According to the latest World Health Organization malaria report [1], there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018. In the same report, the estimated number of malaria deaths worldwide was observed to increase, standing at 409, 000 deaths in 2019 and 411, 000 deaths in 2018. Children under 5 years of age were the most affected by malaria in 2019, accounting for 67% (274, 000) of the malaria deaths worldwide. These malaria data indicate a worrying trend of cases and deaths due to malaria, especially amongst children under five years of age [2].
According to WHO, the African region has a disproportionately high malaria burden. In 2019, the region was home to 94% of the global malaria cases and deaths [2]. In 2015, Uganda had the fourth-highest malaria prevalence globally and the third-highest malaria prevalence in Sub-Saharan Africa [3]. Malaria accounts for over 34% of outpatient visits and 28% of hospital admissions in Uganda, with nearly 100% of the population at risk of acquiring the disease every year [4]. In under-five Ugandan children, malaria is the foremost cause of mortality with approximately 80,000 children dying annually [5]. Children with severe plasmodia falciparum may develop severe anemia, respiratory distress, metabolic acidosis, cerebral malaria, convulsions, and ultimately death [4] [6]. During pregnancy, malaria has been linked to gestational anemia which is associated with abortion [16]. These adverse effects can be prevented if malaria is treated promptly in approved medical facilities within 24 hours of the appearance of the first symptoms.
Unfortunately, there is reported poor health-seeking behavior by caregivers for their children as far as malaria infection is concerned. Since 2015, hospital admissions have remained almost constant within the country at 60% of the confirmed laboratory diseases [11]. The poor health-seeking behaviors related to malaria infection have been largely attributed to the low caregiver education, low economic status of the family members [14], low knowledge on malaria, low perceived malaria severity, increased belief in traditional care [17], negative experiences with the healthcare facilities [8], and unavailability of the required health services in the nearby health facilities [9]. Given these factors, more than 60% of all suspected malaria cases are treated outside the formal health sector, making the projected number of malaria cases to be as high as 60million per annum [5]. Usually, caregivers first resort to self-medication, use of traditional medicine like herbs, and informal facilities [6].
Malaria affects productivity and adds to the already high costs of care at the household and national levels. Also, malaria has a noteworthy deleterious impact on Uganda’s economy due to the loss of productivity from decreased school attendance and sickness. Infection from malaria is reported to cost a family more than 2% of their annual revenues [10]. Overall, Uganda’s GDP is highly affected and will continue being affected unless a permanent solution to malaria infection is found. As such, several measures have been put in place to deal with the malaria-related burden. Uganda accepted the Roll Back Malaria (RBM) and foresaw the enhancement of control practices as a basis to attain the regional targets for malaria control. The RBM initiative emphasized admittance to the most appropriate treatment for malaria within 24 hours of onset by both under-five children and pregnant women [6]. Additionally, Uganda’s efforts against malaria were recently guided by the 6-year Uganda malaria reduction strategic plan for 2014–2020. Through this plan, the ministry of health targeted reducing malaria morbidity to 30 cases per 1,000 by 2020 [6] through a rapid and synchronized nationwide scale-up of cost-effective interventions to achieve universal coverage of malaria prevention and treatment.
Despite the existence of this plan and the RBM initiative, anecdotal evidence showed a surge in malaria cases in Uganda by over one million between June and August 2019, with some border districts like Busia being highly affected [10]. Therefore, the purpose of this study was to identify the factors influencing caregivers’ health-seeking behavior for malaria treatment of children under five years in Busia district, Uganda. The following objectives guided this study;
-
To establish the caregiver characteristics influencing their health-seeking behavior for malaria treatment in children under five years in Busia municipality.
-
To determine the health system factors influencing caregivers’ health-seeking behavior for the treatment of malaria in children under five years in Busia municipality.
-
To identify the treatment-seeking patterns for malaria in children under five years in Busia municipality, so as to make appropriate recommendations.