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Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study

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Kabaghe, Alinune Nathanael, Chipeta, Michael Give, McCann, Robert Sean, Terlouw, Anja, Tizifa, Tinashe, Truwah, Zinenani, Phiri, Kamija Samuel and van Vugt, Michele (2018) 'Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study'. Malaria Journal, Vol 17, Issue 104.

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Abstract

Background
Despite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities.
Methods
One year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015 –April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6-59 months and women aged 15-49 years and IPTp uptake (for women aged 15-49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models.
Results
A total of 2046 participants were included from 1328 households; 56.6% were women aged 15-49 years and 43.4% were children aged 6-59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3% and 33.5% compared to 70.2% and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6% and 19.5% sought care and sought care within 24 hours, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI: 0.53 (0.35 - 0.81)]. Uptake of two and three or more doses of IPTp were 40.6% and 15.0%, respectively, among women with a pregnancy in the last two years.
Conclusion
To achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1186/s12936-018-2253-1
Depositing User: Stacy Murtagh
Date Deposited: 01 Jun 2018 08:36
Last Modified: 01 Jun 2018 08:36
URI: http://archive.lstmed.ac.uk/id/eprint/8713

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