Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9%) and grandparents 4 (12.1%). Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%), patent medicine seller 12 (36.4%), home treatment 10 (30.3%), and herbal concoction 6 (18.2%) with majority 24 (72.7%) using more than one option. Antimalarial therapy was instituted in 25 (75.6%) of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.
Cerebral malaria, a severe form of malaria caused by
Thus, appraising caregiver health care seeking behavior is necessary for effective prevention and control of grave childhood diseases such as cerebral malaria.
This study was undertaken to examine the health care seeking behavior of caregivers of sick children who presented with cerebral malaria at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria and the impact, if any, on the outcome of the disease.
The study was carried out, with approval of the ABUTH ethical and research committee, in the Department of Paediatrics, ABUTH, Zaria, situated in northwestern Nigeria. All received standard treatment for cerebral malaria in accordance with WHO recommendations [
Presence of asexual forms of
An individual whose responsibility, at a given time, is the care of a child.
Administration of drugs at home without prescription.
Use of herbal mixtures topically or orally.
Individual licensed to sell and dispense limited number of drugs such as over the counter drugs.
Primary health care centre, private or government hospital offering health care at a lower level than ABUTH.
The classification by Oyedeji was further grouped as Upper Social Class (I–III) and Lower Social Class (IV and V).
Department of Paediatrics, ABUTH, Zaria.
Determination of sample size was dependent on the case definition which can be tenuous in cerebral malaria particularly with regards to the challenge of excluding all other possible causes of coma in a resource poor setting like ours. The last study carried out in Zaria reviewed 50 cases over a period of seven years [
The variables were analyzed using frequencies, statistical averages, and standard deviation for variability. Test for significance was carried out using Chi-square with Fisher’s exact test, and
A total of 33 cases were reviewed, 24 were males and 9 females (M : F, 2.7 : 1). The age range was 0.75 to 11 years (mean 3.0 ± 1.1 years), and 12 (36.4%) were under fives. The presenting features are as shown in Table
Presenting features in 33 children with cerebral malaria.
Presenting features | No. of children | Percent of total |
---|---|---|
Fever | 33 | 100 |
Coma | 33 | 100 |
Convulsion | 29 | 87.9 |
Headache | 19 | 57.6 |
Abdominal pain | 10 | 30.3 |
Parents and grandparents were primarily responsible for care in 29 (87.9%) and 4 (12.1%) of the cases, respectively.
The Social class distribution of the caregivers was: I 2 (6.1%), II 3 (9.1%), III 15 (45.4%), IV 11 (33.3%), and V 2 (6.1%). Thus, 20 (60.6%) were in the upper social class, while 13 (39.4%) made up the lower social class. There were 4 cases of mortality associated with the lower class and 1 in the upper class. However, this association was not significant (
Of the 33 cases, 24 (72.7%) utilized more than one option before eventual presentation at the unit (Table PMS: This was the commonest 12 (36.4%) health care option used as first choice (Table Home Treatment: All received oral acetaminophen for fever, while 4 (40%) were given an oral antimalarial drug (chloroquine or a sulphadoxine/pyrimethamine combination). No mortality was associated with this option. Health Facility: Similarly, all who used this option received either an oral or a parenteral antimalarial drug. In addition, 22 (91.7%) received antibiotics. A case of mortality was associated with this health care option. Herbal Concoction: 6 (18.2%) of the cases used this option. Its use was associated with 3 cases of mortality.
Distribution of health care option utilization among caregivers of 33 children with cerebral malaria.
Health care option | No. per choice of health care option | Total no. per health care option | Percent of total | |||
1st | 2nd | 3rd | 4th | |||
Health facility | 9 | 13 | 2 | 0 | 24 | 72.7 |
PMS | 12 | 0 | 0 | 0 | 12 | 36.4 |
Home treatment | 10 | 0 | 0 | 0 | 10 | 30.3 |
Herbal concoction | 2 | 4 | 0 | 0 | 6 | 18.2 |
The unit | 0 | 9 | 22 | 2 | 33 | 100.0 |
4 cases of mortality occurred among the 8 cases that did not receive any antimalarial therapy before presentation at the unit, while only one was associated with the 25 who had. The occurrence of mortality among those who did not receive any antimalarial drug was significant (
Day of presentation at the unit in relation to onset of symptoms was: 3, 5, 11, 6, and 8 cases on days 1, 2, 3, 4, and 5, respectively. Most 25 (75.8%) presented at the unit more than 2 days after onset of symptoms. None utilized the unit as first choice health care option, while 9 (27%), 22 (67%), and 2 (6%) utilized the facility as second, third, and fourth option, respectively. The least distance of the abode of any of the caregivers from the unit was about 3 kilometers.
There were 5 (15.2%) cases of mortality (Tables
Presenting features associated with mortality in 33 children with cerebral malaria.
Presenting features | Total | Survived | Died | |
---|---|---|---|---|
All patients | 33 | 28 | 5 | |
Age < 5 years | 12 | 8 | 4 | 0.047 |
Multiple convulsions | 17 | 12 | 5 | 0.044 |
Prolonged coma | 8 | 3 | 5 | 0.002 |
Severe anemia | 8 | 3 | 5 | 0.002 |
Low GCS (<5) | 14 | 12 | 2 | 1.00 |
Health care option utilization and outcome in 33 children with cerebral malaria.
Health care option utilized | Total | Survived | Died | |
---|---|---|---|---|
Health facility | 24 | 23 | 1 | 0.01 |
PMS | 12 | 11 | 1 | 0.63 |
Home treatment | 10 | 10 | 0 | 0.29 |
Herbal concoction | 6 | 3 | 3 | 0.03 |
This study showed the use of health care options by caregivers of sick children who developed cerebral malaria. Generally, their initial options were inappropriate, and there was delay in presentation at the unit.
Majority (60.6%) of the caregivers were in the upper social class. This could be a reflection of the ability of those in this group to afford the cost of accessing care at higher levels of health care delivery. However, there was no significant difference in the outcome of the cases, between the two main social classes. The marginal difference could have been higher with a larger sample size.
Out of the health care options employed by the caregivers, the PMSs was the commonest first choice. The PMS belong to the informal health care sector and have been found to be routinely patronized by caregivers of sick children in the region of study and are often found selling, prescribing, and administering drugs for a variety of disease conditions [
Home treatment was another treatment option used by the caregivers. It was the second most preferred first choice health care option. The practice of home treatment of disease is equally common in the region. In studies conducted about the management of fever, acute lower respiratory tract infections, and diarrhea in the region, home treatment was used in 67.2%, 60.5%, and 53.5% of the patients, respectively [
The use of herbal concoction in 6 (18.2%) cases reflect to some degree the practice of the use of traditional medicine in tropical Africa where 70–80% of the populations patronize traditional healers [
Over 60% of the cases in this study made use of formal health facility as an initial choice of health care. However, its preference in this study was as second or third choice of health care signifying that though desirable, there were limitations to its use as a first choice health care option. Perception of disease, severity, cost of management, accessibility to care, and attitude of health workers are some of the factors that influence utilization of services of formal health facilities. Optimizing these factors would contribute to preventing delay in accessing definitive management.
Overall, most caregivers in the study utilized health care options, in a similar manner to that observed with other febrile illnesses [
The authors state that there were no competing interests in the study.