Impact of home-based management of fever on progression to severe illness in children under five years undergoing treatment for malaria at Kericho District Hospital, Kenya
Abstract
Background: Mortality in children under five years of age is contributed substantially by
- malaria and 75% of estimated malaria deaths occur in African children. Home-based
management of fever is common as the first step in treatment of malaria. It has been adopted as
one among strategies for Roll-Back Malaria (RBM) by the WHO through training of caregivers
at community level to enhance prompt and correct use of antimalarial drugs.
Objective: To establish the impact of home-based management in progression of fever to severe
illness in children under 5 years undergoing treatment for malaria.
Method: A case-control study was conducted between so" July and 31st August 2007 at Kericho
District Hospital in Rift Valley Province on children under five years undergoing treatment for
malaria. Diagnosis was based on National Guidelines for Diagnosis, Treatment and Prevention of
Malaria for Health Workers in Kenya (MOH, 2006) and for purpose of this study both confirmed
and probable cases of malaria were included in the study. Cases were children seeking inpatient
treatment for malaria whereas controls consisted of febrile children treated for malaria as
- outpatients at the hospital. Mothers for both cases and controls were interviewed using a standard
questionnaire collecting data on home-based management characteristics.
Results: 45 children (22 cases and 23 controls), mean age of 22.8 months, diagnosed with
malaria were consecutively enrolled. Out of all the children that were studied, 55.6% received
home-based management of fever. None of home-based management reported having
administered antimalarial drugs to their febrile childrep but 73.1% used analgesics (panadol and
paracetamol). The practice of home-based management was detected in 31.8% and 78.3% of
cases and controls respectively with an odds ratio of 0.13, P=O.OOand indicating that it was not
associated with increased risk of severe illness but on the contrary was protective against severe
illness.
Majority (61.1%) of the severely ill children were treated at the dispensary or private clinic
before being brought to the hospital while none of the children with mild illness reported the
same. Treatment in the dispensary/private clinic seemed to have caused delay in coming to the
hospital, 113.5 hours. after detection of illness in the children compared to 70.4 hours. P= 0.12.
Due to the small numbers of controls that were treated in dispensary or private clinic, it was
impossible to obtain odds ratio associated to it; consequently, though a possible confounding
factor, was not controlled for in obtaining association between home-based management of fever
and severe illness.
In addition, duration of illness, place of residence and presence of training in prevention of
malaria were not significantly different between the cases and the controls. Though statistically
insignificant, place of residence and presence of training in prevention of malaria increased the
risk by two fold (OR= 2.8 and 2.5 respectively). Furthermore, duration of illness. place of
residence and presence of training in prevention of malaria that were possible independent risk
factors did not need to be controlled for because of their lack of association with severe illness.
Conclusions: The practice of home-based management of fever in children under 5 years was
prevalent and it reduces the likelihood of progression from mild fever to severe illness in
malaria. This may appear as a spurious finding given that the type of medications administered
during home-based management did not include antimalarial drugs. Treatment in dispensary or
private clinic that resulted in delay among the cases is a factor to investigate given that none of
the children treated with mild illness reported having utilized it hence resulting to an infinitely
high odds ratio in its association with severe illness. Place of residence, though not significantly
associated, cannot be ruled out as a contributing factor and requires further investigation as well.
Citation
Postgraduate Diploma in Biomedical Research Methodology of University of Nairobi Institute of Tropical & Infectious DiseasesPublisher
University of Nairobi Institute of Tropical & Infectious Diseases
Description
A Research Project Report Submitted in Part Fulfillment of
Postgraduate Diploma in Biomedical Research Methodology of
University of Nairobi Institute of Tropical & Infectious Diseases