UCSF

DELAY IN CARE SEEKING FOR CHILDREN AGED FIVE AND UNDER WITH FEVER IN THE MALARIA ENDEMIC SETTING OF RURAL MALAWI

Irene Ritterman

The purpose of this retrospective descriptive study is to examine the factors associated with delay in seeking care among residents in the Mulanje District of rural Southern Malawi, who have febrile children aged five and under. This study will contribute to the literature on care seeking and malaria. It will also help inform public health efforts and health care delivery programs in rural Malawi. A cross-sectional household demographic health survey was conducted in June 2013 and January 2014. Survey data included information on 589 households. The study sample was a subset of families whose youngest child, aged five and under, had experienced a fever in the three months prior to the survey. The dependent variable was binary and defined as timing of care seeking following fever onset. Care seeking was considered delayed when it occurred more than twenty-four hours after fever onset and prompt when it occurred within twenty-four hours of fever onset. Associations between the dependent variable and a number of explanatory variables were explored in the analysis. Data were cleaned and analyzed using STATA 13. The final study sample included 196 families. Eighty-four percent of respondents sought care for their febrile children within 24 hours and 16% delayed care seeking. Overall, participants in the two care seeking groups were found to be similar in terms of median household size, mother’s age, marital status, and level of education, access to care, and travel time walking to source of care. However, the group who sought care promptly appeared to be better off socioeconomically than the group who delayed care seeking, based on a multidimensional poverty index. Eighty-seven percent of the total study population owned at least one mosquito net and 78% had comprehensive malaria knowledge. Only one variable approached statistical significance: naming fever as a sign of malaria (p = .06). Based on the results, it appeared that knowing fever is a sign of malaria made families more likely to delay care seeking. This study found that families who promptly sought care and those who delayed care seeking were similar based on the majority of examined explanatory variables. One possible explanation for why people delayed care seeking, despite having a high level of comprehensive malaria knowledge, is that the fever was not perceived as being severe enough to be malaria or warrant care seeking. The primary limitation in the study was the small sample size. This study suggests that public health efforts in the malaria endemic region of rural Malawi should incorporate education on the potential severity of malaria among children five and under and the importance of prompt care seeking, regardless of perceived severity. Nurses can play an important role by advocating for systemic changes to help relieve barriers to care seeking for families.