Feasibility of home management using ACT for childhood malaria episodes in an urban setting

Dickson S Nsagha^1,2, Jean-Bosco N Elat^2,3, Proper AB Ndong^2,4, Peter N Tata^2,5, Maureen-Nill N Tayong², Francios F Pokem², Christian C Wankah^6
1Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon; ²Public Health Research Group, Yaounde, Cameroon; ³National AIDS Control Committee, Ministry of Public Health, Cameroon; ⁴National Malaria Control Programme, Ministry of Public Health, Cameroon; ⁵Department of Anthropology, Faculty of Arts, Letters and Social Sciences, University of Yaounde 1, Yaounde, Cameroon; ⁶Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon

Background: Over 90% of malaria cases occur in Sub-Saharan Africa, where a child under the age of 5 years dies from this illness every 30 seconds. The majority of families in Sub-Saharan Africa treat malaria at home, but therapy is often incomplete, hence the World Health Organization has adopted the strategy of home management of malaria to solve the problem. The purpose of this study was to determine community perception and the treatment response to episodes of childhood malaria in an urban setting prior to implementation of home management using artemisinin-based combination therapy (ACT).
Methods: This qualitative exploratory study on the home management of malaria in urban children under 5 years of age used 15 focus group discussions and 20 in-depth interviews in various categories of caregivers of children under 5 years. One hundred and eighteen people participated in the focus group discussions and 20 in the in-depth interviews. The study explored beliefs and knowledge about malaria, mothers' perception of home management of the disease, health-seeking behavior, prepackaged treatment of malaria using ACT and a rapid diagnostic test, preferred channels for home management of uncomplicated malaria, communication, the role of the community in home management of malaria, and the motivation of drug distributors in the community.
Results: The mothers' perception of malaria was the outcome of events other than mosquito bites. Home treatment is very common and is guided by the way mothers perceive signs and symptoms of malaria. Frequent change of malarial drugs by the national health policy and financial difficulties were the main problems mothers faced in treating febrile children. Rapid diagnostic testing and prepackaged ACT for simple malaria in children under 5 years would be accepted if it was offered at an affordable price. Tribalism and religious beliefs might hinder the delivery of home management of malaria. The availability of rapid diagnostic testing and ACT all year round is one of the challenges of home management of malaria. Although radio and television featured among the current sources of information within the community, meetings, churches, schools, and other public gatherings were the best venues for social mobilization, while community health workers and community leaders were the best sensitization agents for positive behavior change to adhere to home management of malaria. Monetary incentives should be offered to community drug distributors. This should be deducted from the combined price of ACT and rapid diagnostic testing.
Conclusion: For successful implementation of home management of malaria, there should be proper education, social mobilization of the population, and continuous monitoring and evaluation of field activities to ensure adequate stocks of ACT and rapid diagnostic testing within the framework of the intervention.

Keywords: malaria, home management, children, urban, rapid diagnostic test, artemisinin-based combination therapy, Cameroon