Background: Malaria is one of the diseases which contributes significantly to morbidity and mortality in Africa. 90% of the estimated 300-500 Million malaria cases per year worldwide occur in sub-Sahara Africa. There are at least one million deaths attributed to malaria every year in Africa. To reduce childhood mortality, early and adequate treatment of malaria is essential. In areas of intense transmission, WHO, therefore, recommends all children with fever to be presumptively treated with antimalarials, as part of the strategy of Integrated Management of Childhood Illnesses(IMCI). The need for early adequate treatment, the poor accessibility of health posts and the economic situation, especially in Sub-Saharan Africa, make self-medication and treatment at home often the only option for receiving any kind of treatment.
This paper describes health seeking behaviors, as well as perceptions of malaria used as diagnostic criteria and judgment on severity of malaria. The quality of drug treatment is investigated in detail (self medication and outpatient treatment at official health providers) and compared to the treatment standards. Factors contributing to the actual treatment seeking behavior, in particular inner-household decision making dynamics among mothers and fathers, are analyzed.
Methods: The study was carried out in the Juansa and Agogo sub-districts of Asante Akim North District in the Asante Region of Ghana. The Asante Akim North district is a holoendemic malaria area. In the Asante Region an overall prevalence of parasitaemia of 49.7-50.7 % was found in the period February April 1998 with Plasmodium falciparum as the predominant species.The study was designed as a cross sectional survey. This study combined both qualitative and quantitative data collection methods to provide a broad understanding of factors and the context influencing mothers´ and fathers´ definition and treatment of childhood malaria. Besides Focus Group Discussions, 1;885 caretakers of children <10 years old and 955 of their husbands were interviewed using a structured questionnaire. Treatment strategies were investigated for perceived malaria episodes within the last 4 weeks preceding the interviews.
Results: Fever was perceived as the leading symptom of malaria by 76.4% of mothers and 78.8% of fathers. All study methods applied indicated that fever was solely measured by touch. Out of 801 perceived malaria episodes reported, self-treatment was done within 48 hours after onset of symptoms in 662 (82.6%), non-layperson treatment in 168 (21%). As self-medication, only 329 children (49.7%) received antimalarials, the majority of them Chloroquine. Out of 250 children who received self-administered antimalarials and for whom information on dosage was available, only 14 (5.6%) received a correct dosage. Over-dosages occurred frequently. 576 (71.9%) of the caretakers were married; information on decision dynamics was available from 573 of them. In about two thirds of these cases, the final treatment decision was made by the husband, who was also responsible for the payment in 77.5% of the cases.
Conclusions: Self-treatment at home is the most prevalent action taken to manage malaria. The quality of home treatment is low. Efforts should be made to improve home treatment and drug compliance through the availability of pre-packed drugs and the introduction of community health workers. In the face of frequently encountered over-dosages, particularly in infants and the low specificity of the symptom fever, the diagnosis of fever should be more accurate. The use of fever thermometers by community health workers should therefore be considered in order to avoid unnecessary exposure to adverse drug effects due to misdiagnosis of fever, particularly in infants. Furthermore the role of the husband has to be given more adequate consideration in the planning of malaria control programs. Although further investigations into the decision dynamics at household level are clearly needed, it seems to be evident that interventions to improve early treatment of childhood malaria should include both parents.
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