EXAMINING CHILD MALARIA DIAGNOSIS AND TREATMENT PRACTICES AT AN OUTPATIENT CLINIC IN SOUTHWEST NIGERIA
Open Access
- Author:
- Iwelunmor, Juliet
- Graduate Program:
- Biobehavioral Health
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- January 27, 2011
- Committee Members:
- Collins O Airhihenbuwa, Dissertation Advisor/Co-Advisor
Collins O Airhihenbuwa, Committee Chair/Co-Chair
Rhonda Belue, Committee Member
Marianne Messersmith Hillemeier, Committee Member
Gary King, Committee Member
Edward A Smith, Committee Member - Keywords:
- Malaria
diagnosis
treatment
outpatient clincs - Abstract:
- Funded by the Eunice Shriver National Institute of Child Health and Human Development, this dissertation examined factors that influence the diagnosis and treatment of child malaria in a clinical setting in southwest Nigeria. If Millennium Development Goal 6-–to halt and reverse malaria incidence by 2015 particularly among children––is to be achieved, all factors that affect malaria reduction among children living in endemic countries must be identified. These factors are individual (maternal or physician characteristics), sociocultural (perceptions and beliefs) and contextual(availability of antimalaria drugs and malaria rapid diagnostic tests). Moreover, a firm understanding of the impact of these factors on diagnosis and treatment practices will substantially contribute to the success of malaria control in sub-Saharan Africa. A mixed method of qualitative and quantitative research methods were used in this study. They included: observations, semi-structured interviews, informal discussions, field notes, and the collection of finger prick blood samples for malaria rapid diagnostic tests. Paper 1 describes a study involving the use of the PEN-3 cultural model to identify mothers’ positive health beliefs and practices associated with treatment-seeking for child febrile illness, to examine existential (unique) practices indigenous to mothers that have no harmful health consequences, and to explore negative beliefs and practices that limit recommended responses to febrile illness in children. The study presented in Paper 2 examined the concordance among physician’s diagnosis of malaria, mother’s perception of child malaria, and the results of malaria rapid diagnostic tests. In Paper 3, the Health Access Livelihood Framework was used to explore how services provided at an outpatient clinic in southwest Nigeria enabled and/or discouraged effective diagnosis and treatment of child malaria. Despite more than 100 years of control and eradication efforts, malaria remains one of the primary health problems encountered by children in sub-Saharan Africa. While there is increasing optimism about new opportunities for improved malaria control and possibly elimination, the success of such strategies is based on an understanding of the individual, socio-cultural, and contextual factors that influence effective case-management of malaria among children. Simply put, promising advances in malaria rapid diagnostic tests, or new drugs and vaccines to combat parasite resistance as well as other interventions, may have no effect if the same vigor is not applied to understanding the contexts in which human behaviors occur. Study findings illustrate the importance of understanding the multiple factors that influence diagnosis and treatment of malaria in children at an outpatient clinic. Incorporating knowledge of these factors into efforts aimed at controlling malaria is fundamental to effective case management of child malaria in sub-Saharan Africa.