Influence of child care practices on malaria severity in children under five years of age in Mbeere district of Eastern province, Kenya

Malaria, a blood parasitic disease is a leading cause of mortality and morbidity particularly among children and pregnant women because they are most at risk in many developing countries, especially those in Sub-Saharan Africa. Most of the deaths due to malaria could be averted if care-takers recognized the signs and symptoms of malaria and instituted appropriate measures without delay. Early recognition followed by correct management is a key strategy for malaria control in endemic areas. The effectiveness of this strategy requires an understanding of careseeking patterns including the actions the care-takers initiate in response to an episode of childhood febrile illness since they greatly influence the severity of the disease. A health facility-based descriptive cross-sectional study was carried out in Mbeere District (a malaria endemic area), where caretakers seeking treatment for their children aged under-five years who tested positive for malaria parasites were recruited into the study. The main objective was to determine health care practices during the illness and their effect on the severity of the illness. A questionnaire was used to collect primary qualitative data from caretakers. Additional qualitative data was obtained through focus group discussions with women groups in each of the study sites. The data was entered using Epi-Info interface and analysis done using the Statistical Package for Social Sciences (SPSS) version 12.0 software. Pearson‘s chisquare test of independence was used to determine level of associations at 95% confidence interval. The results established that the children had been unwell for mainly 2 days prior to health facility visit. The mean duration of illness for the children was 2.1 (S.D ±1.4) days. On diagnosis and classification of the illness at the health facility, 23.9% of all children seen had complicated malaria, 74.3% had uncomplicated malaria while 1.7% were not classified. There was no significant difference in severity of malaria among the different age groups of children (χ 2 = 2.32, p=0.67). Analysis of actions taken at home showed that 81.3% of the caretakers had taken one or more actions at home while 18.7% never took any action. The action of giving drugs was the most common (64.1%) followed by removal of excessive clothing (16.5%). Although caretakers were not able to accurately identify the specific drugs they gave to the sick children, they were able to report that the drugs were for a specific sign or symptom like drug to reduce fever, pain, drugs to treat malaria etc. Only 8% of the respondents reported having given an antimalarial drug at home. The variation on the caretakers‘ immediate action was also noted to be associated with the levels of education of the individual caretaker particularly in giving a drug (χ 2 = 15.900, P < 0.05), more fluids to the child (χ 2 = 4.322, P < 0.05) and doing nothing on first notice (χ 2 = 15.924, P < 0.05). All the caretakers with college education gave drugs on first notice that the child was unwell. There was also a significant association between caretakers‘ religion and occupation with the severity of malaria (χ 2 = 8.62, p = 0.01; χ 2 = 50.2, p=0.001) respectively. Among the Akorino sect, a significant 48.1% of the caretakers and slightly more than half (56.6%) of those in semi-skilled labour had their children diagnosed with complicated malaria. The association between feeding practices and severity of malaria was also significant. Among caretakers who gave food and fluids less frequently during the illness 25.8% and 34.7% of the children had complicated malaria (p=0.42 and 0.001) respectively.