Prompt treatment with relatively cheap and effective drugs can prevent deaths from malaria. So why does this disease still cause more deaths than any other throughout Tanzania? The growth in the use of modern medicines has reduced the delaying impact of traditional remedies. The introduction of the 'integrated management of childhood illness' approach, which focuses on the overall wellbeing of a child, is crucial in reducing malaria deaths

The persistently high mortality rates from malaria suggest that a barrier exists in the pathway to effective care in Tanzania. Around 90 percent of Tanzanians live within one hour of government health services, where care for children under five years old is free. Do parents, relatives and other carers use these services when children develop malaria and can they get access to them in time?

This research by the Tanzanian Ministry of Health's Essential Health Intervention Project (TEHIP) looks at care-seeking for 320 children under five who died from malaria in the Rufiji District of Coast Region, southern Tanzania. The results from a demographic surveillance system with follow-up for all deaths revealed that:

• Convulsions (fits – an indicator of cerebral malaria) are seen in 9.4 percent of fatal cases. Tanzanians see these convulsions as a different disease - ‘degedege’, with different causes.
• While people see ‘malaria’ as an illness that they can manage at home, using modern medicine from shops and health facilities, ‘degedege’ is a life-threatening condition for which they must quickly seek treatment.
• Modern medical care is the first resort in 79 percent of malaria-attributable deaths; 9 percent use traditional care, at home or from traditional practitioners; 12 percent do not seek care at all.
• Government health workers are the most common providers of modern care (45 percent) followed by home care with anti-malarials from shops (20 percent).
• These patterns are unrelated to the sex of the child or of the head of the household, socioeconomic status or presence of convulsions. But cases with convulsions are less likely to receive no care at all.

More than half of cases seek care two or more times for the same illness from different types of provider. This is more common with convulsions. In malaria deaths where care is accessed more than once, modern care is the first or second resort for at least 90 percent of cases.

This study shows that traditional remedies are no longer a significant delaying factor in accessing modern treatment for life-threatening malaria in Tanzania. At the time of this study, all government providers in Rufiji had adequate drug supplies and offered integrated management of childhood illness (IMCI). This could be a factor in the popularity of government providers. However, the first line anti-malarial in use was chloroquine for which drug resistance was common.

Most care-givers now include modern care early in their search for treatment for eventually severe and fatal malaria. And yet many children are still dying. The recent introduction of IMCI into the study area and replacement of chloroquine with sulfadoxine-pyrimethamine as the first-line drug treatment are important steps to reduce malaria mortality. The researchers also recommend:

• focusing public messages on improving early recognition of malaria and severe malaria and improving promptness of treatment seeking
• improving quality of modern care in public, private and NGO sectors
• simplifying and reinforcing patient adherence to modern treatments.

Source(s):
‘Care-seeking patterns for fatal malaria in Tanzania’, Malaria Journal 3: 27 by D. de Savigny et al, 2004 Full document.
Tanzania Essential Health Interventions Project (TEHIP) Full document.

Funded by: International Development Research Centre, Canada; UK Department for International Development; US Centers for Disease Control; National Academy of Sciences, Institute of Medicine

id21 Research Highlight: 31 March 2005

Further Information:
Don de Savigny
Swiss Tropical Institute
Basel 4002
Switzerland

Tel: +41 61 284 8160
Fax: +41 61 284 8105
Contact the contributor: d.desavigny@unibas.ch

Tanzania Essential Health Intervention Project

Tanzania Ministry of Health

International Development Research Centre (IDRC), Canada

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'Like mother, like child? Impact of maternal anaemia on infant survival in Tanzania'

'Managing childhood illness: how effective is IMCI in Tanzania?'

'Young, poor and sick: socioeconomic inequities and child health in rural Tanzania'

'Danger in disguise – spotting the warning signs of severe childhood illnesses'

'Danger signs: when to seek treatment for sick children in rural India'