Treatment Seeking Behaviors Among Caretakers Of Children With Suspected Malaria In Eastern Uganda
Berg, Katrina Anne
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Malaria is the single, biggest cause of childhood mortality in Uganda. Efforts to increase access to first-line treatment, artemisinin-based combination therapies (ACTs), for uncomplicated malaria have had a significant impact on their uptake. However, many people continue to engage in self-treatment and rely on non-ACT antimalarials. This dissertation aims to explore the facilitators and barriers to appropriate treatment-seeking behaviors and outcomes for childhood malaria in eastern Uganda. A synthesis of existing literature indicates that self-treatment is the preferred first step in the illness resolution process for suspected malaria, including treating suspected malaria with drugs stored at home or from a local drug shop. Initiating treatment in the formal sector is associated with receiving first-line treatment for malaria. Illness severity emerges as a primary determinant of seeking immediate care in a formal healthcare facility. Access and local illness concepts are identified as significant barriers to seeking appropriate, timely treatment. Overall, there existed a lack of complexity in the types of predictors used in previous research. A quantitative analysis was conducted to understand determinants of seeking care at various levels of the healthcare system. Attitudes and knowledge were associated with seeking care outside of the household. Illness severity and access were the most salient predictors of initiating care at a formal healthcare facility. A multilevel analysis explored the determinants of treatment outcomes for uncomplicated malaria, mainly use of first-line, nationally-recommended drugs. Caretakers continue to rely on non-ACT antimalarials for severe illness, children under five, and confirmed malaria. High levels of malaria knowledge and perceived efficacy in malaria-related services were associated with ACT-use. Findings from this research indicate that caretakers of young children continue to rely on self-treatment for non-serious malarial illness. Efforts should continue to maintain increased access to ACTs, especially in rural areas. National malaria control strategies and behavior change campaigns must target consumers to increase consumer utilization of formal healthcare facilities where diagnostics are available and encourage their sale in local drug shops. Education campaigns are recommended to increase treatment guideline awareness, malaria knowledge, and perceived efficacy in ACTs as well as malaria-related services within the healthcare system.