Factors associated with malaria care seeking among children under 5 years of age in Mozambique: a secondary analysis of the 2018 Malaria Indicator Survey.

BACKGROUND: Mozambique is ranked fourth in a list of the 29 countries that accounted for 95% of all malaria cases globally in 2019. The aim of this study was to identify factors associated with care seeking for fever, to determine the association between knowledge about malaria and care seeking and to describe the main reasons for not seeking care among children under five years of age in Mozambique. METHODS: This is a quantitative, observational study based on a secondary data analysis of the 2018 Malaria Indicator Survey. This weighted analysis was based on data reported by surveyed mothers or caregivers of children aged 0-59 months who had fever in the two weeks prior to the survey. RESULTS: Care was reportedly sought for 69.1% [95% CI 63.5-74.2] of children aged 0-59 months old with fever. Care-seeking was significantly higher among younger children, < 6 months old (AOR = 2.47 [95% CI 1.14-5.31]), 6-11 months old (AOR = 1.75 [95% CI 1.01-3.04]) and 12-23 months old (AOR = 1.85 [95% CI 1.19-2.89]), as compared with older children (48-59 months old). In adjusted analysis, mothers from the middle (AOR = 1.66 [95% CI 0.18-3.37]) and richest (AOR = 3.46 [95% CI 1.26-9.49]) wealth quintiles were more likely to report having sought care for their febrile children than mothers from the poorest wealth quintile. Additionally, mothers with secondary or higher education level were more likely to seek care (AOR = 2.16 [95% CI 1.19-3.93]) than mothers with no education. There was no association between maternal malaria knowledge or reported exposure to malaria messages and care-seeking behaviours. The main reasons reported for not seeking care included distance to health facility (46.3% of respondents), the perception that the fever was not severe (22.4%) and the perception that treatment was not available at the health facility (15%). CONCLUSION: Health facility access and socioeconomic barriers continue to be important constraints to malaria service utilization in Mozambique.

Caracterização Hemato-linfocitária em Crianças Infectadas por Malária / Hematolymphocyte Characterization in Malaria Infected Children

Introdução: Moçambique é um dos países endémicos à malária. Em 2011, a estimativa de prevalência desta doença era de 40­80% em crianças dos 2­9 anos e 90% em crianças menores de 5 anos. Estas altas prevalências podem ser devido à dificuldade das crianças em desenvolverem uma resposta imune eficaz. São necessários mais estudos para entender a resposta imune nestas crianças. Este estudo teve como objectivo descrever as características imuno-hematológicas em crianças menores de 15 anos infectadas por Plasmodium falciparum. Metodologia: Foram recrutadas crianças de 2-15 anos, infectadas por P. falciparum. Em cada criança, cujo tutor legal consentiu que participasse no estudo, colheu-se 5 ml de sangue venoso para um tubo com anticoagulante K3EDTA. O sangue foi usado para a contagem automática de células por citometria de fluxo. Os resultados foram agrupados por idade, dos 2-8 anos e 9-15 anos. Resultados: Das 50 crianças incluídas no estudo, 84% tinham idades entre os 2-8 anos, 70% do sexo masculino e 4% com serologia positiva para HIV. O nível de hemoglobina foi mais elevado no grupo de 9-15 anos (10,3g/dL) em relação ao grupo de 2-8 anos (8,7g/dL). A contagem absoluta de linfócitos T-CD4 foi maior no grupo de 2-8 anos (819 cél./µl). A activação celular não apresentou diferenças entre os grupos. Conclusão: A maioria dos casos de malária e anemia aguda foi observada em crianças dos 2 aos 8 anos, predominantemente do sexo masculino. Os valores absolutos de linfócitos foram mais elevados nas crianças dos 2-8 anos, mas os valores percentuais linfocitários não diferiram entre os grupos.

Introduction: Mozambique is one of the endemic countries to malaria. In 2011, the estimated prevalence of this disease was 40­80% in children aged from 2­9 years and 90% in children under 5 years. These high rates may be due to the difficulty of children in building an effective immune response. Further studies are needed to understand the immune response mounted by children in the presence of Plasmodium. This study aimed to describe the immuno-haematological characteristics of children under 15 years infected with Plasmodium falciparum. Methodology: Children aged from 2-15 years, infected with P. falciparum, were recruited for the study. In each child, whose legal guardian consented to take part of the study, was collected 5 ml of venous blood to a K3EDTA anticoagulant tube. The samples were tested using automatic full blood cell counting and flow cytometry. The results were grouped by age, 2-8 years and 9-15 years. Results: From the 50 children included in the study, 84% were aged 2-8 years, 70% were male and 4% were HIV positive. The haemoglobin level was higher in the 9-15 year old group (10.3g/dL) compared to the 2-8 year old group (8.7g/dL). The absolute T-CD4 lymphocytes levels were higher in the 2-8 year old group (819 cells/µl). The T-CD8 lymphocytes activations levels were similar in both groups. Conclusion: The majority of the children attended in the Paediatric Emergency who diagnosed malaria were 2 to 8 years old. These children were predominantly male and presented acute anaemia. The absolute T-CD4 and T-CD8 lymphocytes levels were higher in children aged 2-8 years, but the percentage levels of lymphocytes did not differ between groups.

Care-seeking behaviour and treatment practices for malaria in children under 5 years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets.

BACKGROUND: In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria. METHODS: Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data. RESULTS: A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether-lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15-4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83-1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34-0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03-6.01]), Sofala ([AOR = 2.91 [1.03-8.24]), Inhambane (AOR = 3.95 [1.25-12.45]), Gaza (AOR = 3.25 [1.22-8.65]) and Maputo Province (AOR = 2.65 [1.10-6.41]) were more likely to seek care than people from Maputo City. CONCLUSION: Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.