MALARIA TREATMENT OUTCOME AMONG UNDER-FIVE CHILDREN ATTENDING PRIMARY HEALTH CARE CENTRES IN UMUAHIA NORTH LOCAL GOVERNMENT AREA OF ABIA STATE NIGERIA.

Abstract

Malaria remains a major health problem in Africa where one child in 10 dies before the age of five years. Despite the availability of affordable preventive/curative interventions in the Primary Health Centres (PHC) in Nigeria, morbidity and mortality from malaria remains high. This study was carried out to determine factors associated with malaria treatment outcome of under-five children that were treated for malaria at the PHC facilities in Umuahia North Local Government Area (LGA) of Abia State. An analytical cross sectional study involving caregivers of children less than five years attending PHCs in Umuahia North LGA was carried out. A three stage sampling technique was used to select four of 31 PHCs, at Amaogwugwu, Umuawa-Alaocha, Ojike and World Bank Housing Estate, based on site and population of under-five attendees. Key Informant Interview (KII) was carried out with the PHC coordinator of the LGA and heads of the four selected PHC facilities to assess their knowledge and practices of malaria treatment. A semi-structured questionnaire was administered on caregivers of 562 consecutive children presenting with fever to determine factors associated with malaria treatment outcome. Outcome was considered good when a sick child recovers within 48hrs of commencing treatment. Data were analyzed using descriptive statistics, Chi square test and logistic regression at 5% level of significance. From KII, the facility health workers based malaria treatment on presumptive diagnosis. Median age for children was 24 months (Range = 2 – 59 months) and mean age of caregivers was 32.5 ± 6.6 years. Two hundred and fifty-five (45.4%) of the children were brought to the health centre early. Among the mothers, 355 (63.2%) had been taught homecare of malaria. At presentation, 48 (8.5%) of the children had anaemia; 248 (44.1%) of them were sleeping under Insecticide Treated Nets (ITN). About 416 (74%) of the children had good treatment outcome. More children (77.9%) treated on outpatient basis had a good treatment outcome compared with those who were admitted for observation (22.1%) p < 0.05. Also, a higher proportion of children presenting without anaemia (76.7%) had a significantly good treatment outcome compared with those that presented with anaemia (23.3%). Presence of anaemia [O.R 0.25 (C.I 0.13-0.500)] and being admitted [O.R 3.40 (C.I 2.22-6.49)], were both associated with poor treatment outcome. Providing health education on homecare of malaria to caregiver [O.R 3.85 (C.I 2.31-5.55)], making a child to sleep under ITN [O.R 2.37 (C.I 1.52-3.71)] and taking a sick child early to the health centre [O.R 2.07 (C.I 1.34-3.18)], were all significant predictors of good treatment outcome. Educating caregivers on home management of malaria for their children, children sleeping under insecticide treated nets and taking sick children to the health centre promptly would improve malaria treatment outcome in the health centre