Access to appropriate malaria treatment among children in the Chikhwawa district of Malawi

Ewing, Victoria Access to appropriate malaria treatment among children in the Chikhwawa district of Malawi. Doctor of Philosophy thesis, University of Liverpool.

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Abstract

Access to appropriate antimalarial treatment is essential to reduce the impact of malaria - a major cause of morbidity and mortality in Malawi. This study responds to recent calls to improve access to malaria treatment, by providing insight into existing barriers and making suggestions for improvement. It is among a limited number of studies which explore multiple dimensions of access. A mixed-methods approach was taken to investigate the influence of a number of factors on access to appropriate treatment among children in the Chikhwawa district of Malawi. Two cross-sectional household surveys enabled quantification of differences in health facility attendance between two study areas, which differed in terms of distance from health facility and ethnic and cultural backgrounds. Mean costs associated with childhood fever were calculated and compared between study areas. Qualitative methodologies provided insight into caregivers’ behaviour during treatment-seeking and after receiving antimalarials. The study found that individuals engaged in a three-phased approach to treatment-seeking. During Phase 1 caregivers assessed the illness in order to establish the need for care and appropriate action. Phase 2 involved seeking care outside of the home, in most cases from a health facility. However a number of barriers to health facility attendance were identified, including: geographic location, direct and opportunity costs; women's lack of decision-making and financial autonomy; and perceptions of available care. Health facility attendance did not guarantee appropriate treatment. Adverse events, such as vomiting; lack of understanding of the correct dosing schedule; and challenges associated with administering antimalarials to children impacted on adherence. Treatment failure led to Phase 3, which frequently involved returning to the health facility. However, repeated treatment failure, fear of receiving repeated antimalarial treatment, and advice from health facility staff led caregivers to seek alternative sources of care, such as traditional healers. This thesis provides a valuable addition to our knowledge of multiple dimensions of access to appropriate malaria treatment. Caregivers experience a number of barriers during treatment-seeking and utilisation of antimalarials, and equity of access remains a challenge. The issues raised within this thesis are specific and targetable, and the findings indicate the considerable potential impact of strengthening the existing community-based treatment and referral system, community based health education, and diagnosis and treatment at health facility level.

Item Type:	Thesis (Doctor of Philosophy)
Additional Information:	Date: 2012-06 (completed)
Uncontrolled Keywords:	malaria, Malawi, treatment-seeking, antimalarials, perceptions, acceptability, Sub-Saharan Africa, cost, economic, ACT, fever, artemisinin-lumefantrine, access, adherence, utilisation, diagnosis, behaviour
Divisions:	Faculty of Health and Life Sciences
Depositing User:	Symplectic Admin
Date Deposited:	08 Aug 2013 08:43
Last Modified:	17 Dec 2022 00:50
DOI:	10.17638/00011153
Supervisors:	Lalloo, David Sanjoaquin, Miguel
URI:	https://livrepository.liverpool.ac.uk/id/eprint/11153