Asiimwe John Bosco, Kadubira Eriot
Department of Planning and Applied Statistics, School of Statistics and Planning, Makerere University, Kampala, Uganda.
BMC Pediatr. 2025 May 24;25(1):414. doi: 10.1186/s12887-025-05768-5.
Malaria is ranked among the major causes of morbidity and mortality in children under 5 years of age in Uganda. Prompt and early appropriate malaria treatment can prevent progression of illness to severe stages, thereby mitigating mortality and morbidity. Therefore, this study aimed at determining the factors associated with timeliness to malaria treatment in children under five years in Uganda.
This study used 2016 Uganda Demographic and Health Survey data and a total of 4,063 children under age of five years who had fever as a proxy for malaria two weeks prior to the survey were included. The median time to malaria treatment using Kaplan Meier curve were computed. A multivariable Cox regression model were fitted to establish factors associated with time to malaria treatment. Proportional hazard assumption was checked graphically and using Schoenfeld residual statistical test.
Forty one percent of the children delayed to receive prompt malaria treatment beyond the recommended 24 hours. The median time to malaria treatment was 24 hours after onset of malaria symptoms. Children whose mothers made decisions jointly as a wife and a spouse on treatment were associated with faster time to malaria treatment (HR=1.11, 95%CI: 1.02-1.21) compared to when the mother made decisions alone. Children whose mothers sought treatment from community health workers were associated with faster time to malaria treatment (HR=1.17, 95%CI: 1.02-1.34) compared to those who did not. Children whose mothers/caregivers were from Western region (HR=0.84, 95%CI: 0.73-0.96) of the country were associated with delayed time to malaria treatment compared to other regions of the country. Similarly, children whose mothers frequently listened to radio were significantly associated with faster time (HR=1.11, 95%CI: 1.02-1.21) to treatment of malaria compared to those who did not listen to radio.
Faster time to malaria treatment was significantly associated with joint spousal health decision making, utilization of community health workers, not being in Western region of Uganda and frequency of listening to radio. Thus, the government and non-government organizations should organize community dialogues that involve both men and women to discuss malaria prevention, treatment, and the importance of joint decision-making, ensure Community Health Workers receive regular, in-depth training on malaria diagnosis (using Rapid Diagnostic Tests or RDTs), treatment, and prevention strategies, provide CHWs with adequate transportation to facilitate their visits to households and communities, develop engage radio programs that feature community leaders, CHWs and health experts to promote malaria prevention messages, ensure all communication materials and messages are in local languages to ensure maximum understanding and engagement.
疟疾位列乌干达5岁以下儿童发病和死亡的主要原因之中。及时且早期进行适当的疟疾治疗可预防疾病发展至严重阶段，从而降低死亡率和发病率。因此，本研究旨在确定乌干达5岁以下儿童疟疾治疗及时性的相关因素。
本研究使用了2016年乌干达人口与健康调查数据，共纳入4063名5岁以下儿童，这些儿童在调查前两周出现发热症状，以此作为疟疾的替代指标。使用Kaplan Meier曲线计算疟疾治疗的中位时间。拟合多变量Cox回归模型以确定与疟疾治疗时间相关的因素。通过图形检查和使用Schoenfeld残差统计检验来检验比例风险假设。
41%的儿童延迟接受及时的疟疾治疗，超过了推荐的24小时。疟疾治疗的中位时间是在疟疾症状出现后24小时。与母亲独自做决定相比，母亲作为妻子和配偶共同做出治疗决定的儿童接受疟疾治疗的时间更快（风险比=1.11，95%置信区间：1.02 - 1.21）。与未向社区卫生工作者寻求治疗的儿童相比，向社区卫生工作者寻求治疗的儿童接受疟疾治疗的时间更快（风险比=1.17，95%置信区间：1.02 - 1.34）。与该国其他地区相比，母亲/照顾者来自该国西部地区的儿童疟疾治疗时间延迟（风险比=0.84，95%置信区间：0.73 - 0.96）。同样，与不听广播的儿童相比，母亲经常听广播的儿童疟疾治疗时间显著更快（风险比=1.11，95%置信区间：1.02 - 1.21）。
疟疾治疗时间更快与配偶共同做出健康决策、利用社区卫生工作者、不在乌干达西部地区以及听广播的频率显著相关。因此，政府和非政府组织应组织涉及男性和女性的社区对话，讨论疟疾预防、治疗以及共同决策的重要性，确保社区卫生工作者接受关于疟疾诊断（使用快速诊断检测或RDTs）、治疗和预防策略的定期、深入培训，为社区卫生工作者提供充足的交通便利以方便他们走访家庭和社区，开展以社区领袖、社区卫生工作者和健康专家为特色的广播节目，以推广疟疾预防信息，确保所有宣传材料和信息使用当地语言，以确保最大程度的理解和参与。
