Research: Qualitative Assessment of rural health workers’ management of malaria in sick children
Reference:
MWJ2015, 6, 7
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Febrile illnesses are common causes of morbidity and mortality among under-five children in sub-Saharan Africa. The recommended strategy for effective case management of uncomplicated malaria is parasitological confirmation prior to use of artemisinin-based combination therapy (ACT). There is a lack of qualitative information explaining factors, which influence malaria case management practices among health workers. This study explores the perceptions of health managers and health care providers on the case management of uncomplicated malaria among under-fives in selected primary health care (PHC) facilities of two Local Government Areas (LGAs), Katcha and Gbako, as part of baselines for capacity-building interventions planned in Niger State, Nigeria. Interviewees included state- and LGA-level health programme managers, and frontline health workers purposively selected to cover a range of cadres involved in case management of sick children. Issues explored were history taking, diagnosis, appropriate diagnosis of malaria, prescription for malaria, referrals and adherence to referral. Data coding was carried out with Nvivo qualitative software (version 8) and content analysed. History taking was often not carried out appropriately by the health workers. Treatment of malaria was not based on parasite-based diagnosis. Most of the health workers reported that they prescribed ACTs for treating presumed uncomplicated malaria. Care givers’ preferences, poor transportation systems and lack of financial resources led to poor adherence to referral advice. Absence of health workers from their duty post hindered effective service delivery. Prescription of ACTs as a first line of treatment for uncomplicated malaria without a parasite-based diagnosis was the standard case management practice. Parasite-based diagnosis for malaria will invariably lead to better treatment for non-malaria fever cases among the studied age group. Continuous capacity building aimed at improving adherence to current recommendations on parasite- based diagnosis and good clinical practice would be required to support the paradigm shift to parasite-based diagnosis of malaria.
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A malaria vaccine is a potentially effective addition to the armamentarium for malaria control. The candidate RTS,S malaria vaccine has undergone phase III clinical trials and WHO has indicated that a policy recommendation is possible in 2015. Given the delays with adoption of other novel interventions including vaccines, there is a need to ensure that all elements that will inform the decision to adopt a malaria vaccine, including community willingness, will be available on time. This study was carried out to assess the willingness of caregivers of under-5 children to accept a malaria vaccine once available and recommended for use. 427 consenting caregivers, selected using a cluster sampling technique, from five communities in Ibadan, Nigeria, participated in a questionnaire. In-depth interviews (IDIs) were conducted among 47 key community members. Data were analysed using descriptive statistics, Chi-square and logistic regression at p≤0.05. Thematic content analysis was used to analyse the transcribed IDI data. The mean age of survey respondents was 29.8±5.8 years. Only 20.1% of the respondents had ever heard of malaria vaccine; 87.0% showed willingness to accept a malaria vaccine. Reasons stated for not willing included ‘husband did not want immunisation’ (73.6%), ‘felt it might be expensive’ (47.2%) and ‘felt it might paralyse children’ (24.5%). Nearly half (48.7%) of the respondents said that if vaccine is not given orally like polio vaccine it might not be accepted. Influence of community health workers was found to predict willingness to accept a malaria vaccine (OR: 0.316, 95% CI: 0.142-0.705). IDI participants were favourably disposed to introduction of a vaccine against malaria, although they had concerns about the formulation of the vaccine and possible adverse events. Well-designed communication strategies implemented prior to the introduction of a malaria vaccine would be essential to foster a supportive environment for eventual adoption and acceptance thereof. 