |
---|---|---|---|---|---|
Characteristics | 492 (100) | 69 (14.02) | 153 (31.10) | 150 (30.49) | 120 (24.39) |
Gender | |||||
Male | 266 (54.07) | 41 (59.42) | 83 (54.25) | 82 (54.67) | 60 (50) |
Female | 226 (45.93) | 28 (40.58) | 70 (45.75) | 68 (45.33) | 60 (50) |
Age (years) | |||||
≤ 5 | 275 (55.89) | 43 (62.32) | 87 (56.86) | 73 (48.67) | 72 (60) |
> 5 | 217 (44.11) | 26 (37.68) | 66 (43.14) | 77 (51.33) | 48 (40) |
Caregiver-child relationship | |||||
Son/daughter | 412 (83.74) | 59 (85.51) | 143 (93.46) | 111 (74) | 99 (82.50) |
grandchild | 58 (11.79) | 10 (14.49) | 6 (3.92) | 33 (22) | 9 (7.50) |
Niece/nephew | 20 (4.07) | 0 (0) | 3 (1.96) | 5 (3.33) | 12 (10) |
Adopted/step child | 1 (0.20) | 0 (0) | 1 (0.65) | 0 (0) | 0 (0) |
Not related | 1 (0.20) | 0 (0) | 0 (0) | 1 (0.67) | 0 (0) |
Knowledge of malaria
OTCMS’ knowledge of malaria
“It is the same mosquito. If it bites someone and goes on to bite another, it will be spreading malaria. Malaria is not contagious. It is the mosquito that carries it around” (Agyeikrom)
“When it bites one person, with the blood still in the mouth, it will bite another person and transfer it to him” (Ahomamon 4)
“If stagnant water piles up in the containers we leave around. It breeds mosquitoes. Also, if we do not clean our gutters it becomes a dwelling place for mosquitoes, and they will cause the malaria” (Agyeikrom)
These qualitative findings are similar to the majority stand of quantitative findings among caregivers of children under 10 years old.There are so many causes of malaria. Normally the mosquito lives in the chocked gutters and they mostly causes malaria. Chocked gutters and places with overgrown bushes breed mosquito, which comes out at night to bite us and cause malaria” (Ahomamon 4)
Caregivers’ knowledge of malaria
Characteristics | n(%) | Asirebuso n(%) | Ahomamu n(%) | Dominase n(%) | Dedeso n(%) |
---|---|---|---|---|---|
254 (100) | 38 (14.96) | 91 (35.83) | 72 (28.35) | 53 (20.87) | |
Perceived cause of malaria | |||||
Malaria germ | 9 (3.54) | 0 (0) | 0 (0) | 6 (8.33) | 3 (5.66) |
Mosquito | 207 (81.50) | 22 (57.89) | 82 (90.11) | 62 (86.11) | 41 (77.36) |
others | 33 (12.99) | 15 (39.47) | 7 (7.69) | 2 (2.78) | 9 (16.98) |
Don’t know | 5 (1.97) | 1 (2.63) | 2 (2.20) | 2 (2.78) | 0.(0) |
Perceived malaria transmission | |||||
Mosquito bite | 189 (74.41) | 28 (73.68) | 79 (86.81) | 43 (59.72) | 39 (73.58) |
Walking in the sun | 24 (9.45) | 1 (2.63) | 4 (4.40) | 17 (23.61) | 2 (3.77) |
Eating oily foods | 9 (3.54) | 2 (5.26) | 1 (1.10) | 4 (5.56) | 2 (3.77) |
Spiritual | 1 (0.39) | 0 (0) | 0 (0) | 0 (0) | 1 (1.89) |
others | 31 (12.20) | 7 (18.42) | 7 (7.69) | 8 (11.11) | 9 (16.98) |
Management of malaria
OTCMS management of malaria
“If they complain of high temperature and vomiting; if their urine is deep yellow then it’s probably malaria” (Ehiamenkyene 1)
“….Yes, sometimes you can see from the person’s eyes. It becomes very yellowish and his palms becomes pale, with such manifestations you can say that condition is serious” (Agyeikrom)
“Sometimes it will make you have a high temperature and a severe headache, yellowish eyes which means it is severe” {Ahomamu 1)
“Some people have had the disease for a long time without treatment. In such cases I refer them to the hospital. But some people say it just started, so I treat those people” {Ahomamu 1)
“You know, I have to give them malaria medicine, Paracetamol and blood tonic. But some people can’t afford all of them, so I take the blood tonic out” (Ahomamu 4)
“First aid, I can give them paracetamol & Malafan (Sulfadoxine pyremethamine). If it is an elderly person, from 15 years above I give paracetamol & Malafan and multivitamin tablets before directing them to go to the hospital to check whether it is just malaria or something else” (Ahomamu 2)
“When I give them the medicine and the condition does not get better, I refer the person to the clinic for further management” (Agyeikrom)
Caregivers’ management of malaria
Treatment | Sources of treatment and diagnosis | ||||||||
---|---|---|---|---|---|---|---|---|---|
Caregiver | Drug vendors | OTCMS | CHPS compound | ||||||
n(%) | Tested | Not tested | Tested | Not tested | Tested | Not tested | Tested | Not tested | |
Herb | 5 (3.3) | 1 (20) | 4 (80) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
ACT | 127 (83.6) | 1 (33.3) | 2 (66.7) | 10 (52.6) | 9 (47.6) | 2 (20) | 8 (80) | 91 (95.8) | 4 (4.2) |
Antibiotics | 9 (5.9) | 0 (0) | 1 (100) | 1 (100) | 0 (0) | 0 (0) | 4 (100) | 3 (100) | 0 (0) |
Others | 11 (7.2) | 0 (0) | 4 (100) | 0 (0) | 1 (100) | 0 (0) | 5 (100) | 0 (0) | 1 (100) |
Total | 2 (15.4) | 11 (84.6) | 11 (52.4) | 10 (47.6) | 2 (10.5) | 17 (89.5) | 94 (94.9) | 5 (5.1) | |
Grand Total | 152 (100) | 13 (8.6) | 21 (13.8) | 19 (12.5) | 99 (65.1) |
Knowledge of OTCMS on test, treat and track (T3) malaria strategy
“Test means that you need to find something. As I was saying, I tell people to go to the hospital to go and do a lab test to see exactly what is wrong with them. And “treat” refers to the treatment that is given to them. But I don’t understand the track” (Agyeikrom)
“The first word is Test. That means you have to test a person who comes to your shop with malaria, to see if it is malaria or not” (Ahomamu 4)
“….After the person comes to complain, firstly you need to test the person with RDT kit. That is what we use here because this place is not a lab where we can use machines to test. If you test the blood and read the results as positive you then give the drugs e.g. AA (Artesunate Amodiaquine) or AL (Artemether Lumefantrine). There are other drugs that accompany either the AA or AL…” (Bosuso 2)
Knowledge and training of OTCMS on malaria rapid diagnostic test (mRDT) kit usage
“It (mRDT) is used to check malaria. After removing the slip there is a small needle used to prick the person before putting it (blood) on the kit. It must be diluted with water (buffer) before putting it on the kit. It will show if the person has malaria” (Ahomamu 2)
“The test tube is in an envelope kind of thing. You open it and then use the needle to prick the person’s finger and when the blood comes out, there is something we use to collect the blood and put it on the tube. The blood will flow to one side of the device and will show a red sign. If the red sign appears twice the person is positive. If it appears once the person is negative” (Ahomamu 3)
“You prick the person’s hand with a needle. You wear gloves and squeeze a little. Blood will appear then you take it and put it on a tube and it will show. Lines appear. It might be one or two. Two is positive and one is negative” (Ahomamu 1)
“I remember we went for a training program organized by the pharmacy council. That is where I heard those words when they were teaching about malaria. But it’s been a long time so I have forgotten” (Ehiamankyene 1)
“I had my training in Tema where I used to be before coming here. Every year the pharmacy council trains us on new products that comes into market. So, we were trained on the usage of the test kit at its inception stage. That is during the time it was first introduced” (Bosuso 2)
Challenges faced by OTCMS on effective management of uncomplicated malaria cases
Test before treatment of malaria
“We have the malaria test which we use, but now it is costly so the ordinary people cannot buy at ¢5.00 before paying for the drug dispensed. So, if you people can help us with it (RDT) so that we test them for free, it will be good” (Asirebuso 1)
“But sometimes the person can insist on only the medicine; with that you cannot force the person for an RDT test. It can be due to financial problem” (Bosuso 2)
“I get about 10 people complaining of malaria on daily basis but only about 3 will agree to the test” (Agyeikrom)
Interviewees therefore suggested government to supply OTCMS with the mRDT kits free of charge to enable them comply with the testing before treatment. This according to interviewees could help improve testing before treating suspected cases of malaria that report to their shops. The following illustrate this point:“My challenge has to do with the fact that some people refuse the test. They will tell you that before the era of the test, they were still taking antimalarials, so just give them the drugs. I have realised that it has to do with financial difficulty. I believe that if they had the money they will insist on the testing in addition to the drugs. Also, most of the elderly are not educated on testing before treatment. You will talk at length yet they won't listen to you” (Bosuso 2)
“The government should try and supply free test kits to the drug stores….because some clients are not able to afford the cost which is about GHS4” (Ahomamu 3)
“As I said initially, when you do the test here, they will think you are turning the place into a clinic, so I haven’t gone to buy some of the test kits. A while ago they said we should start selling those things. It was said at a meeting. But matters of this village differ from matters of the town. Even if they come and you want to test them, they will say you are not a doctor. So, as you people are coming to educate us (community), maybe next time we try to test them, they will understand” (Asirebuso)
“Just like how the young man who came to buy malaria drugs (a gentleman visited the shop for some painkillers), I asked what was wrong with him and he said he had a headache, he urinates yellow and he feels weak. So with him, I can tell him I will test him to confirm if its malaria. Other people also say they feel its malaria so give them medication. With that I’ll still say I want to test but others still refuse” (Bosuso 1)
“You know it has an expiry date, so most of the time they expire because the people can’t afford it. Then I have to throw it away. You see, if you always buy it only to throw it away due to expiry then that’s not good. It is also sold in full box not half that is the problem. So, if the cases come frequently, then I will go to buy. Sometimes I also go to borrow some few from the clinic” (Dominase Quarters).
Treatment of suspected malaria cases
“…Some people also complain of not having enough money to buy the full dosage of medicine (ACT) and may decide to buy a portion of it” (Ehiamankyene 1)
“Yes it happens. So they tell you to give them half so that when they are done with the half, they come and get the other half. Then I explain that the dosage is for 3 days so if it’s a child from 9 to 12 years, they take less depending on their weight. So with such kids half can be their dosage but with adults who take 4, they need to take the whole dose which is 24 tablets or else you wouldn’t fully recover. And after a month or two, there will be malaria present again…….. Some people will say they know all that but they insist on the half because they will come later” (Bosuso 1)
“Some people do not have enough money to buy the full dose of the medicine like the amodiaquine. They want you to cut a share for them according to the money they have. They won’t buy if you don’t divide it as they want. At times, looking at the condition of the person, you are forced to give them what they want even though you know it is not the right way of treating malaria” (Asirebuso 1)
“Some people don’t have enough money to buy the medicine. So, they can’t buy the full dosage. For example, AL. It’s 24. They sometimes ask for 12.” (Ahomamu 1)
“Not all of them. Some say they are fine, others come and say they are feeling the same thing”(Bosuso 1)
“We also have many drug peddlers around. Instead of giving the full dose or course, they can cut only 4 out of the 24 tablets. They are the cause of this habit. The government should do something about it. There are many of them in the village and Begoro here. On market days, they go around doing business in the hot sun. The drugs should be stored under a particular temperature, but they are selling under the sun. So, if you don’t sell the full box of drugs to the person, they will buy the divided one from the drug peddlers.” (Ahomamu 5)
“Sometimes they come with a small plaster on their hand showing that they have been to the lab, and was confirmed that it is malaria, but they didn’t have money to buy the drugs there” (Agyeikrom)
“Some people go to the hospital to check if it’s malaria. They will be given medicine but if it is still positive after a while, they come to check for other alternatives” (Ahomamu 1)
Perception of OTCMS on solution to challenges
“The test kit should also be made available for us to buy and the price should come down for everyone to afford it. If the price is down (less expensive) the people will not hesitate to pay to be tested. Sometimes you don't even get it to buy” (Bosuso 2)
“The government should try and supply free test kits to the drug stores” (Ahomamu 3).
“Reducing the price of the medicine, so they (clients) can buy the right dosage” (Ahomamu 1).
“We also have many drug peddlers around. Instead of giving the full dose or course, they can cut only 4 out of the 24 tablets. They are the cause of this habit. The government should do something about it” (Ahomamu 5).
“The people should be educated on how to take malaria drugs. They see me to be a local guy and I am close to them (native of the community), so they won’t listen to me. But when people like you (Noguchi) comes to educate them, they will listen” (Asirebuso 1).