Be quick – seeking care for life threatening malaria in southern Tanzania

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 suggestthat a barrier exists in the pathway to effective care in Tanzania. Around 90percent of Tanzanians live within one hour of government health services, wherecare for children under five years old is free. Do parents, relatives and othercarers use these services when children develop malaria and can they get accessto them in time?

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

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

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

This study shows that traditional remedies are no longer asignificant delaying factor in accessing modern treatment for life-threateningmalaria in Tanzania. At the time of this study, all government providers in Rufiji had adequate drug supplies and offered integratedmanagement of childhood illness (IMCI). This could be a factor in thepopularity of government providers. However, the first line anti-malarial inuse was chloroquine for which drug resistance wascommon.

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

• focusing public messages on improving earlyrecognition of malaria and severe malaria and improving promptness of treatmentseeking
• improving quality of modern care in public,private and NGO sectors
• simplifying andreinforcing patient adherence to modern treatments.