Research Article: Factors Associated with Testing and Prompt Use of Recommended Antimalarials following Malaria Diagnosis: A Secondary Analysis of 2011-12 Tanzania HIV and Malaria Indicator Survey Data

Date Published: July 17, 2015

Publisher: Public Library of Science

Author(s): Juma Adinan, Damian J. Damian, Sia E. Msuya, Clive Shiff.


Malaria is still a public health problem in Sub-Saharan Africa. Malaria causes mortality mostly in children under-five years. Early detection and prompt treatment using recommended antimalarials is key to malaria control. However, in Tanzania, contrary to the national goals, a large proportion of children with fever taken to health facilities are not tested for malaria and those tested positive are not promptly treated using recommended antimalarials. The aim of this study was to determine factors associated with malaria testing and prompt use of recommended antimalarials among under-five children with fever in Tanzania.

This was a secondary analysis of Tanzania HIV and Malaria Indicator Survey (THMIS) data 2011-12 obtained from a national cross sectional survey. The analysis involved children aged 6-59 months whose mothers reported they had fever two weeks preceding the survey. Factors associated with testing and uses of recommended antimalarials were obtained using logistic regression.

Of the 1675 under-five children with fever, 951 (56.8%) were taken to the health facilities. Of the 951 children, only 394 (41.48%) febrile children were tested for malaria. Of those tested, 291 (78.91%) were diagnosed with malaria. Of those diagnosed with malaria, only 124 (42.68%) children used recommended antimalarials within 1st 24 hours of diagnosis. In multivariate analysis, children taken to health centers (OR 1.79; 95%CI: 1.07 – 3.00) and to the hospitals (OR 3.4; 95%CI: 1.75 – 6.77) had higher odds of being tested compared to those taken to dispensary and other lower level health facilities. Children were more likely to use recommended antimalarial promptly if they had a caretaker with secondary or higher education (OR: 4.07; 95%CI: 0.61 – 2.68) or living in the rural area (OR: 3.21; 95%CI: 1.09 – 9.44) compared to those with an uneducated caretaker or from an urban area.

Training on malaria testing and treatment guidelines should be provided, and preventing stock outs of malaria testing kits and medications at dispensary level should be made available as it is the first point of health care for most Tanzanians. Reasons on why urban people are less likely to use recommended antimalarials need to be investigated and addressed for proper malaria management.

Partial Text

Malaria is still a public health problem especially in SSA [1]. It kills mostly children under-five years. In Tanzania malaria is the second cause of under-five morbidity and mortality, contributing to 10% of under-five mortality [2]. Malaria symptoms overlap with other microbial and viral diseases. However, fever, in malaria endemic areas is the key symptom to offer malaria treatment [3]. The WHO malaria treatment guideline recommends that parasitological confirmation should be done on all suspected malaria cases. Those found positive, should be treated promptly (within 24 hours of diagnosis) using recommended antimalarials [4]. It is therefore important for caretakers of children with fever to take their children to health facilities where malaria testing can be done. Malaria is a preventable and treatable disease, however if not timely diagnosed and treated uncomplicated malaria progresses to severe malaria which often leads to death [5].

This is a secondary analysis of data from Tanzania HIV and Malaria indicator survey (THMIS) 2011–2012 which is the third and most recent in a series of national sample surveys that aims to estimate the key indicators of malaria and HIV for each Tanzania’s region.

This study determined factors associated with testing and prompt use of recommended antimalarials. The results show that still there is substantial number of febrile children under-five years that are not tested for malaria despite being taken to the health facilities and very few of those diagnosed with malaria use recommended antimalarials and within recommended time.