Factors associated with children's health facility visits for primaquine treatment in rural Papua New Guinea

• Published in: Malaria journal Vol. 18; no. 1; p. 42
• Main Authors: Yoshii, Akiko, Sekihara, Makoto, Furusawa, Takuro, Hombhanje, Francis, Tsukahara, Takahiro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.02.2019; BioMed Central; BMC
• Subjects: Access; Analysis; Antimalarials; Blood; Case management; Child; Child health; Children; Childrens health; Continuity of patient care; Data collection; Dehydrogenases; Diagnosis; Drug therapy; Economics; Epidemiology; Glucose; Health facilities; Health service accessibility; Health services; Households; Human diseases; Malaria; Medical diagnosis; Medical treatment; Patient compliance; Patients; Policies; Primaquine; Principal components analysis; Regression analysis; Rural areas; Studies; Surveying; Therapeutic uses; Transportation; Tuberculosis; Vector-borne diseases; Vivax malaria; Papua New Guinea; Asia; Africa; Continuity of patient care; Health service accessibility; Patient acceptance of health care; Antimalarials; Therapeutic uses; Appointments and schedules; Child; Patient compliance; Vivax malaria
• DOI: 10.1186/s12936-019-2675-4
• ISSN: 1475-2875

To control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective. A community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria. Of 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF. Few children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment.