Malaria is the single, biggest cause of childhood mortality in Uganda. Efforts to
increase access to first-line treatment, artemisinin-based combination therapies (ACTs),
for uncomplicated malaria have had a significant impact on their uptake. However, many
people continue to engage in self-treatment and rely on non-ACT antimalarials. This
dissertation aims to explore the facilitators and barriers to appropriate treatment-seeking
behaviors and outcomes for childhood malaria in eastern Uganda.
A synthesis of existing literature indicates that self-treatment is the preferred first
step in the illness resolution process for suspected malaria, including treating suspected
malaria with drugs stored at home or from a local drug shop. Initiating treatment in the
formal sector is associated with receiving first-line treatment for malaria. Illness severity
emerges as a primary determinant of seeking immediate care in a formal healthcare
facility. Access and local illness concepts are identified as significant barriers to seeking
appropriate, timely treatment. Overall, there existed a lack of complexity in the types of
predictors used in previous research.
A quantitative analysis was conducted to understand determinants of seeking care
at various levels of the healthcare system. Attitudes and knowledge were associated with
seeking care outside of the household. Illness severity and access were the most salient
predictors of initiating care at a formal healthcare facility.
A multilevel analysis explored the determinants of treatment outcomes for
uncomplicated malaria, mainly use of first-line, nationally-recommended drugs.
Caretakers continue to rely on non-ACT antimalarials for severe illness, children under
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five, and confirmed malaria. High levels of malaria knowledge and perceived efficacy in
malaria-related services were associated with ACT-use.
Findings from this research indicate that caretakers of young children continue to
rely on self-treatment for non-serious malarial illness. Efforts should continue to maintain
increased access to ACTs, especially in rural areas. National malaria control strategies
and behavior change campaigns must target consumers to increase consumer utilization
of formal healthcare facilities where diagnostics are available and encourage their sale in
local drug shops. Education campaigns are recommended to increase treatment guideline
awareness, malaria knowledge, and perceived efficacy in ACTs as well as malaria-related
services within the healthcare system.