Academic journal article Bulletin of the World Health Organization

Home Care of Malaria-Infected Children of Less Than 5 Years of Age in a Rural Area of the Republic of Guinea

Academic journal article Bulletin of the World Health Organization

Home Care of Malaria-Infected Children of Less Than 5 Years of Age in a Rural Area of the Republic of Guinea

Article excerpt

Bulletin of the World Health Organization, 2001, 79: 28-32.

Voir page 31 le resume en francais. En la pagina 32 figura un resumen en espanol.

Introduction

Malaria is a major public health problem in sub-Saharan Africa (1, 2). It represents 20% to 50% of all consultations in health centres and is the greatest cause of mortality in hospitals (3). Mortality is estimated at 2 million deaths annually, mainly in children less than 5 years of age (1, 2). In Africa, 10% of mortality in children less than 5 years of age is directly attributable to malaria. To reduce the morbidity and mortality of malaria, the World Health Organization (WHO) has developed a strategy which includes, as one of its main components, the early diagnosis and treatment of malaria (4). It is recommended that antimalarial drugs be given at home to all febrile children (4). As many deaths occur within 48 hours of onset of symptoms, this strategy will have optimal impact if treatment is given early. Generally, it is the mothers who identify fever in their children and provide presumptive treatment, but there are few data on these initial steps. Most studies focus on people presenting at health centres and dispensaries, who represent a highly selected proportion of the infected population as most febrile children will not be brought to consultations (5, 6). Taking their children to health certres is the last thing that mothers consider when a sick child has failed to respond to home treatment or the condition is exceptionally severe (5, 7, 8). In rural areas, where about 75% of the population live, consultation is less frequent than in urban areas (5). Glick found that 33% of mothers in rural areas of Guinea reported taking their sick children to a health care worker during the last episode of fever compared with 69% of mothers in urban areas (9). Although not unexpected, failure to use chloroquine was associated with mothers' lack of access to health services. Mothers living closer to health care facilities were more likely to consult and to give chloroquine early than mothers living farther away (9). The preferred home treatments are antipyrefic and analgaesic drugs and herbal preparations (5, 9). Generally, antimalarial drugs are given to less than 30% of febrile children, and they are mostly bought in shops (5, 9-11).

The objectives of this study were both to assess the ability of mothers to identify fever in their children and to estimate the proportion of children who received antimalarial drugs as recommended by WHO.

Methods

This transversal study was conducted between 1 February and 30 June 1996 in the prefecture of Maferinyah, a rural area located 75 km from Conakry in Guinea. This area spreads over 650 [km.sup.2] and comprises 41 villages, one health centre and five dispensaries. The population is estimated at 18 000 people of whom 17% are less than 5 years of age (12). Malaria is mesoendemic, with high transmission between May and November during the rainy season.

Children were selected by a two-step cluster sampling technique, comprising villages and households (13). Children had to be less than 5 years of age and had to have lived in the study area for at least 6 months. All selected households agreed to participate in the study. Data were collected during a home visit. For every child of the household the mother was asked "Is this child sick today?". If the mother answered yes, she was asked to describe the symptoms and their duration and to name the disease. The mothers were also asked "By which symptoms and signs do you identify malaria?" and "How did you treat your child?". Malaria is designated as foulakoka, dembadimi and dannawali in Soussous, as dembale in Malinke and as dionte in Peuhl. Fever was designated as fategangni in Soussous, fadikalaya in Malinke and bande no wouli or ngouleedi bhandu in Peuhl (all meaning "hot body"). Used in isolation these words are not synonymous with malaria in these languages. …

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