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Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data.

Shah JA, Emina JB, Eckert E, Ye Y - Malar. J. (2015)

Bottom Line: A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001).Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

View Article: PubMed Central - PubMed

Affiliation: MEASURE Evaluation/ICF International, Rockville, MD, USA. jui.shah@icfi.com.

ABSTRACT

Background: Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment.

Methods: This study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.

Results: The percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8-4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7-66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1-38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001).

Conclusions: This study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

No MeSH data available.


Related in: MedlinePlus

Prompt treatment with ACT among children under five treated with any anti-malarial medicine—Chi square automatic interaction detector tree diagram, level 1. N number of children. The total line of each box represents the share of the total number of children who received any anti-malarial treatment
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Fig2: Prompt treatment with ACT among children under five treated with any anti-malarial medicine—Chi square automatic interaction detector tree diagram, level 1. N number of children. The total line of each box represents the share of the total number of children who received any anti-malarial treatment

Mentions: Country was the best predictor of access to prompt treatment with ACT (p value <0.0001) and therefore makes up the first level of the CHAID tree diagram. The analysis classified countries into six parent nodes that minimize variance of prompt and effective treatment within each node and maximize variance across nodes: (1) Angola, Ghana, and Zambia; (2) Kenya and Madagascar; (3) Liberia; (4) Malawi, Rwanda, Senegal, and Tanzania mainland; (5) Mozambique and Zanzibar; and, (6) Uganda. At the next levels of the CHAID tree diagram, these parent nodes were further split into child nodes by secondary and tertiary predictor variables, which were most commonly education of the mother or wealth quintile (Figs. 2, 3, 4, 5, 6, 7).Fig. 2


Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data.

Shah JA, Emina JB, Eckert E, Ye Y - Malar. J. (2015)

Prompt treatment with ACT among children under five treated with any anti-malarial medicine—Chi square automatic interaction detector tree diagram, level 1. N number of children. The total line of each box represents the share of the total number of children who received any anti-malarial treatment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4549012&req=5

Fig2: Prompt treatment with ACT among children under five treated with any anti-malarial medicine—Chi square automatic interaction detector tree diagram, level 1. N number of children. The total line of each box represents the share of the total number of children who received any anti-malarial treatment
Mentions: Country was the best predictor of access to prompt treatment with ACT (p value <0.0001) and therefore makes up the first level of the CHAID tree diagram. The analysis classified countries into six parent nodes that minimize variance of prompt and effective treatment within each node and maximize variance across nodes: (1) Angola, Ghana, and Zambia; (2) Kenya and Madagascar; (3) Liberia; (4) Malawi, Rwanda, Senegal, and Tanzania mainland; (5) Mozambique and Zanzibar; and, (6) Uganda. At the next levels of the CHAID tree diagram, these parent nodes were further split into child nodes by secondary and tertiary predictor variables, which were most commonly education of the mother or wealth quintile (Figs. 2, 3, 4, 5, 6, 7).Fig. 2

Bottom Line: A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001).Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

View Article: PubMed Central - PubMed

Affiliation: MEASURE Evaluation/ICF International, Rockville, MD, USA. jui.shah@icfi.com.

ABSTRACT

Background: Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment.

Methods: This study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.

Results: The percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8-4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7-66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1-38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001).

Conclusions: This study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

No MeSH data available.


Related in: MedlinePlus