Understanding caretakers' dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate

Malaria Journal

Research

Deodatus C Kakoko¹  Daudi O Simba²  Zul Premji³  Marian Warsame⁴  Goran Tomson⁵  Eva Johansson⁶  Melba F Gomes⁷ 

[1] Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Division of Global Health [IHCAR], Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Department of Medical Parasitology and Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Division of Global Health [IHCAR], Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Division of Global Health [IHCAR], Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Medical Management Centre [MMC], Karolinska Institutet, Stockholm, Sweden;Division of Global Health [IHCAR], Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Nordic School of Public Health, Gothenberg, Sweden;UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases [TDR], Geneva, Switzerland;

关键词: Malaria;    Health Facility;    Male Participant;    Severe Malaria;    Artesunate;   

DOI  :  10.1186/1475-2875-9-123

 received in 2009-12-31, accepted in 2010-05-12,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundMalaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate.MethodsFour focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis.ResultsThe theme "Caretakers dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate" depicts the challenge they face. Caretakers' understanding of the rationale for going to hospital after treatment - when and why they should adhere - influenced adherence. Caretakers, whose children did not improve, usually adhered to referral advice. If a child had noticeably improved with pre-referral treatment however, caretakers weighed whether they should proceed to the facility, balancing the child's improved condition against other competing priorities, difficulties in reaching the health facilities, and the perceived quality of care at the health facility. Some misinterpretation were found regarding the urgency and rationale for adherence among some caretakers of children who improved which were attributed to be possibly due to their prior understanding.ConclusionSome caretakers did not adhere when their children improved and some who adhered did so without understanding why they should proceed to the facility. Successful implementation of the rectal artesunate strategy depends upon effective communication regarding referral to clinic.

【 授权许可】

CC BY   
© Simba et al; licensee BioMed Central Ltd. 2010