Malaria control and prevention among the under five children in slums: A case of Bwaise.

Abstract

Malaria is the leading killer disease to the extent that every year there are 300-500 million cases and about 1 million deaths in children under the age of five, 90% of which occurs in sub Saharan Africa. Research reveals that annually malaria claims between 70,000 to 110,000 lives in Uganda; approximately 320 people every day, most of whom are pregnant women and children below the age of five years. Aware of the critical danger that malaria imposes on the population of Uganda, notably, the under five children. This study took the initiative to investigate malaria control and prevention among the under five children in slum areas. The study utilized a cross sectional study design by applying both the quantitative and qualitative methods to collect data from the mothers of the under-five, health workers, local leaders and opinion leaders. The primary informants were the mothers of the under-five who provided the quantitative data whereas the key informants were health workers, leaders and opinion leaders. Four (4) Focus Group Discussions (FDG) were also conducted to provide enough qualitative data. For triangulation purposes both the qualitative was needed to supplement the quantitative findings. The study was carried out in Kawempe division, in the parishes of Bwaise I and II because of the uniqueness of the slum and malaria endemic features in those areas. The study interviewed 110 mothers to generate primary data, while 4 Focus group discussions conducted and 17 key informants interviewed to obtain qualitative data. The findings reveal that most mothers (55.5%) mainly because of their low income, they take their children to health centres. However, 86% reported that health centres are faced with a problem of malaria drug stock out which greatly affects the treatment of malaria struck under five children. As a result almost 46% (41.4) of the mothers use drugs purchased from drug shops for their children before consulting any health worker. The study found out that chloroquine (35.5%) was the common drug used by the mothers for their children, given that on open market coartem as a first line drug recommended for malaria treatment is very expensive for the urban poor mother. The results also indicated that there is limited utilization of malaria preventive measures were 35% used ordinary mosquito nets as only 20% use ITNs. When interviewed, 45% of the mothers were not in possession of a mosquito net, which shows low coverage among the urban poor. There was no evidence to show that IRS is applied in Bwaise slum, yet in urban areas, the slum population remains the most vulnerable to malaria, particularly Kampala. Since malaria is curable and at the same time preventable, the Health Belief model indicated that the perceived susceptibility and severity by the mother of the under-five children was found to be relatively low to pose significant danger which can influence an effective positive malaria prevention behaviors and treatment seeking. Generally, there is a conviction that the urban population is better off when it comes to the control and prevention of malaria, without considering the conditions and the health needs of the urban poor. The study reveals that most of the malaria treatment for the under-five is conducted in public health facilities which experience drug stock outs and high patients tern-up due to the free service available and as such a bigger percentage of the malaria struck children fail to get the adequate treatment, yet, the utilization of the Mosquito nets is still low among the urban poor in slums. It is therefore important that greater efforts are made to reduce drug stock in government hospitals, promote effective and efficient home based treatment and also re-emphasize public health concerns at the community level into the malaria control and prevention programme.