Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092？±？0.3084. Guideline use reduced with increasing age and lower education. 1. Background Malaria remains an important public health problem and a principal cause of childhood mortality. It is estimated that at least 10 percent of all childhood deaths are due to malaria [1]. Mortality is highest among children under five years of age who do not receive prompt/appropriate treatment [1]. Despite the fact that the main strategy for reducing childhood mortality and morbidity is presumptive treatment of all fevers in children with antimalarial drugs [2], the greatest challenge of malaria treatment still occurs during treatment as many children with malaria are treated at home [3]. Emphasis on prompt treatment and distribution of pre-packaged antimalarial drugs are strengths of the Home Management of Malaria [4], a strategy proposed by the World Health Organization in an effort to improve prompt access to treatment. This is predicated on the observation that the majority of fevers in that age group in Sub-Saharan Africa are due to malaria [5]. The need to reduce malaria morbidity and mortality through the improvement of home treatment of childhood fevers has led to a number of community-based initiatives, including the training of mothers, community health workers, or shopkeepers in diagnosis, appropriate antimalarial use, and referral [6]. It is very important to help the caregivers in overcoming the problems associated with prompt and effective treatment. A study by NetMark Africa Regional Malaria Program showed that the core of the home management of malaria is the