Mothers and under five children’s characteristics
Six hundred and twenty-nine (99.8%) mothers or caregivers completed the interview of which 258 (41.1%) were employed, and 300 (47.7%) were living in rural communities. The median (interquartile range, IQR) age of mothers in the rural communities was higher 30 (IQR, 10) than the urban 27 (IQR, 6). Table 1 shows that 61.7% (185/360) of rural mothers had no education, but 45.3% (149/329) urban mothers had secondary level of education. There were significant differences in the rural and urban mothers’ age (p = 0.001), educational level (p = 0.001) and occupations (p = 0.001). The median age (IQR) of the children was 12 months (IQR, 12). Of the 629 children 56.4% (355/629) were males, 50.6% (318/629) were aged 1 – 12 months and 29.1% (183/629) aged 13 – 24 months.
Table 1: Sociodemographic characteristics of respondents by location of residence (Rural/Urban), Igabi LGA, Kaduna Nigeria (N = 629)
Characteristics
|
Rural
|
Urban
|
Total
|
Mother's age group (Years)
|
|
|
|
15 - 19
|
11 (3.7)
|
11 (3.3)
|
22 (3.5)
|
20 - 24
|
34 (11.3)
|
56 (17.0)
|
90 (3.5)
|
25 - 29
|
63 (21.0)
|
141 (42.9)
|
204 (32.4)
|
30 - 34
|
112 (37.3)
|
72 (21.8)
|
184 (29.3)
|
35 - 39
|
54 (18.0)
|
28 (8.5)
|
82 (13.0)
|
40 - 44
|
21 (7.0)
|
17 (5.2)
|
38 (6.0)
|
> 44
|
5 (5.5)
|
4 (4.4)
|
9 (1.4)
|
Tribe
|
|
|
|
Fulani
|
6 (02.0)
|
33 (10.0)
|
39 (6.2)
|
Hausa
|
276 (92.0)
|
254 (77.2)
|
530 (84.3)
|
Igbo
|
0 (0.0)
|
9 (2.7)
|
9 (1.4)
|
Yoruba
|
0 (0.0)
|
15 (4.6)
|
15 (2.4)
|
Others*
|
18 (6.0)
|
18 (5.4)
|
36 (5.7)
|
Educational level
|
|
|
|
None
|
185 (61.7)
|
70 (21.3)
|
255 (40.5)
|
Primary
|
90 (30.0)
|
54 (16.4)
|
144 (22.9)
|
Secondary
|
25 (8.3)
|
149 (45.3)
|
174 (27.6)
|
Tertiary
|
0 (0.0)
|
56 (17.0)
|
56 (8.9)
|
Occupation
|
|
|
|
Housewife
|
208 (69.3)
|
153 (42.4)
|
361 (57.5)
|
Trader
|
39 (13.0)
|
72 (21.9)
|
111 (17.6)
|
Civil servant
|
5 (1.7)
|
55 (16.7)
|
60 (9.5)
|
Craft/Artisan
|
20 (6.7)
|
34 (10.3)
|
54 (8.6)
|
Farmer
|
28 (9.3)
|
6 (1.8)
|
34 (5.4)
|
Student
|
0 (0.0)
|
9 (2.7)
|
9 (1.4)
|
*Nupe (8), Jaba (3), Ebira (3), Gwari (1), Kanuri (1), Mada (1) Shuwa arba(1)
Urban under-five children were younger, median age (IQR) was 12 (IQR 12) months compared to 24 (IQR 12) months in rural children.
Knowledge of malaria
Overall, 553 (87.9%) respondents knew that malaria is transmitted to humans through the bites of infected mosquito, 432 (68.7%) knew that malaria causing mosquitoes commonly feed on humans at night-time, 527 (83.8%) knew malaria symptoms, and 381 (60.6%) knew that malaria Rapid Diagnostic Testing kit and microscopy are useful in detecting if malaria causing organisms (parasites) is the cause of a fever. Of all the respondents, 342 (54.4%) mentioned that malaria can be prevented with the use of LLINs, indoor residual spray and mosquito repellent coils.
Table 2: Knowledge of malaria among respondents by location of residence (Rural/Urban), Igabi LGA, Kaduna Nigeria, (N = 629)
Knowledge Items
|
Rural
|
Urban
|
Total
|
Cause of malaria
|
|
|
|
Mosquito bite
|
145 (48.3)
|
212 (64.4)
|
357 (56.8)
|
Fever
|
17 (5.7)
|
0 (0.0)
|
17 (2.7)
|
Stagnant water, dirty environment,
|
21 (7.0)
|
32 (9.7)
|
53 (8.4)
|
No response
|
117 (39.0)
|
85 (25.8)
|
202 (32.1)
|
Malaria transmission route to humans
|
|
|
|
Bite of malaria infected mosquito
|
261 (87.0)
|
292 (88.7)
|
553 (87.9)
|
Through contaminated water and foods
|
9 (3.0)
|
22 (6.7)
|
31 (4.9)
|
Don't know
|
30 (10.0)
|
15 (4.6)
|
45 (7.2)
|
Malaria mosquito feeding time
|
|
|
|
Night-time
|
156 (52.0)
|
276 (83.9)
|
432 (68.7)
|
Both day and night-time
|
73 (24.3)
|
44 (13.4)
|
117 (18.6)
|
Day time
|
11 (3.7)
|
4 (1.2)
|
15 (2.4)
|
Don’t know
|
60 (20.0)
|
5 (1.5)
|
65 (10.3)
|
Malaria Symptoms
|
|
|
|
Headache
|
217 (72.3)
|
262 (79.6)
|
479 (76.1)
|
Fever
|
269 (89.7)
|
309 (93.9)
|
578 (91.9)
|
Shivering
|
162 (54.0)
|
119 (36.2)
|
281 (44.7)
|
Vomiting
|
164 (54.7)
|
188 (57.1)
|
352 (56.0)
|
Nausea
|
40 (13.3)
|
86 (26.1)
|
126 (20.0)
|
Dizziness
|
44 (14.7)
|
115 (34.9)
|
159 (25.3)
|
Loss of appetite
|
28 (9.3)
|
96 (29.2)
|
124 (19.7)
|
Diarrhoea
|
50 (16.7)
|
38 (11.5)
|
88 (14.0)
|
Malaria diagnosis
|
|
|
|
Testing blood with RDT
|
158 (52.7)
|
128 (38.9)
|
286 (45.5)
|
Symptomatically
|
58 (19.3)
|
134 (40.7)
|
192 (30.5)
|
Blood microscopy
|
47 (15.7)
|
48 (14.6)
|
95 (15.1)
|
Don’t know
|
37 (12.3)
|
19 (5.8)
|
56 (8.9)
|
Malaria Prevention
|
|
|
|
LLINs
|
108 (36.0)
|
144 (43.8)
|
252 (40.1)
|
Indoor Residual Spray
|
1 (0.3)
|
66 (20.1)
|
67 (10.5)
|
Use mosquito coil or repellent
|
51 (17.0)
|
90 (27.4)
|
141 (22.4)
|
Clearing of grasses/avoid breeding sites
|
197 (65.7)
|
228 (69.3)
|
425 (67.6)
|
Wearing long sleeve shirts
|
9 (3.0)
|
10 (3.0)
|
481 (76.1)
|
Knowledge of malaria
|
|
|
|
Good
|
114 (38.0)
|
121 (34.6)
|
268 (42,6)
|
Average
|
77 (25.7)
|
94 (26.9)
|
165 (26.2)
|
Poor
|
109 (36.3)
|
135 (38.5)
|
196 (31.2)
|
Fever occurrence in under-five children and mothers’ care seeking practice
Overall, 441 (70.0%) of the respondents reported any fever episode in last two weeks before survey among their under-five children but only 155 (35.2%) sought advice for care/treatment of fever within 48 hours of onset. Fever in last two weeks was commonly reported by mothers of under-five children in rural settlements 258/300 (86.0%) than the urban counterpart 183/329 (55.6%). But less rural mothers 63/258 (24.4%) than the urban counterpart 92/183 (50.3%) sought care or advice for fever within 48 hours of onset.
Of the 155 mothers who sought advice for care/treatment for fever within 48 hours of onset, 52 (33.5%) did home self-medication, 28 (18.1%) sought care at general hospital, 27 (17.4%) went to the pharmacy or patent medicine vendors’ shop, 17 (11.0%) visited private hospitals and 5 (3.2%) sought advice from traditional/herbal treatment home. More rural mothers, 195/258 (75.6%) compared to 91/183 (49.7%) from urban settlements did not seek advice or care for fever within 48 hours. Of the 155 mothers who sought advice for care or treatment for fever within 48 hours of onset, 115 (74.2%) were given drugs to treat fever or what was perceived to cause the fever, but only 17 (11.0%) had their children’s blood tested for malaria, and 11 (7.1%) had their children hospitalised following the fever episode (Table 3).
Table 3: Fever in under-five children and mothers’ care seeking practice for fever, Igabi LGA, Kaduna Nigeria.
Characteristics
|
Rural
|
Urban
|
Total
|
OR (95% C.I)
|
p Value
|
Child had fever (n = 629)
|
|
|
|
|
|
Yes
|
258 (86.0)
|
183 (55.6)
|
441 (70.0)
|
4.9 (3.3 - 7.3)
|
< 0.01
|
No
|
42 (14.0)
|
146 (44.4)
|
188 (30.0)
|
|
|
Total
|
300 (47.7)
|
329 (52.3)
|
629
|
|
|
Mother sought care within 48 hrs (n = 441)
|
|
|
|
No
|
195 (75.6)
|
91 (49.7)
|
286 (64.8)
|
3.1 (2.1 - 4.7)
|
< 0.01
|
Yes
|
63 (24.4)
|
92 (50.3)
|
155 (35.2)
|
|
|
Total
|
258 (58.5)
|
183 (41.5)
|
441
|
|
|
Child given drugs for fever (n = 155)
|
|
|
|
Yes
|
41 (65.1)
|
74 (80.4)
|
115 (74.2)
|
0.4 (0.2 - 0.9)
|
< 0.04
|
No
|
22 (34.9)
|
18 (19.6)
|
40 (25.8)
|
|
|
Total
|
63 (52.6)
|
92 (47.4)
|
155
|
|
|
Any nets in household for sleeping (n = 629)
|
|
|
|
Yes
|
269 (89.7)
|
228 (69.3)
|
497 (79.0)
|
3.8 (2.5 - 6.0)
|
< 0.01
|
No
|
31 (10.3)
|
101 (39.7)
|
132 (21.0)
|
|
|
Total
|
300 (47.7)
|
329 (52.3)
|
629
|
|
|
Factors associated with delayed care seeking for fever in U5 children
Women who lived in rural communities were three times more likely to delay seeking care compared to their urban counterpart (OR: 3.1, 95% CI: 2.1 – 4.7, p < 0.001) as shown in Table 4. Mothers with no formal education were twice more likely to delay care seeking for fever (OR: 1.8, CI: 1.2 – 2.7, p = 0.003) compared to those with formal education. Those who sees malaria as not a major health problem were thrice more likely (OR: 2.6, CI: 1.2 – 5.6, p = 0.01) to delay care seeking for fever in U5 and those having poor knowledge of cause of malaria were twice more likely to delay care seeking compared to mothers with good knowledge (OR: 1.7, CI: 1.1 – 2.5, p = 0.01). Those who had poor knowledge of malaria mosquitoes feeding time were twice more likely to delay care seeking for fever in U5 children (OR: 1.7, CI: 1.1 – 2.6, p = 0.01).
Table 4: Factors associated with delayed care seeking for fever by mothers of U5 children, Igabi LGA, Kaduna Nigeria. (N = 441)
Characteristics
|
Delayed care seeking
|
Total
|
95% CI
|
p Value
|
|
Yes
|
No
|
|
|
|
Mother’s age < 30 years
|
|
|
|
|
|
Yes
|
122 (59.8)
|
82 (40.2)
|
204
|
0.7 (0.4 – 0.9)
|
0.04
|
No
|
164 (69.2)
|
73 (30.8)
|
237
|
|
|
Type of community
|
|
|
|
|
|
Rural
|
195 (75.6)
|
63 (24.4)
|
258
|
3.1 (2.1 – 4.7)
|
< 0.01
|
Urban
|
91 (49.7)
|
92 (50.3)
|
183
|
|
|
Mother’s had formal education
|
|
|
|
|
|
No
|
150 (72.1)
|
58 (27.9)
|
208
|
1.8 (1.2 – 2.7)
|
< 0.01
|
Yes
|
136 (58.4)
|
97 (41.6)
|
233
|
|
|
Religion
|
|
|
|
|
|
Christianity
|
11 (78.6)
|
3 (21.4)
|
14
|
2.0 (0.6 – 7.4)
|
0.27
|
Islam
|
275 (64.4)
|
152 (35.6)
|
427
|
|
|
Malaria, a major health problem
|
|
|
|
|
No
|
40 (81.6)
|
9 (18.4)
|
49
|
2.6 (1.2 – 5.6)
|
0.01
|
Yes
|
246 (62.8)
|
146 (37.2)
|
392
|
|
|
Mothers knows what causes malaria
|
|
|
|
No
|
137 (71.4)
|
55 (28.6)
|
192
|
1.7 (1.1 – 2.5)
|
0.01
|
Yes
|
149 (59.8)
|
100 (40.2)
|
249
|
|
|
Mothers knows mode of malaria transmission
|
|
|
|
No
|
27 (57.4)
|
20 (42.6)
|
47
|
0.7 (0.4 – 1.3)
|
0.26
|
Yes
|
259 (65.7)
|
135 (34.3)
|
394
|
|
|
Mothers knows mosquitoes feeding time
|
|
|
|
No
|
111 (72.5)
|
42 (27.5)
|
153
|
1.7 (1.1 – 2.6)
|
0.01
|
Yes
|
175 (60.8)
|
113 (39.2)
|
288
|
|
|
Mothers knows malaria symptoms
|
|
|
|
No
|
232 (65.9)
|
120 (34.1)
|
352
|
1.3 (0.7 – 2.0)
|
0.35
|
Yes
|
54 (60.7)
|
35 (39.3)
|
89
|
|
|
Mothers knows how to detect if fever is caused by malaria
|
|
|
No
|
189 (66.5)
|
95 (33.5)
|
284
|
1.2 (0.8 – 1.8)
|
0.32
|
Yes
|
97 (61.8)
|
60 (38.2)
|
157
|
|
|
Mothers knows malaria prevention measures
|
|
|
|
No
|
142 (61.2)
|
90 (38.8)
|
232
|
0.7 (0.4 – 1.0)
|
0.09
|
Yes
|
144 (68.9)
|
65 (31.1)
|
209
|
|
|
Total
|
286 (64.9)
|
155 (35.1)
|
441
|
|
|
Overall, the observed significant associations between mothers’ characteristics and delayed care seeking for fever was modified by rural – urban community stratification. On stratification, among the urban mothers, the perception that malaria is not a major health problem (OR: 2.1, CI: 1.4 – 3.1) and not knowing the cause of malaria (OR: 1.7, CI: 1.1 – 2.5) were the significant factors associated with delayed care seeking for fever in U5. But in rural dwelling mothers, those who did not know the mode of malaria transmissions were 70% less likely to delay care seeking for fever (OR: 0.3, CI: 0.2 – 0.7).
The predictors of mothers delaying seeking care for fever were rural location and mothers’ perception that malaria is not transmitted to human through mosquito bites. Mothers in rural settlements were about thrice more likely to delay care seeking for fever in U5 children (adjusted OR: 2.7, CI: 1.8 – 4.2, p < 0.01). Finally, mothers who lacked the knowledge of malaria transmissions to humans were 60% less likely to delay seeking care for fever in U5 children (adjusted OR: 0.4, CI: 0.2 – 0.8, p = 0.02).