Trend and factor modeling for early treatment for fever in children under 5 years of age in Guinea

doi:10.21203/rs.3.rs-4138622/v1

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Trend and factor modeling for early treatment for fever in children under 5 years of age in Guinea

https://doi.org/10.21203/rs.3.rs-4138622/v1

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Malaria remains the leading cause of morbidity in Guinea. To contain it, the national program to combat malaria, following the directives of the World Health Organization, prioritizes: the mass distribution of mosquito nets impregnated with insecticides, seasonal chemo-prevention, intermittent preventive treatment of in pregnant women, and the correct management of all confirmed cases. The latest survey on malaria and anemia indicators carried out in 2021 indicates a malaria prevalence of 17% among children under 5 years old. Among these children who contracted fever during the last two weeks preceding the survey, seeking care within 48 hours was only made for 32% of cases in 2021 while it was 37% in 2018 Or a drop in healthcare use while malaria prevalence remains high. Faced with this observation, it is important to identify the factors which explain this low recourse to care and/or treatment in cases of fever in children under five years of age in Guinea?

In this perspective, we used data from the 2018 demographic and health survey and those from the 2021 malaria and anemia indicators survey. Descriptive and predictive analyzes were used to identify the factors common and specific conditions associated with early recourse to care for fever in children in Guinea.

The results show that early care-seeking is low and is decreasing while the prevalence of malaria has remained constant at 17% since 2018. In addition, care-seeking is lower in rural areas and among poor households. and in the regions of Boké, Kindia, Labé and Nzérékoré.

Studies on the use of care in cases of fever in children including endemic areas would make it possible to identify new strategies towards the eradication of malaria in Guinea.

fever

malaria

children under 5 years old

early care

Guinea

Malaria remains the leading cause of morbidity in developing countries, particularly in Africa. The lethality of malaria is higher than that recorded for other pathologies (Mutombo, et al. 2018). Signs of seriousness are also severe anemia and cerebral malaria.

In 2021, the total number of malaria infections worldwide was estimated at 247 million and the total number of deaths at 627,000. However, almost 95% of malaria cases and 96% of deaths from this disease were recorded in Africa (OMS 2021a). Yet in 2015, the international community committed to reducing malaria incidence and mortality rates by at least 90% by 2030 (OMS 2021b).

This political commitment is reflected in the national programs to combat malaria currently being implemented in endemic regions, especially in Africa where the risk of infection remains persistent. This program must be further strengthened with a view to eliminating infections which constitute a public health problem in the Africa zone, particularly in Guinea.

Indeed, the prevalence of malaria among children under 5 years old is 17% in Guinea (INS et ICF 2021). Fever, one of the clinical signs of malaria, is present in most patients. It affected 23% of children in the last two weeks preceding the Malaria and Anemia Indicator Survey (EIPA 2021). Only 32% of cases sought advice or treatment. However, early recourse to treatment against fever is one of the strategic recommendations to fight against malaria (Das et Ravindran 2012, Awantang, et al. 2018)when we want to focus on eradicating it. Thus, the persistence of the low level of use of care demonstrates that we must take an interest in it (Deressa 2007, Birhanu, et al. 2016)if we want to reduce the resulting incidence and mortality rates.

Therefore, to help the national malaria control program achieve its objectives, it is essential to know the main factors associated with early recourse to care in the event of fever in children under 5 years of age. The recourse is early if it was made within 48 hours following the start of the fever, that is to say the same day or the following day (INS et ICF 2021).

The objective of this study is to analyze the factors associated with early recourse to care in the event of fever among children under 5 years of age in Guinea. Included in the use of care are appeals made to health structures (public and private), health providers and pharmacies.

This present article includes the methodology, the presentation of the results and their discussions, the conclusion and the recommendations. The methodology describes the data sources, the target population, the variables used in this study and the analysis methods (descriptive and explanatory).

Data source

The data used in this study comes from the 2018 Demographic and Health Survey and the 2021 Malaria and Anemia Indicator Survey (INS & ICF 2018, INS et ICF 2021). Both surveys are part of the International Demographic and Health Survey Program, a program funded by USAID and implemented by ICF. The results of these surveys are representative at the national level, of urban and rural areas and of each of the 8 administrative regions of the country. Information on fever and malaria concerns prevalence, use of care and treatment and the type of drugs used to treat fever/malaria.

These two surveys were carried out in Guinea by the National Institute of Statistics (INS) in collaboration with the National Institute of Public Health (INSP). The DHS program provided technical assistance during all phases of conducting these surveys. Furthermore, the protocol and collection tools were validated by the National Committee for Ethics and Health Research and the ICF International Review Board.

The results of the 2021 Malaria and Anemia Indicators Survey are representative at the levels of the entire country, urban and rural areas and each of the eight administrative regions of Guinea. In each region, an urban stratum and a rural stratum have been identified, except the Conakry area which only includes the urban environment. Then, in each stratum, the sample was drawn using a stratified area survey and drawn at 2 stages. At the first stage, 169 Primary Sampling Units (PSU) were drawn from the list of Enumeration Areas established during the General Population and Housing Census (RGPH) carried out in 2014, by carrying out a draw systematic with probability proportional to size (number of households). At the second stage, a sample of 24 households per cluster with systematic sampling with equal probability was drawn. On the one hand, all women aged 15–49 usually living in the selected households or having spent the night preceding the survey were eligible to be surveyed. Furthermore, all children under 5 years of age in these households were eligible for the various biological tests and measurements. The methodology of the 2018 Demographic and Health Survey (EDS) is similar to that of the 2021 EIPA.

The individual data files from these surveys (EDS 2018 and EIPAG 2021) have been downloaded from the DHS Program website. STATA version 16 software was used to calculate the indicator values and their confidence intervals taking into account the complex sampling design.

Target population

The target population of the study corresponds to children under 5 years of age who had a fever during the last two weeks preceding the survey and for whom advice or treatment was sought in the first two days following the survey. onset of fever.

Study variables

The World Health Organization (WHO) reports that early diagnosis and treatment of malaria reduces morbidity and prevents malaria-related mortality and contributes to the reduction of transmission. It recommends that suspected cases be confirmed by a diagnosis based on the search for plasmodia in order to distinguish malarial and non-malarial fevers for the choice of appropriate treatment. Thus, the variable of interest in this study is to be constructed on the basis of this concern. It corresponds to the use of advice or treatment for fever in children under 5 years of age on the same day or the day following the start of the fever. Thus, it is assigned the value 1 if the recourse took place within 48 hours following the onset of the fever as recommended by the WHO, and otherwise it takes the value 0. The explanatory variables are as they :

the individual characteristics of the child (sex, age): Sex and age play a central role in demographic analysis, as highlighted by various (Franckel, 2004; Faye, 2022);
the characteristics of mothers/caregivers (level of education, age): education is a factor in increasing the couple's income and its allocation to health expenses. Studies have shown that the choice of seeking care is linked to the perception of the seriousness of the illness (Baxerres & Le Hesran, 2004) which depends on the level of education. The latter acts on the socio-cultural constraints which trivialize diseases. As Nganda Mekogo (2012) points out, out of a desire to protect children against bad luck, we prefer to keep quiet about their health conditions. In addition, the role of education is widely documented, such as in childhood vaccination (Diallo, 2021) and in the mortality of children under 5 (Kaba, 2020; Kaba, Beninguisse, & Nganawara, 2020).. As for the age of the mother, it is an indicator of physical health as well as reproductive capacity (HAMADOU DAOUDA 2012)
household characteristics (quintile of standard of living, sex of head of household, number of children, area of residence and region of residence): the level of resources is important for early recourse to care (Kane, 2017). Indeed, studies have shown that the use of care increases when the standard of living improves (Manzambi & ali., 2000; Saidou, 2018; Ngwen, 2018; Faye, 2022). The chances of seeking care are higher among children when the household is headed by a man than by a woman (Faye, 2022). Studies have also proven that inequalities in access to care are more pronounced in rural areas than in urban areas (Cissé & Sauvain-Dugeedil, 2018; Faye, 2022). Finally, education is identified as one of the main determinants of therapeutic practices (Caldwell et al., 1989; Caldwell et al., 1990; Fabrega, 1977; Kloos et al., 1987; Ben Youssef et al., 1974; Cleland et al., 1989)

Data analysis methods

This study includes descriptive and analytical analyses. Indeed, descriptive statistics are used to summarize the characteristics of children, mothers and households which would influence the use of care. Next, binary logistic regressions are used to identify factors associated with early care-seeking behavior, with crude and adjusted odds ratios estimated. To do this, binary logistic regressions were univariate and multivariate. The statistical tests will make it possible to conclude on the significance of the odds ratios in terms of early recourse to care in the event of fever in children.

The calculations are made using Stata software (version 16) and the data are weighted taking into account the type of complex sampling of the survey.

Data analyzes not only allow the calculation of the percentages of children for whom care was sought within 48 hours following the onset of fever by different characteristics, but also to quantify the net odds ratios.

Variation in early seeking of care for fever in children

At the national level, the percentage of children under 5 years of age who had a fever during the last two weeks preceding the interviewer's visit for whom care was sought within 48 hours following the appearance of fever is 32% in 2021 compared to 37% in 2018.

Early seeking of care for fever in children under 5 years of age varies depending on the characteristics of the child, his mother and the household. Indeed, between 2018 and 2021, early recourse to care in the event of a fever increased from 38–33% for girls, and for boys from 36–31%. Depending on age, low use of care in case of fever is observed among children aged 24 months and over (30%) in 2021 while in 2018 there was no disparity between age groups ( Graph 1 ).

The percentage of children who have benefited from healthcare increases with the age of the mother and her level of education both in 2018 and in 2021. Among mothers aged under 20 to those aged 35 or over, the percentage of children benefiting from healthcare increases from 27–48% in 2018, but has not really increased in 2021 (28–33%).

In 2018, early use of care was lower for children born to teenage mothers (27%) and higher among children born to mothers aged 35 or over (48%). However, this gap narrowed in 2021 with 28% for children born to teenage mothers and 33% for mothers aged 35 and over.

The same trend is observed for the level of education, with 35% of children born to mothers without education to 47% of those born to mothers with a secondary level or more in 2018 and 28% and 39% respectively in 2021. According to the educational level percentage increases from 35–47% in 2018 and from 33–38% in 2021 ( Graph 2 ).

The percentage of children seeking treatment for fever within 48 hours of symptom onset varies by standard of living quintile. From the lowest quintile to the highest quintile of standard of living, it increases from 20–52% in 2018 and from 22–45% in 2021. When the number of children under 5 in the household decreases, there is no guarantee that the percentage of use of care will increase. In 2018, the percentage increases when the number of children in the household decreases while in 2021, the increase in the number of children is accompanied by an increase in the use of care. Indeed, when the number of children in the household increases from less than 3 to 5 or more, the 2018 statistics show a drop in recourse from 38–30% while with those of 2021, we see an increase from 30–37%. Likewise, the same trend returns when we look at variations according to the sex of the head of household. The percentage of recourse is higher in households headed by men (37%) in 2018 than by women (34%), while in 2021, it is higher in households headed by women (36%) than by men (32%). Finally, the improvement in the standard of living quintile increases the use of care, but the number of children in the household and the sex of the household head do not determine the direction of its variation ( Fig. 3 ).

Furthermore, the children who benefit least from these remedies are often in rural areas and this trend is observed both in 2018 and in 2021. Thus, in rural areas the percentages are 31% in 2018 and 29% in 2021 while in urban areas, they correspond to 48% in 2018 and 42% in 2021. The lowest recourses are recorded in the regions of Boké (33% in 2018 and 19% in 2021) and Labé (7% in 2018 and 22% in 2021) compared to other regions. In addition to these two regions, the Faranah region in 2018 followed by the Nzérékoré (21%) and Kindia (28%) regions in 2021 were also areas of low early recourse to care in the event of fever in children. As a result, healthcare use is low in the Boké and Labé regions, and in rural areas. ( Fig. 3 ).

Explanatory results for early recourse to care in case of fever in children

In this study, the results of logistic regression make it possible to identify the factors associated with early use of care and their trends between 2018 and 2021 in children with fever.

Odds ratios estimated with children's characteristics show that there is no significant difference between girls and boys, and between children of different age groups. This result concerns not only the models which evaluate the simultaneous effect of the different independent variables on the use of care in case of fever, but also the two years of study (2018 and 2021). These results show that the odds ratios are not linked to the sex and age of the children.

On the other hand, maternal factors (age and level of education) influence the use of care: in 2018, children of mothers aged 20–34 and 35 or over have odds of 1.5 times and 2 times higher to benefit from early seeking care when they contract fever than their counterparts of adolescent mothers (under 20 years old). However, taking into account the simultaneous effect of other variables shows that it is only children whose mothers are aged 35 or over who are more advantageous compared to those of teenage mothers, and the 2021 data does not show no difference in terms of crude or adjusted effects. In addition, the influence of the mother's level of education on recourse varies depending on the year. In 2018, it was the children of mothers with secondary education or more who were more likely to benefit from healthcare, while in 2021 even those of mothers with a primary education level were advantageous compared to those of mothers without level. But, taking into account the simultaneous effect of other independent variables shows that the influence of the mother's level of education only appears in 2021, and it is only the children of mothers with primary education who have more chance of benefiting from early recourse to care in the event of a fever. Finally, improvement in health-seeking behavior would be linked to advancing age, but this relationship would be inhibited by the simultaneous influence of other factors taken into account in the model. It is also linked to the improvement of the mother's educational level, but it is in 2021 that this relationship is established.

The analyzes also show that household characteristics influence healthcare use. In 2018, children living in households in a poor or higher standard of living quintile are increasingly likely to benefit from seeking care in the event of a fever in the following 48 hours, even in the presence of the simultaneous effects of other variables. independent. Then, the results for 2021 align with those for 2018, except that the chances of seeking care only become effective from the average standard of living quintile. We also realize that this influence is partly linked to the simultaneous effect of other independent variables. On the other hand, the influence of the number of children under 5 years old in the household on recourse is not significant, except that in 2018 we realize that taking into account the simultaneous effects of other factors reveals that children are less likely to benefit from seeking care in the event of fever when there are many of them in the household. Then, the gender of the head of household is not a discriminating factor in seeking care. Finally, the improvement in the household's standard of living quintile and the reduction in the number of children in the household are accompanied by an increase in the need for care in the event of fever in children under 5 years old.

Children are twice, then 1.8 times more likely to benefit from seeking care in the event of fever in urban areas than in rural areas, respectively in 2018 and in 2021, but the effects of the environment of residence are inhibited when we take into account the simultaneous effects of other factors. Then, in certain regions, children are more likely to benefit from healthcare than in others. These include the regions of Faranah (6.2), Conakry (2.9), Mamou (2.2) and Kankan (2.1) in 2021, in terms of adjusted effects, but the other regions are not distinguished from that of Boké. Then, this relationship is not linked to the simultaneous influence of other factors. However, in 2018 none of them stands out from the Boké region, except that of Labé where children are 84% less likely to benefit from healthcare when we take into account the simultaneous effects of other independent variables.. The odds ratio observed in the Conakry region (2.25) in terms of raw effect compared to the Boké region is inhibited by other factors. Finally, we note that the chances of seeking care in the event of fever are highest in urban areas and in the regions of Conakry, Faranah, Kankan and Mamou.

Table 1

crude and adjusted odds ratios of factors associated with early seeking of care among children under 5 years of age who had fever during the last two weeks preceding the survey for whom advice or treatment was sought in the 48 hours following the start of the fever, Guinea 2021
	Odd ratios 2018		Odd ratios 2021
Variable	Raw	Adjusted	Raw	Adjusted
Sex
Male	ref.	ref.	ref.	ref.
Feminine	1.12	1.14	1.11	1.18
Age in months
< 24	ref.	ref.	ref.	ref.
24+	1.06	0.95	0.86	0.85
Age of mother
15–19	ref.	ref.	ref.	ref.
20–34	1.52*	1.52	1.23	1.22
35 and over	2.04**	2.28**	1.27	1.43
Educational level
Without level	ref.	ref.	ref.	ref.
Primary	0.97	0.82	1.67**	1.60**
Secondary+	1.62**	1.00	1.64**	1.31
Gender of head of household
Male	ref.	ref.	ref.	ref.
Feminine	0.90	1.08	1.21	1.22
Number of children
< 3	ref.	ref.	ref.	ref.
3–4	0.86	0.95	1.30	1.18
5+	0.68	0.56**	1.37	1.40
Place of residence
rural	ref.	ref.	ref.	ref.
urban	2.07***	1.12	1.78***	0.85
Region of residence
Boké	ref.	ref.	ref.	ref.
Conakry	2.25***	1.36	4.14***	2.91**
Faranah	0.73	0.80	5.53***	6.16***
Kankan	1.46	1.28	2.07*	2.11
Kindia	1.26	1.18	1.63	1.54
Labe	0.14***	0.16***	1.19	1.19
Mamou	1.27	1.25	2.30**	2.21*
Nzerekore	1.41	1.36	1.11	1.96
Standard of living quintile
Very poor	ref.	ref.	ref.	ref.
Poor	1.98***	1.80**	1.26	1.39
AVERAGE	2.03***	1.88**	1.90**	1.97**
Rich	3.45***	3.35***	2.12**	1.95*
Very rich	4.21***	3.84***	2.96***	2.40*
_cons	0.25***	0.15***	0.28***	0.10***
Effective	1221	1221	921	921

Table 2

Percentage of children aged 0 to 4 years having had a fever in the last two weeks preceding the survey for whom advice or treatment was sought within 48 hours of the onset of the fever, Guinea 2018
	Early seeking care in case of fever (%)	LB ¹	UB2	Effective
Sex
Male	35.5	31.3	39.9	653
Feminine	38.0	33.9	42.3	581
Age of child (months)
< 24	36.0	31.7	40.6	600
24+	37.3	33.1	41.6	634
Age of mother/guardian
< 20	26.7	18.6	36.8	98
20–34	35.6	31.7	39.7	827
35 +	42.6	35.6	50.0	310
Education level of mother/guardian
None	35.2	31.4	39.1	932
Primary	34.4	27.0	42.6	137
Secondary +	46.9	38.6	55.3	166
Place of residence
Urban	48.3	42.4	54.1	401
Rural	31.1	27.2	35.3	834
Administrative Region
Boké	32.8	24.3	42.5	94
Conakry	52.3	42.9	61.6	170
Faranah	26.2	17.0	38.2	104
Kankan	41.6	34.9	48.7	204
Kindia	38.1	31.6	45.0	294
Labe	6.5	2.7	14.5	111
Mamou	38.2	27.2	50.6	144
Nzerekore	40.8	28.4	54.5	113
Gender of head of household
Male	37.0	33.5	40.6	1,081
Feminine	34.4	26.7	43.1	153
Number of children in the household
< 3	38.0	34.0	42.1	865
3–4	34.5	28.8	40.7	298
5+	29.5	19.1	42.6	72
Household well-being quintile
The lowest	20.1	15.4	25.8	258
Second	33.3	26.6	40.6	259
AVERAGE	33.8	27.4	40.7	244
Fourth	46.5	38.6	54.6	235
The highest	51.5	44.4	58.4	239
Total	36.7	33.4	40.1	1234

Table 3

Percentage of children aged 0 to 4 years old having had a fever in the last two weeks preceding the survey for whom advice or treatment was sought within 48 hours of the start of the fever, Guinea 2021
	Early seeking care in case of fever (%)	LB ¹	UB2	Effective
Sex
Male	31.1	26.6	36.0	494
Feminine	33.4	27.4	39.9	427
Age of child (months)
< 24	34.0	29.0	39.5	397
24+	30.7	25.9	35.9	524
Age of mother/guardian
< 20	28.0	18.2	40.4	76
20–34	32.4	28.0	37.1	644
35 +	33.0	26.0	40.7	201
Education level of mother/guardian
None	27.9	23.5	32.7	570
Primary	39.2	31.0	48.0	198
Secondary +	39.8	31.0	47.4	153
Place of residence
Urban	41.6	34.6	49.1	251
Rural	28.6	24.1	33.6	670
Administrative Region
Boké	19.3	11.0	31.7	112
Conakry	49.8	39.5	60.1	119
Faranah	57.0	38.2	74.0	78
Kankan	33.2	25.2	42.3	198
Kindia	28.1	19.5	38.6	141
Labe	22.1	14.7	31.9	95
Mamou	35.5	25.1	47.6	47
Nzerekore	20.9	13.2	31.6	131
Gender of head of household
Male	31.6	27.5	36.0	801
Feminine	35.8	26.2	46.7	120
Number of children in the household
< 3	29.9	25.7	34.5	580
3–4	35.7	27.7	44.5	273
5+	36.9	23.2	53.2	68
Household well-being quintile
The lowest	21.8	14.8	30.9	200
Second	25.9	20.0	33.0	202
AVERAGE	34.7	27.5	42.7	199
Fourth	37.2	27.3	48.2	174
The highest	45.2	36.6	54.1	147
Total	32.1	28.1	36.5	921
¹ Lower bound
² Upper bound

Sex and age are central variables par excellence in demographic analysis. Various studies have focused on their associations with the use of healthcare in children (Franckel 2004, Faye 2022). The use of care is made in the same way for girls as for boys and without distinction of age. These would result from the fact that awareness messages about malaria in the media do not differentiate the risk according to the sex or age of the child. The recent 2021 Malaria and Anemia Indicators Survey showed that more than half of women (58%) have seen or heard a message about malaria in the last 6 months. These messages often concern the risk, seriousness and consequences of late seeking care, especially among children (without distinction of sex or age) and pregnant women who constitute the most vulnerable group. Then, many women fear the onset of fever as a sign of malaria infection, regardless of gender or age. This is why treatment for fever is required for both girls and boys and at any age (INS et ICF 2021). Other studies have also shown that gender does not determine health-seeking behavior when sick in children (Franckel 2004, Nganda Mekogo 2012, Faye 2022). Likewise, the recommendations on care concern all children under 5 years old (OMS 2009).

Various studies have also looked at the influence of the mother's age on children's recourse behavior in the event of illness. It turns out that the choice of recourse strongly depends on the perception of the seriousness of the illness (Baxerres et Le Hesran 2004). The results of the Malaria and Anemia Indicator Survey (EIPA) showed that mothers have relatively the same level of information. Exposure to malaria messages in the media, perception of risk and severity are relatively invariant according to age (INS et ICF 2021). This explains the non-association between the age of the mother and the need for care among children in the event of fever. Other studies have also reached the same conclusion (Nganda Mekogo 2012).

Educational attainment plays an important role in children's health. It increases the couple's income and increases spending on health. It facilitates access to messages about malaria and acts on behavior that trivializes illnesses. Out of a desire to protect children against bad luck, we often prefer to keep their state of health quiet (Nganda Mekogo 2012). Childhood illnesses are sometimes trivialized. However, through the mother's instruction, such beliefs are eradicated. In terms of health, the role of education is widely documented, such as in childhood vaccination (Diallo 2021)and in the mortality of children under 5 years old (Kaba 2020, Kaba, Beninguisse et Nganawara 2020). Indeed, this study shows that improving the level of education increases the chances of children seeking care in the event of fever. Then, the percentage of children for whom an appeal was made within 48 hours of the onset of fever increases when the mother's level of education improves. Similar results have been found elsewhere (Nganda Mekogo 2012, Yaogo & ali. 2014, Dieng & ali. 2014).

Children's health expenses are primarily borne by the father and mother. The social obligation for this care falls to the father, who rarely seeks help from those around him, exposing him to shame. It is the same for the mother. Therefore, the level of resources is important for early recourse to care (Kane 2017). The results of this study point in this direction, because early recourse to care is increasingly practiced when the household's standard of living improves. Various studies have also reached the same conclusion (Manzambi & ali. 2000, Saidou 2018, Ngwen 2018, Faye 2022).

The results of this study showed that the direction of the relationship between the number of children in the household and the use of care in the event of fever is ambiguous. In 2018, children are less likely to benefit from healthcare when they are in households with more than 4 children. However, the relationship disappears in 2021. Descriptive statistics also showed that the percentages of use of care are relatively invariant with the number of children in the household. On the one hand, such a result would mean that the care of children in the event of fever is primarily provided by the mother, who rarely requests help from the head of the household unless the latter is the father of the child. child. On the other hand, expenses related to treatment in the event of a fever could be less expensive. The second hypothesis is the most plausible, because among the priorities of the national policy for the fight against malaria are the mobilization of viable financing to fight malaria and the reduction of the burden of malaria for long-term achievement of the goal of eliminating the disease (PNLP 2014). This effective involvement of the State facilitates the management of children's health in the process of eradicating malaria in Guinea.

This study found no relationship between the sex of the head of household and the use of care among children in the event of fever. The percentages of children receiving care are insensitive to whether the household is headed by a woman or a man. This result would be linked to the fact that the malaria control program not only makes efforts to raise awareness, but also to facilitate universal access to health care. However, other studies have proven more reliance among children when the household is headed by a man than a woman (Faye 2022).

The environment and region of residence are important variables in spatial analyses. They provide information on the impact of health programs and differences in behavior in the different areas of intervention. Malaria control programs are often implemented according to the endemic area. Thus, they differ from one region to another and from rural to urban areas. In addition, the results of this study show that the use of health care is higher in urban areas than in rural areas. The rural environment is characterized by the lack of quality health personnel, insufficient health services, language barriers to messages about malaria in the media, precarious living conditions and the influence of socio-cultural constraints. Studies have also proven that inequalities in access to care are more pronounced in rural areas than in urban areas (Cissé et Sauvain-Dugeedil 2018, Faye 2022).

The objective of this study was to analyze the factors associated with early recourse to care in the event of fever among children under 5 years of age in Guinea. The study focused on the characteristics of children (sex and age), mothers (age and level of education) and households (standard of living, number of children, sex of head of household, place of residence and region). of residence).

In summary, the results of this study highlighted the factors associated with early recourse to care in children in the event of fever. These include the mother's level of education, the household's standard of living, the environment and region of residence. Conversely, the use of care among children is not differentiated according to the sex and age of the child. There is no difference between whether the household is headed by a man or a woman. In terms of political involvement, the national malaria control program would benefit from directing its interventions more in rural areas which until now remain disadvantaged although efforts are being made at the national level. Given the desire to eliminate malaria in Guinea and the current level of early recourse (32%), it is important to further strengthen current strategies in all 8 regions, with greater emphasis in the regions of Boké, Kindia, Labé and Nzérékoré, where the lowest percentages of health care use have recently been recorded.

The results of this study highlight strengths as well as limitations. The relevance of the study lies on two levels. On a political level, it is in line with the objection to significantly reduce the transmission of malaria in the population with a view to its elimination, as highlighted in Guinea's national malaria control program. On a scientific level, various studies did not take into account the hierarchical structure of the data as recommended by the DHS program. On the other hand, the non-stratification of the study by malaria endemic area hides the common and specific factors linked to early recourse to care in the event of fever in children under 5 years of age.

In terms of perspective, it emerges from the previous paragraph the need to carry out analyzes on regional inequalities in early recourse to care among children in cases of fever to identify common and specific factors, but also to share knowledge and experiences. in order to better plan interventions in regions that are under high exposure to malaria infection in Guinea.

Declarations

Not applicable for that section

FUNDING

There was no funding

Author Contribution

MD: review of literature, modeling, discussionSK: review of literature, modeling, discussionMW: proofreading

Awantang, G, S Babalola, H Koenker, K Fox, M Toso, and N Lewicky. "Correlates of social behaviour change communication on care-seeking behaviours for children with fever: an analysis of malaria household survey data from Liberia." Malaria Journal, 2018: 17-105.
Baxerres, Carine , and Jean-Yves Le Hesran. "Recours aux soins en cas de fièvre chez l’enfant en pays Sereer au Sénégal : entre contrainte économique et perception des maladies." Sciences Sociales et Santé, 2004: 5-24.
Birhanu, Z, L Abebe, M Sudhakar, G Dissanayake, Y Y Yihdego, and G Alemayehu. "Malaria related perceptions, care seeking after onset of fever and anti-malarial drug use in malaria endemic setting of Southwest Ethiopia." PloS One, 2016.
Cissé, Siaka, and Claudine Sauvain-Dugeedil. "Inégalités géographiques de recours aux soins de santé maternelle au Mali: roles respectifs des caractéristiques individuelles, familiales et communautaires." African Population Studies 32, no. 3 (2018): 469-4485.
Das, A, and T S Ravindran. "Dactors afecting treatment-seeking for febrile illness in a malaria endemic block in Boudh district." Malaria Journal, 2012.
Deressa, W. "Treatment-seeking behaviour for febrile illness in an area of seasonal malaria transmission in rural Ethiopia." Malaria journal, 2007: 6-49.
Diallo, Mamadou Dian Dilé. "Facteurs associés à la vaccination complète chez les Enfants de 12 à 23 Mois en Guinée." European Scientific Journal, 2021: 80-97.
Dieng, Moussa, Martine Audibert, Jean-Yves Le Hesran, and Anta Ta Dial. "Déterminants de la démande de soins en milieu en milieu péri-urbain dans un contexte de subvention à Pikini, Sénégal." CERDI, Centre d'études et de recherches sur le développement international, 2014: 1-26.
Faye, Fatoumata M. "Gratuité des soins pour les enfants de moins de cinq ans au Sénégal : les inégalités d’accès ont-elles disparu ?" Revue Réflexions Économiques, 2022: 67-82.
Franckel, Aurélien. Les comportements de recours aux soins en milieu rural au Sénégal: Le cas des enfants fébriles à Niakhar. Thèse de doctorat, Paris: Centre de Recherche Populations et Sociétés - Université Paris X – Nanterre, 2004.
HAMADOU DAOUDA , Youssoufou. "Déterminants de la mortalité infantile et infanto-juvénile et la pauvreté au Niger." Revue d’Economie Théorique et Appliquée 2, no. 1 (2012): 23-47.
INS, and ICF. Enquête sur les Indicateurs du Paludisme et de l'anémie en Guinée. Conakry: Institut National de la Statistique, 2021.
Institut National de la Statistique (INS), and ICF. Enquête Démographique et de Santé en Guinée 2018. Conakry, Guinée, et Rockville, Maryland, USA: INS et ICF., 2018.
Kaba, Sidiki. "Evolution de la mortalité infanto-juvénile en Guinée." Journal of Business and Social Science Review, 2020: 47-52.
Kaba, Sidiki, Gervais Beninguisse, and Didier Nganawara. "Etudes rétrospectives des facteurs individuels et contextuels sur la variation de la mortalité des enfants de moins de 5 ans durant l’année 2018 en Guinée." European Scientific Journal, 2020: 173-186.
Kane, Hélène. "Configurations familiales et accès des enfants aux soins à Nouakchott (Mauritanie)." Open edition journal, 2017: 1-20.
Manzambi, J K, V Tellier, A Albert, J Y Reginster, and H Van Balen. "Les déterminants du comportement de recours au centre de santé en milieu urbain africain: résultats d’une enquête de ménage menée à Kinshasa, Congo." Tropical Medicine and International Health 5, no. 8 (2000): 563-570.
Mutombo, Augustin M, et al. "Paludisme grave chez les enfants âgés de moins de 5 ans à l’hôpital Panda à Likasi, République Démocratique du Congo." Revue De l’Infirmier Congolais 2, no. 1 (2018): 4–10.
Nganda Mekogo, Serge Bruno. Contribution du genre à l’explication du recours aux soins modernes en cas de diarrhée chez les enfants de moins de cinq ans au Cameroun. Mémoire de master professionnel, Yaoundé: IFORD, 2012.
Ngwen, Ngangué. "Effets des prix et des revenus sur le recours aux soins au Cameroun." Mondes en développement, 2018: 29-48.
OMS. Manuel de prise en charge des enfants en situation d'urgence humanitaire. Genève: Organisation Mondiale de la Santé, 2009.
—. Paludisme. Décembre 6, 2021a. https://www.who.int/fr/news-room/fact-sheets/detail/malaria.
—. Stratégie technique mondiale de lutte contre le paludisme 2016-2030. Juillet 19, 2021b. https://www.who.int/fr/publications/i/item/9789240031357.
PNLP. Programme National de Lutte Contre le Paludisme en Guinée. Conakry: Direction Nationale de la Prévention et de la Santé Communautaire, 2014.
Saidou, Hamadou. "Recours thérapeutiques en cas de paludisme : impact d’une réforme de l’offre de soins de santé au Cameroun." INSEE, La revue méthodologique Statéco, 2018: 3-20.
Traoré, Oumar. Les déterminants du recours aux soins en cas de fièvre palutre des enfants de l'observatoire de population de Niakhar. Dakar: Institut de Recherche pour le Développement et Institut Supérieur de Santé, 2002.
Yaogo, Ahmed, Alain Sommer, Pierre Moulaï, Saïd Chebili, and Agnès Abaoub-Germain. "Niveau socioéconomique et processus du recours aux soins par les familles de Niveau socioéconomique et processus du recours aux soins par les familles de." Pan African Medican Journal, 2014: 1-5.

No competing interests reported.

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Trend and factor modeling for early treatment for fever in children under 5 years of age in Guinea

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Abstract

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BACKGROUND

METHODS

Data source

Target population

Study variables

Data analysis methods

RESULTS

Variation in early seeking of care for fever in children

Explanatory results for early recourse to care in case of fever in children

DISCUSSIONS

CONCLUSION

Declarations

Declarations

FUNDING

Author Contribution

References

Additional Declarations

Status:

Version 1