The impact of equity factors on receipt of timely appropriate care for children with suspected malaria in eastern Uganda
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Date
2021
Authors
Humphreys, David
Nakayaga Kalyango, Joan
Alfvén, Tobias
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Malaria accounts for more than one-tenth of sub-Saharan Africa’s 2.8 million annual childhood
deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased communitybased
treatment in Uganda, children continue to die because services fail to reach those most at risk. This study
explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with
fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria.
Methods: This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6–
59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing
schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-
Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received
prompt and appropriate care for symptoms of malaria if they received the recommended drug in the
recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic
regression models were developed to explore associations of the two equity factors with the outcome. The STROBE
checklist for observational studies guided reporting.
Results: Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was
the most common. Children from rural households were statistically more likely to receive prompt and appropriate
treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17–4.59, p =
0.016). This association remained significant following application of an adjusted regression model that included the
age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own
right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48–2.15,
p = 0.958). Conclusions: The findings from this study help to identify the role and importance of two key equity determinants
on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the
limitations of data and context, further studies have the potential to assist policy makers to target inequitable social
and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.
Description
Keywords
Equity, Uganda, Care-seeking, Malaria, Fever, Child mortality
Citation
Humphreys, D., Kalyango, J. N., & Alfvén, T. (2021). The impact of equity factors on receipt of timely appropriate care for children with suspected malaria in eastern Uganda. BMC Public Health, 21(1), 1-9. https://doi.org/10.1186/s12889-021-11908-0