Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries.

Abstract

BACKGROUND:

Access to artemisinin-based combination therapy (ACT) remains limited in high malaria-burden countries, and there are concerns that the poorest people are particularly disadvantaged. This paper presents new evidence on household treatment-seeking behaviour in six African countries. These data provide a baseline for monitoring interventions to increase ACT coverage, such as the Affordable Medicines Facility for malaria (AMFm).

METHODS:

Nationally representative household surveys were conducted in Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia between 2008 and 2010. Caregivers responded to questions about management of recent fevers in children under five. Treatment indicators were tabulated across countries, and differences in case management provided by the public versus private sector were examined using chi-square tests. Logistic regression was used to test for association between socioeconomic status and 1) malaria blood testing, and 2) ACT treatment.

RESULTS:

Fever treatment with an ACT is low in Benin (10%), the DRC (5%), Madagascar (3%) and Nigeria (5%), but higher in Uganda (21%) and Zambia (21%). The wealthiest children are significantly more likely to receive ACT compared to the poorest children in Benin (OR = 2.68, 95% CI = 1.12-6.42); the DRC (OR = 2.18, 95% CI = 1.12-4.24); Madagascar (OR = 5.37, 95% CI = 1.58-18.24); and Nigeria (OR = 6.59, 95% CI = 2.73-15.89). Most caregivers seek treatment outside of the home, and private sector outlets are commonly the sole external source of treatment (except in Zambia). However, children treated in the public sector are significantly more likely to receive ACT treatment than those treated in the private sector (except in Madagascar). Nonetheless, levels of testing and ACT treatment in the public sector are low. Few caregivers name the national first-line drug as most effective for treating malaria in Madagascar (2%), the DRC (2%), Nigeria (4%) and Benin (10%). Awareness is higher in Zambia (49%) and Uganda (33%).

CONCLUSIONS:

Levels of effective fever treatment are low and inequitable in many contexts. The private sector is frequently accessed however case management practices are relatively poor in comparison with the public sector. Supporting interventions to inform caregiver demand for ACT and to improve provider behaviour in both the public and private sectors are needed to achieve maximum gains in the context of improved access to effective treatment.

• Authors: Megan Littrell, Hellen Gatakaa, Illah Evance, Stephen Poyer, Julius Njogu, Tsione Solomon, Erik Munroe, Steven Chapman, Catherine Goodman, Kara Hanson, Cyprien Zinsou, Louis Akulayi, Jacky Raharinjatovo, Ekundayo Arogundade, Peter Buyungo, Felton Mpasela, Cherifatou Bello Adjibabi, Jean Angbalu Agbango, Benjamin Fanomezana Ramarosandratana, Babajide Coker, Denis Rubahika, Busiku Hamainza, Tanya Shewchuk, Desmond Chavasse, Kathryn A O'Connell
• Journal: Malaria journal (Malar J) Vol. 10 Pg. 327 (Oct 31 2011) ISSN: 1475-2875 [Electronic] England
• PMID: 22039892 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Lactones
• artemisin

Topics

• Antimalarials (therapeutic use)
• Artemisinins (therapeutic use)
• Child, Preschool
• Drug Therapy, Combination (methods)
• Fever of Unknown Origin (drug therapy)
• Humans
• Infant
• Infant, Newborn
• Lactones (therapeutic use)
• Malaria (diagnosis, drug therapy)
• Patient Acceptance of Health Care (statistics & numerical data)
• Socioeconomic Factors