Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria

摘要

BackgroundHome-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6–59?months). MethodsA descriptive cross-sectional study carried out from June 2012–July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16. ResultsOf the 290 caregivers (31.2?±?6.1?years)/child (21.3?±?14.4?months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71?±?1655.06/μL) of children who received home-based treatment and those who did not (2405.27?±?1905.77/μL) (t?=?1.02, p =?0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ2?=?18.4, OR 4.2, p =?0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment ( p p =?0.00), late presentation significantly predicted mortality (β?=?1.87, OR 6.5, p =?0.02). ConclusionsThe expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality.