ABSTRACT
In the context of a larger study on malaria related knowledge, attitudes, practices and beliefs in western Uganda 813 women aged 15-49 years were shown a sample of a pre-packed, unit-dosed malaria treatment for children, its use was explained and attitudes of the women were investigated. Of all women, 90.5% (86% urban, 92% rural) said they would prefer the pre-packed over the conventional type of treatment and 93.9% of these were willing to pay between 0.17 (rural) and 0.29 (urban) US dollars more for this treatment. Two-thirds (67.8%) thought that they would not have to ask their spouses before making a decision on the kind of treatment and 59.5% said they would rather stock the treatment at home than buy it when a child gets sick. The most mentioned reason for preferring pre-packs was their safety and cleanliness, while ease of application, dosing and compliance were secondary. We conclude that pre-packed, unit-dosed malaria treatment is accepted by the caretakers of children in the area studied and that they readily understand and accept its concept. This indicates a high potential for this approach to improve the home management of malaria fevers and reduce malaria-related morbidity and mortality if adequate coverage can be achieved and if the intervention is embedded into an appropriate programme of behavioural change communication and provider training.
Subject(s)
Antimalarials/administration & dosage , Drug Packaging/methods , Health Knowledge, Attitudes, Practice , Malaria/drug therapy , Adolescent , Adult , Caregivers/psychology , Child , Cross-Sectional Studies , Decision Making , Female , Humans , Malaria/psychology , Middle Aged , Mothers/psychology , Rural Health , Uganda , Urban HealthABSTRACT
A rapid test for the diagnosis of Plasmodium falciparum infections based on the detection of histidine-rich-protein II, the ParaSight-F test, was evaluated after introduction in a district malaria control program in Uganda. Suspected treatment failures, pregnant women and infants with clinical malaria and general fever cases were tested at health facilities in malaria hypo-, meso- and holoendemic areas. A total of 1326 tests were carried out by health unit staff, cross read by experienced laboratory staff and results compared with thick film microscopy as the standard. Rater agreement in reading the dipstick result between health unit staff and laboratory staff was high, kappa index 0.94 (0.88-0.99). Sensitivity was 99.6% (99.0-100) for parasite densities above 500/microl, 98.6% (97.7-99.6) for densities above 50/microl and 22.2% (8.6-42.3) for densities below 10/microl. With the applied testing strategies no differences were found between endemicity levels or patient categories. Specificity was 86.2% (83.3-88.8) overall, but significantly higher in general fever cases (92.7%) compared to the other patient groups (84.3%, P=0.009). At the given prevalences positive predictive values (ppv) were above 80% and negative predictive values (npv) above 90% in all cases except in pregnant women (ppv: 77.8%). We conclude that in certain situations this test is an alternative to microscopy to improve diagnostic facilities for case management in malaria control programs in endemic African countries.
Subject(s)
Malaria, Falciparum/diagnosis , Plasmodium falciparum/isolation & purification , Proteins/analysis , Protozoan Proteins/blood , Reagent Strips , Adolescent , Animals , Child , Child, Preschool , Endemic Diseases , Evaluation Studies as Topic , Female , Humans , Infant , Infant, Newborn , Malaria, Falciparum/prevention & control , Outpatient Clinics, Hospital , Pregnancy , Rural Health , Sensitivity and Specificity , UgandaABSTRACT
In the context of the 'integrated management of childhood illnesses' (IMCI) programme the World Health Organization recommends treating children in malarious areas presenting with fever and respiratory symptoms with co-trimoxazole. In order to verify its effectiveness in uncomplicated Plasmodium falciparum malaria we carried out a study in vivo in western Uganda: 180 children under 5 years old were enrolled and treated with 40/8 mg/kg/d co-trimoxazole over 5 d, and 159 could be followed on days 3, 7 and 14. Effectiveness of treatment was found to be significantly different in various parts of the study area. In Bundibugyo District, bordering République Democratique du Congo (Zaire), 59.1% (39/66) of children were clinically cured after 14 d and 56.1% were parasitologically cured. In the east of Kabarole District (43 children), the figures were 76.7% and 65.1%, respectively. In western Kabarole (50 children) the rates were 96.0% and 90.0%, respectively. We conclude that, in view of the high level of clinical failures in parts of the study area, co-trimoxazole should not be used in the IMCI programme for combined treatment of malaria and pneumonia in the region. Assessment of therapeutic effectiveness of antimalarial drugs needs to consider the microepidemiology of resistance.
