The impact of a community awareness strategy on caregiver treatment seeking behaviour and use of artemether-lumefantrine for febrile children in rural Kenya
Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya; Department of Public Health Research, Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100 GPO, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), London, Keppel Street, London, United Kingdom; Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, Keppel Street, London, United Kingdom; Health Systems and Social Science Research, Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast (CGMR-C), P.O. Box 230, Kilifi, Kenya
Background: Access to prompt and effective treatment is the cornerstone for malaria control. Population Services International in collaboration with the Ministry of Health launched a malaria behaviour change communication intervention in Nyanza province, Kenya. The initiative aimed to improve: symptom recognition and prompt access to government health facilities for febrile children; effective treatment with the recommended first-line drug artemether-lumefantrine (AL) in public health facilities and adherence to the AL regimen. Methods: Pre- and post-intervention cross-sectional household surveys were used to evaluate the impact of the intervention on prompt and correct use of AL for febrile children below five years of age. The primary outcome was the proportion of children below five years of age with fever in the last 14 days accessing AL within 48 hours of fever onset. Results: There was an increase from 62.8% pre-intervention to 79.4% post-intervention (95% CI: 11.1, 22.1) in caregivers who reported seeking formal treatment promptly (on the same day, or next day) for their febrile children. However, there was a decrease in the use of government health facilities in the post-intervention period. There was a small increase in the proportion of children accessing AL within 48 hours of fever onset [18.4% vs 23.5% (0.1-10.0)]. Conclusion: The findings of this evaluation demonstrate that interventions that target only one sector may have a limited impact on improvements in prompt and effective treatment where multiple sources of treatments are sought for febrile illness. Additionally, the context in which an intervention is implemented is likely to influence the process and outcomes. © 2015 Wasunna et al.
amodiaquine; artemether plus benflumetol; chloroquine; dihydroartemisinin plus piperaquine; pyrimethamine plus sulfadoxine; quinine; Article; behavior change; caregiver; child; childhood disease; community care; cross-sectional study; female; fever; health care access; health care facility; health care utilization; health promotion; help seeking behavior; human; Kenya; major clinical study; malaria; male; medication compliance; outcome assessment; patient compliance; rural area