Challenges in Treatment for Fever among School-Age Children and Adults in Malawi

Am J Trop Med Hyg. 2019 Feb;100(2):287-295. doi: 10.4269/ajtmh.18-0687.

Abstract

Prompt and effective treatment is key to malaria control and prevention, as it reduces disease morbidity and mortality and minimizes the number of transmission reservoirs. Transmission reduction may be particularly important among school-age children (SAC, 5-15 years old), who have the highest prevalence of Plasmodium falciparum infection in southern Malawi. We hypothesized that one factor contributing to this difference in prevalence is that SAC are less likely to seek appropriate treatment for fever than children younger than 5 years. In this study, we assessed treatment-seeking behaviors of people of all ages between 2012 and 2014 in Malawi. During each of the five cross-sectional surveys, all members of ∼900 households reported on fever and treatment-seeking in the previous 2 weeks. Multilevel logistic regression was used to analyze predictors of whether febrile people sought treatment and whether they did so at formal (government/private clinics) or informal sources (primarily shops). Twenty-two percent of participants (3,579/16,621) reported fever, and 2,715 of those (75.9%) sought treatment. Seeking treatment exclusively from local shops remains a common practice, although use of recommended diagnostic testing and antimalarial drugs was infrequently reported there. Although SAC were not significantly less likely than children aged < 5 years to seek treatment, SAC and adults (age ≥ 16 years) were significantly less likely to use formal sources. Our results indicate that encouraging treatment at government/private clinics and increasing retail access to appropriate antimalarial testing and treatment, especially among SAC, could help remedy inadequate treatment of symptomatic disease and potentially reduce Plasmodium transmission in Malawi.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Antimalarials / therapeutic use*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Family Characteristics
  • Female
  • Fever / diagnosis
  • Fever / drug therapy
  • Fever / epidemiology
  • Fever / psychology*
  • Hospitals / ethics
  • Humans
  • Logistic Models
  • Malaria, Falciparum / diagnosis
  • Malaria, Falciparum / drug therapy*
  • Malaria, Falciparum / epidemiology
  • Malaria, Falciparum / psychology*
  • Malawi / epidemiology
  • Male
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pharmacies / ethics
  • Plasmodium falciparum / drug effects
  • Plasmodium falciparum / growth & development
  • Plasmodium falciparum / pathogenicity
  • Prevalence
  • Seasons

Substances

  • Antimalarials