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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6917 |
| Date | 04 May 2009 |
| Creators | Ameh, Soter Sunday |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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