Local Management Of Childhood Malaria In The Manya Krobo District Of Ghana

ABSTRACT

Malaria has been identified as the single most important infectious disease in children, being responsible for the death of about one million children per year or 25 percent o f all childhood deaths worldwide. Most clinical cases of the disease occur in sub-Saharan Africa. Malaria may also contribute to the severity of other childhood diseases and repeated infections can be a cause of chronic anaemia in children due to their relatively weak immune system. About one million children under five suffer from malaria in Ghana; malaria leads to 45 deaths of children under five every day (MOH, 2003). The health burden of malaria has far-reaching implications for child health and survival. Apart from the morbid and socio-economic impact of the disease on children and their carers, death of children under five resulting from malaria has been increasing in Ghana over the years. This is reflected in the infant and under five mortality rate for Ghana from 1999-2003 (GDHS, 2003). Adoption of new strategies to combat malaria based on increased participation of all stakeholders and improved case management requires in-depth appreciation of carers perception and management of childhood malaria episode. The main thrust of the thesis is to investigate how mothers/carers perceived and managed childhood malaria. In furtherance o f this main objective, the study xvassessed mother’s perception/knowledge of the aetiology and transmission of malaria; investigated actions taken during episodes of childhood malaria; examined factors influencing choice of treatment outlets and ascertained practices on malaria prevention. The study combined both quantitative (survey) and qualitative (Focus Group Discussion) methods in collecting necessary data. A sample size of 230 was used in the survey. Manya Krobo District was selected for the study not only for the endemicity of malaria in that area but also for the fact that it has a very high disease burden including HIV/AIDS. Results of the study show that although respondents are familiar with common signs and symptoms of malaria in children, they generally do not consider childhood convulsion as a manifestation of severe malaria. Regarding the aetiology of childhood malaria, the study found that some respondents attribute it to mosquito bite only while others attribute it to both mosquito bite and other natural and environmental factors such as exposure to excessive heat, playing or walking in the sun, eating oily food, poor nutritional intake and exposure to cold weather condition. Concerning choice of treatment outlet, the majority prefers reporting their child’s conditions to operators of drug retail outlets for appropriate. Accessibility and lower cost o f drugs were some of the consideration for consulting drug retail outlets. Treatment sought is also influenced by individual characteristics such as level of education, income, access to health care and advice from lay referrals. It was also found that the majority of respondents believed that malaria could be prevented by avoiding mosquito bites, avoiding oily foods and protecting oneself from the heat o f the sun, among others. The use of Insecticide Treated Mosquito Nets (ITMN) was found to be very low. Malaria control effort should, therefore, take into account the multi-dimensional human contexts that create and support varying notions of malaria and its prevention, treatment and control. In this context;

• Public health education on malaria should be intensified by relevant agencies, especially, at the community level.

• Stakeholders at all levels must also be included in the malaria control programme.

• The exemption policy for treatment of malaria in children under five must be fully implemented to facilitate assess to health care facilities.

• Government and other stakeholders should subsidize the cost of the ITMN.

• District Assemblies must endeavour to support the implementation of malaria control programmes, provide necessary human and material resources for effective waste management while ensuring the enforcement o f sanitary regulations and by-laws.