ABSTRACT INTRODUCTION : Malaria remains a serious health burden among children in sub- Saharan Africa. The Home Management of Malaria (HMM) programme was adopted by African heads of states in 2000 as a strategy to achieve high coverage of prompt and effective anti malarial treatment within 24 hours of the onset of symptoms by home caregivers in areas with poor access to facility based health care. Strategic components of the programme include communication for behavioural change, training of community based public-private health service providers and making antimalarials available in communities[1]. AIM: To determine the impact of HMM strategy in the home treatment of uncomplicated malaria in children in Kassena-Nankana District (KND) of upper-east region of Ghana. Specific objectives described the knowledge, attitude and practice and tested the association between knowledge, attitude and other factors and accurate HMM. METHOD: Secondary data from a survey on the role of health information recipients in access and utilization of treatment for malaria management in children under 5 years (U5s) conducted among 818 women in KND from 2005 to 2006 were analyzed using a cross sectional study design. A total of 708 Home caregivers (HCGs) aged 15-49 years who responded to knowledge of the treatment of uncomplicated malaria was obtained after data cleaning. Knowledge of the treatment of uncomplicated malaria was used as a proxy for accurate HMM (correct dosage and correct duration of antimalarial) in U5s because the questionnaire did not contain information on the actual treatment given by the HCGs. Data analysis was done in STATA 10 using Chi squared test for categorical variables. Logistic regression models were used to quantify the associations and adjust for potential confounders and effect modification. RESULTS: The study found that 59% of the women had good knowledge of the symptoms of uncomplicated malaria and 25% knew that only mosquitoes transmit malaria. On treatment seeking attitude (advice and autonomy), the majority (91%) of the home caregivers received various forms of advice from the older women. Such advice included: using herbs (77%), buying drugs (41%), visiting Health Clinic (24%), and visiting the Community Health Officers (19%). On receiving advice, only 15% would utilize the services of the Community Health Officers (CHOs) who are the main source of treatment information for the communities. Thirty percent (30%) of the HCGs had autonomy of health care decision-making in the households. Accurate HMM in children was 28%. Knowledge of malaria and treatment seeking attitude were not significantly associated with accurate HMM (p>0.05). In the multivariate model, the HCGs were more likely to do accurate HMM in children if they had secondary education (OR = 2.54, 95% CI 1.18 ; 5.60), were of Nankani ethnicity (OR = 3.00, 95% CI 2.08 ; 4.35) and belonged to the very poor socio-economic status (OR = 2.31, 95% CI 1.25 ; 4.30). A Chi squared analysis to further identify the differences between the women who gave drugs and those who did not showed that the women differed significantly in their ethnicity (p<0.001), occupation (p<0.001) and relationship as the biological mothers to the children (p=0.008). The major limitation of this study was that knowledge of the treatment of uncomplicated malaria was used as a proxy for accurate HMM hence the finding is not a true reflection of the actual malaria treatment practice HCGs give to U5s. Another limitation is that the study could not measure the promptness of initiating malaria treatment within 24 hours of the onset of symptoms in children because of the absence of such variable in the data. CONCLUSION: Although HCGs had good knowledge of the symptoms of uncomplicated malaria, it did not translate to accurate HMM. The study identified poor dosage of treatment with Chloroquine (the first line antimalarial at the time of the study) was responsible for inaccurate HMM. Therefore, HCGs need to receive adequate information on the dosage of the current first line Artemesinin Combination Therapy drugs which have replaced Chloroquine in the treatment of malaria. Home caregivers need to be encouraged to utilize the services of the CHOs as the main source of malaria related information in the HMM programme. Specific groups to be targeted include the older women and the HCGs at risk of inaccurate HMM. Further research on the actual treatment given to children is recommended with particular emphasis on qualitative technique to unpack culturally related ethnic beliefs associated with HMM in children.

The study was a descriptive quantitative survey which endeavoured to identify challenges experienced by IMCI trained registered nurses in implementing the guidelines and procedures of the strategy when tending children under 5 years in Gaborone health district. The study also solicited for recommendations on how to address the identified challenges. The research population comprised of all the IMCI-1 trained registered nurses and systematic sampling was employed to randomly select study participants. Data were collected using a questionnaire and was analysed using Excel Advanced software package. Study findings identified challenges related to political support, cost of IMCI training, training coverage, health systems and features of the IMCI strategy. Recommendations for improving use of the strategy included garnering for more political support, adopting short duration training courses, scaling up both pre-service and in-service training as well as addressing the challenges related to health systems and the unique features of the strategy / Health Studies / M.A. (Public Health)

The study was a descriptive quantitative survey which endeavoured to identify challenges experienced by IMCI trained registered nurses in implementing the guidelines and procedures of the strategy when tending children under 5 years in Gaborone health district. The study also solicited for recommendations on how to address the identified challenges. The research population comprised of all the IMCI-1 trained registered nurses and systematic sampling was employed to randomly select study participants. Data were collected using a questionnaire and was analysed using Excel Advanced software package. Study findings identified challenges related to political support, cost of IMCI training, training coverage, health systems and features of the IMCI strategy. Recommendations for improving use of the strategy included garnering for more political support, adopting short duration training courses, scaling up both pre-service and in-service training as well as addressing the challenges related to health systems and the unique features of the strategy / Health Studies / M.A. (Public Health)

Background Malaria is a major threat to global public health, with adverse health effects. Nigeria alone accounts for 25% of the global burden of malaria. Children are especially vulnerable to malaria, and if the disease is not treated it could have fatal consequences. Mothers have an important role in ensuring that adequate and timely treatment is given to the child. Aim The aim of this study was to investigate whether there was an association between maternal level of education and the treatment with antimalarial drugs in malaria positive children under-5 in Nigeria. Methods This study was a cross-sectional study that utilized Demographic and Health Surveys (DHS) data from the 2015 Nigeria Malaria Indicator Survey. Data on 2’622 malaria positive children were used, and a logistic regression analysis was conducted to determine the association with maternal level of education. Results The mothers with a higher level of education had two times higher odds (OR 2.31, CI 1.62- 3.32) of making sure their child received treatment with antimalarial drugs, compared to the mothers with no education. With an increase of 38% (OR 1.38, CI 1.11-1.71) in the odds for the child receiving treatment with antimalarial drugs if the mother has primary education and an increase of 51% (OR 1.51, CI 1.24-1.84) if the mother has secondary education compared to mothers with no education. Conclusion Mothers with a higher level of education waere more likely to make sure that their child received treatment with antimalarial drugs, compared to the mothers with no education.

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the district / Health Studies / M.A. (Public Health)

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