Abebe Endeshaw Degie, Huang Sikai, Baker Kevin, Awokou Fantche, Zelalem Meseret, Chekol Tadesse Shiferaw, Weldemichael Abebe Tilaye, Richardson Sol
Vanke School of Public Health, Tsinghua University, Beijing, 100083, China.
Ministry of Health, 2P8W+GP6, Sudan St, Addis Ababa, Ethiopia.
Trop Med Health. 2025 Mar 11;53(1):38. doi: 10.1186/s41182-025-00717-5.
Malaria is responsible for 580,000 deaths among children under 5, or 95% of all malaria deaths per year globally. Seasonal Malaria Chemoprevention (SMC) is a malaria control intervention in Togo and other African countries targeting children under 5 years old during the peak malaria transmission season. Delaying access to healthcare for children with malaria can result in serious health problems, including heightened morbidity and mortality, complications related to cerebral malaria and anemia, as well as impaired cognitive development. This study aimed to identify determinants of access to health facilities for children with caregiver-reported fever, in the context of SMC campaigns in Togo.
We analyzed data from three representative annual end-of-round SMC surveys on SMC-eligible children aged 3-59 months residing in the provinces of Savanes, Central and Kara in Togo, conducted during 2020-2022. We performed a descriptive analysis and fitted logistic regression models to assess predictors of health facility access. Our sample included all children with a caregiver-reported fever in the month before the survey. Model variables included household distance to their local health facility, quintiles of household wealth, household visit by SMC distributors in the previous month, household nomad status, literacy of primary caregivers, and the age and sex of both eligible children and their primary caregivers.
Our analytic sample included 6,252 SMC-eligible children, including 1,418 experiencing fevers. Most children with fever (62.6%, 95% CI 60.0-65.0%) accessed health facilities. Adjusted odds ratios and 95% confidence intervals obtained from the logistic regression analysis found a statistically significant linear relationship between children's adjusted odds of access to health facilities and their distance from the nearest facility, with 2% lower odds of access for each additional kilometer of distance (AOR = 0.98, 95% CI 0.97-0.99). Households with SMC distributor visits were significantly more likely to access health facilities (AOR = 2.20, 95% CI 1.22-3.96). Children of female primary caregivers had higher odds of access (AOR = 1.42, 95% CI 1.05-1.93).
Febrile children's access to malaria testing and treatment in Northern Togo requires further improvement, particularly among those further from health facilities and with lower household wealth.
疟疾导致全球每年5岁以下儿童死亡58万例，占所有疟疾死亡病例的95%。季节性疟疾化学预防（SMC）是多哥和其他非洲国家针对5岁以下儿童在疟疾传播高峰期采取的疟疾控制干预措施。疟疾患儿延迟就医会导致严重的健康问题，包括发病率和死亡率升高、与脑型疟疾和贫血相关的并发症，以及认知发育受损。本研究旨在确定在多哥开展的季节性疟疾化学预防运动背景下，照顾者报告有发热症状的儿童获得医疗设施服务的决定因素。
我们分析了2020年至2022年期间在多哥萨瓦内、中部和卡拉省对3至59个月符合季节性疟疾化学预防条件的儿童进行的三次具有代表性的年度SMC轮次结束调查的数据。我们进行了描述性分析，并拟合了逻辑回归模型以评估获得医疗设施服务的预测因素。我们的样本包括在调查前一个月照顾者报告有发热症状的所有儿童。模型变量包括家庭与当地医疗设施的距离、家庭财富五分位数、上个月季节性疟疾化学预防分发人员的家访情况、家庭游牧状态、主要照顾者的识字率，以及符合条件的儿童及其主要照顾者的年龄和性别。
我们的分析样本包括6252名符合季节性疟疾化学预防条件的儿童，其中1418名有发热症状。大多数发热儿童（62.6%，95%置信区间60.0 - 65.0%）获得了医疗设施服务。从逻辑回归分析中获得的调整后的优势比和95%置信区间发现，儿童获得医疗设施服务的调整后优势与其与最近设施的距离之间存在统计学上显著的线性关系，距离每增加一公里，获得服务的几率降低2%（调整后的优势比 = 0.98，95%置信区间0.97 - 0.99）。有季节性疟疾化学预防分发人员家访的家庭获得医疗设施服务的可能性显著更高（调整后的优势比 = 2.20，95%置信区间1.22 - 3.96）。主要照顾者为女性的儿童获得服务的几率更高（调整后的优势比 = 1.42，95%置信区间1.05 - 1.93）。
多哥北部发热儿童获得疟疾检测和治疗的情况需要进一步改善，特别是那些距离医疗设施较远且家庭财富较低的儿童。
