23rd June 2018Clare Strachan, one of CEPA’s senior global health consultants, has had yet another piece of her research published by a leading journal, BMC Health Services Research. Clare’s latest paper provides important insight concerning the pre-referral treatment of severe malaria among children under five, based on a study conducted in western Uganda. In particular, the research explores community understanding of the concept of pre-referral treatment and how this impacts on the likelihood a child with suspected severe malaria will complete their referral after having been given rectal artesunate (RA) by a community health worker (CHW).
The study, based on multiple qualitative methods, finds that there was insufficient emphasis on RA not being a full treatment for severe malaria. Information shared by the CHW appeared to be influenced by the perceived urgency with which the CHW needed to act and the time of day or night the child was seen. Caregivers seemed more likely to adhere to referral advice if they perceived their child’s condition to be severe. Previous caregiver experience and CHW comparisons with Artemisinin-based Combination Therapy (ACT) as a treatment for uncomplicated malaria appeared to raise misperceptions that RA is a complete treatment for severe malaria, thus reducing likelihood to complete referral. CHW implication, or caregiver interpretation, of the need to monitor the child, and some prescription of ACT post RA administration, also confused the need for referral.
The full manuscript is available at BMC Health Services Research or can be downloaded from the CEPA website in PDF format. It concludes that community health worker advice should emphasise RA as providing temporary relief prior to facility-based treatment, the importance of referral whether or not a change is seen in the child’s condition, and the dangers of not completing referral. It suggests that social behaviour change communication, training and support supervision activities could help promote these messages.
To find out more about CEPA’s Global Health team and Clare’s availability, please contact Richard Rodger by email or T. +44 (0)20 7269 0210.