Adinan Juma, Damian Damian J, Mosha Neema R, Mboya Innocent B, Mamseri Redempta, Msuya Sia E
Assistant Medical Officer (AMO)-General Teaching College, KCMC Hospital, Moshi, Tanzania.
Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania.
PLoS One. 2017 Apr 13;12(4):e0175446. doi: 10.1371/journal.pone.0175446. eCollection 2017.
Fever in malaria endemic areas, has been shown to strongly predict malaria infection and is a key symptom influencing malaria treatment. WHO recommended confirmation testing for Plasmodium spp. before initiation of antimalarials due to increased evidence of the decrease of morbidity and mortality from malaria, decreased malaria associated fever, and increased evidence of high prevalence of non-malaria fever. To immediately diagnose and promptly offer appropriate management, caretakers of children with fever should seek care where these services can be offered; in health facilities.
This study was conducted to describe healthcare seeking behaviors among caretakers of febrile under five years, in Tanzania. And to determine children's, household and community-level factors associated with parents' healthcare seeking behavior in health facilities.
Secondary data analysis was done using the Tanzania HIV and Malaria Indicator Surveys (THMIS) 2011-2012. Three-level mixed effects logistic regression was used to assess children's, household and community-level factors associated with appropriate healthcare seeking behavior among care takers of febrile children as well as differentiating between household and community variabilities.
Of the 8573 children under the age of five years surveyed, 1,675(19.5%) had a history of fever two weeks preceding the survey. Of these, 951 (56.8%) sought appropriate healthcare. Febrile children aged less than a year have 2.7 times higher odds of being taken to the health facilities compared to children with two or more years of age. (OR: 2.7; 95%CI: 1.50-4.88). Febrile children from households headed by female caretakers have almost three times higher odds of being taken to the health facilities (OR: 2.85; 95%CI; 1.41-5.74) compared to households headed by men. Febrile children with caretakers exposed to mass media (radio, television and newspaper) have more than two times higher odds of being taken to health facilities compared to those not exposed to mass media. Febrile children from regions with malaria prevalence above national level have 41% less odds of being taken to health facilities (OR: 0.49; 95%CI: 0.29-0.84) compared to those febrile children coming from areas with malaria prevalence below the national level. Furthermore, febrile children coming from areas with higher community education levels have 57% (OR: 1.57; 95%CI: 1.14-2.15) higher odds of being taken to health facilities compared to their counterparts coming from areas with low levels of community education.
To effectively and appropriately manage and control febrile illnesses, the low proportion of febrile children taken to health facilities by their caretakers should be addressed through frequent advocacy of the importance of appropriate healthcare seeking behavior, using mass media particularly in areas with high malaria prevalence. Multifaceted approach needs to be used in malaria control and eradication as multiple factors are associated with appropriate healthcare seeking behavior.
在疟疾流行地区，发热已被证明是疟疾感染的有力预测指标，并且是影响疟疾治疗的关键症状。由于越来越多的证据表明，疟疾导致的发病率和死亡率有所下降，与疟疾相关的发热减少，以及非疟疾发热的高患病率证据增加，世界卫生组织建议在开始使用抗疟药之前对疟原虫进行确诊检测。为了立即进行诊断并迅速提供适当的治疗，发热儿童的看护人应在能够提供这些服务的地方，即卫生机构寻求医疗护理。
本研究旨在描述坦桑尼亚5岁以下发热儿童看护人的就医行为。并确定与父母在卫生机构的就医行为相关的儿童、家庭和社区层面的因素。
使用2011 - 2012年坦桑尼亚艾滋病毒和疟疾指标调查（THMIS）进行二次数据分析。采用三级混合效应逻辑回归来评估与发热儿童看护人适当就医行为相关的儿童、家庭和社区层面的因素，并区分家庭和社区的差异。
在接受调查的8573名5岁以下儿童中，1675名（19.5%）在调查前两周有发热史。其中，951名（56.8%）寻求了适当的医疗护理。与两岁或以上的儿童相比，年龄小于一岁的发热儿童被带到卫生机构的几率高出2.7倍。（比值比：2.7；95%置信区间：1.50 - 4.88）。与由男性担任看护人的家庭相比，由女性看护人当家的家庭中发热儿童被带到卫生机构的几率几乎高出三倍（比值比：2.85；95%置信区间：1.41 - 5.74）。与未接触大众媒体（广播、电视和报纸）的看护人相比，接触大众媒体的发热儿童被带到卫生机构的几率高出两倍多。与来自疟疾患病率低于国家水平地区的发热儿童相比，来自疟疾患病率高于国家水平地区的发热儿童被带到卫生机构的几率低41%（比值比：0.49；95%置信区间：0.29 - 0.84）。此外，与来自社区教育水平较低地区的儿童相比，来自社区教育水平较高地区的发热儿童被带到卫生机构的几率高57%（比值比：1.57；95%置信区间：1.14 - 2.15）。
为了有效且适当地管理和控制发热性疾病，应通过频繁宣传适当就医行为的重要性来解决看护人将发热儿童带到卫生机构的比例较低的问题，特别是在疟疾高流行地区利用大众媒体。由于多种因素与适当就医行为相关，因此在疟疾控制和根除方面需要采用多方面的方法。
