Home Management of Uncomplicated Childhood Malaria by Mothers and Fathers in Lagos State, Nigeria
A Thesis Submitted to the School of Postgraduate Studies, University of Lagos
Malaria is a major public health disease. About 90% of all malaria deaths globally occur in Sub- Saharan Africa where Nigeria is located. Children are particularly susceptible resulting in high mortality. Mothers stay at home to care for children with malaria, thereby increasing absenteeism resulting in economic loss at the micro and macro levels. World Health Organization (WHO) in an attempt to ensure prompt treatment of uncomplicated childhood malaria, introduced home management of malaria involving care givers. The work was designed to study home management of uncomplicated childhood malaria by 485 mothers and 324 fathers in Lagos State, Nigeria using artemisinin combination therapy (ACT) drugs and to determine compliance with the National Treatment Guidelines for malaria. Lagos State is situated in the south-west of Nigeria with 20 local government areas (LGAs). Four LGAs were randomly selected. A town was selected from each LGA. Each town was zoned into 4 (east, west, north and south). From each zone, 30 mothers and 30 fathers were randomly selected. The instrument used for data collection was a structured questionnaire which was either self-administered or interviewer-administered (non-formal education respondents). Data were analysed statistically as means, standard deviation, standard error, Chi-Square test, Pearson analysis were done as appropriate and P<0.05 was accepted as the level of significance. Majority of respondents (87%) were in the age range 18 – 40 years, and 93% had one or two children. Mothers and fathers had a good knowledge of home management of uncomplicated childhood malaria (HMM). Irrespective of educational background, they commenced treatment between 0 and 7hrs after noticing the signs of malaria. Majority of them used artemether-lumefantrine (an ACT) in compliance with the National Treatment Guidelines for malaria. Chloroquine, though withdrawn, was used by 22% of respondents, whilst artesunate-amodiaquine, the second official drug, was rarely used. Educational background was a determinant of their knowledge of the cause and prevention of malaria. Fever ranked highest among the signs of malaria, followed by chills/rigors, vomiting, pallor, dehydration and body temperature in descending order. Majority (72%) of respondents always noticed improvement irrespective of gender and education. Unresolved cases (76%) were referred to a formal health facility. An average of 86% did not notice any of the signs of complicated malaria suggesting that they managed uncomplicated malaria. Fathers (83%) always practised HMM, while 12% did occasionally, 66% preferred paracetamol and/or antimalarial drugs, followed by tepid sponging and others. The rest were counselled as to the importance of referral. Drugs were mostly obtained from the pharmacy > doctors > primary health centre >> “chemist” > others. Factors determining access to drugs included cost, availability, brand, previous efficacy and packaging, were significantly influenced by the educational status. In conclusion, mothers and fathers understood and practised HMM of uncomplicated childhood malaria in Lagos State, using ACTs in compliance with The National Treatment Guidelines for malaria, with referral in unresolved cases.