Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea

Takahiro Tsukahara; Takuma Sugahara; Takuro Furusawa; Francis Wanak Hombhanje

doi:10.3389/fpubh.2018.00075

Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea

Front Public Health. 2018 Mar 13:6:75. doi: 10.3389/fpubh.2018.00075. eCollection 2018.

Authors

Takahiro Tsukahara^{1

2}, Takuma Sugahara², Takuro Furusawa³, Francis Wanak Hombhanje⁴

Affiliations

¹ Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.
² Graduate School of Economics, Hosei University, Tokyo, Japan.
³ Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan.
⁴ Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea.

Abstract

Background: In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction.

Methods: Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services.

Results: Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female.

Conclusion: The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.

Keywords: antimalarials; delivery of health care; health service needs and demand; sex factors; treatment-seeking behavior.