Care-seeking behaviour and treatment practices for malaria in children under 5?years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets

摘要

Abstract BackgroundIn Mozambique, the prevalence of malaria in children under 5?years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5?years of age and to assess the treatment practices for malaria.MethodsSecondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data.ResultsA total of 10,452 and 5168 children under 5?years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether–lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR?=?2.27 [95% CI 1.15–4.49]) and among those in poorer quintile (AOR?=?1.46 [95% CI 0.83–1.90]). Mothers with higher education level (AOR?=?0.16 [95% CI 0.34–0.78]) were less likely to seek out care. People from Manica (AOR?=?2.49 [1.03–6.01]), Sofala ([AOR?=?2.91 [1.03–8.24]), Inhambane (AOR?=?3.95 [1.25–12.45]), Gaza (AOR?=?3.25 [1.22–8.65]) and Maputo Province (AOR?=?2.65 [1.10–6.41]) were more likely to seek care than people from Maputo City.ConclusionData from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.