Malaria case management and associated factors for children under-five years at Abim and Kaabong General Hospitals in Karamoja Sub-Region, Uganda

Abstract

Introduction: Malaria still remains a global health concern, despite the availability of effective prevention and treatment measures. Inappropriate case management is one of the known risk factors for disease progression to severe states, complications and death. In Uganda, Karamoja sub-region has the highest prevalence of malaria in children under five and one of the highest malaria specific mortality rates but its malaria case management practices have not been elaborately studied. To address this gap in knowledge, malaria case management practices and associated factors for children under five in the sub-region were studied. Methods: A cross sectional study was conducted among 857 children under five years of age who presented with fever at two general hospitals in the sub-region between February and March 2020. Socio-demographic data was collected using interviewer administered questionnaires to the caretakers and health workers while hospital chart reviews were used for obtaining information on malaria case management practices. A generalized linear mixed methods adjusting for clustering and reporting robust standard errors was used for statistical analysis. Results: The overall prevalence of inappropriate case management was 37.5% (95%CI: 25.5- 51.1). The factors significantly associated with inappropriate case management included; study site (aPR=0.20, 95%CI: 0.11-0.36), increasing clinician’s years in practice (aPR=0.93, 95%CI: 0.88-0.98), attending clinician’s age (aPR=1.12, 95%CI: 1.04-1.21), no reported bed net use on the night prior to the visit (aPR=1.18, 95%CI: 1.00-1.39), and unavailability of recommended antimalarials on the day of visit (aPR=1.99, 95%CI: 1.78-2.24). Although training has been reported to significantly influence case management, our study found no significant association between the two. Conclusion: The prevalence of inappropriate malaria case management in the region is high with one in every three children being inappropriately managed. Inappropriate management was majorly contributed to by health system factors, which when improved upon may reduce malaria related mortalities in the region. Addressing these factors that influence case management is vital if we are to hit the national target of zero deaths from malaria.