Mothers and U5 children’s characteristics
Of the sampled 630 mothers-child pairs, 629 (99.8%) completed the interview and were included in the analysis, 258 (41.1%) were employed, and 300 (47.7%) were living in rural communities. Rural mothers were older, the median age (interquartile range, IQR) was 30 years (IQR, 10) to 27 years (IQR, 6) of their urban counterpart. Also, more rural mothers had no education with 61.7% (185/360) versus 21.3% (70/329) in urban mothers, but 61.7.% (203/329) of the later had secondary level education compared to 38.3% (115/300) rural mothers. Rural mothers were significantly different from the urban mothers in age (p = 0.001), educational level (p = 0.001) and occupations (p = 0.001). The median age (IQR) of the U5 children was 12 months (IQR, 12). Urban children were younger, with median age (IQR) 12 months (IQR 12), while the median age of rural children was 24 months (IQR 12) months. Male children were 56.4% (355/629).
Knowledge of malaria
Overall, 139 (22.1%) respondents have good malaria knowledge and no significant difference (p = 0.05) in the knowledge of malaria between the rural and urban women. However, on each malaria knowledge items, 553 (87.9%) mothers knew that malaria is transmitted to humans through the bites of infected mosquitoes, 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 RDT kit and/or microscopy are useful in detecting if malaria-causing organisms (parasites) is the cause of a fever, and malaria prevention with the use of LLINs, IRS and mosquito repellent coils were mentioned by 342 (54.4%) mothers. There was a significant difference between the rural and urban mothers on the malaria knowledge items as shown in Table 1. More urban women, 276 (83.9%) versus 156 (52.0%) rural women knew that malaria mosquitoes feeding time was night-time. However, less urban mothers, 128 (38.9%) compared to 158 (52,7%) rural mothers knew that testing of blood with malaria RDT to detect malaria parasite as the cause of fever in U5 children is necessary before antimalaria medication. Associated with mothers’ poor knowledge of malaria was having no formal education (OR: 1.8, 95% CI: 1.3-2.6, p <0.001) and the perception of malaria as not a major health problem in the community (OR: 2.5, 95% CI: 1.5-4.4, p = 0.001).
Table 1 Knowledge of malaria among respondents by location of residence (rural/urban), Igabi LGA, Kaduna Nigeria, (N = 629)
Knowledge characteristics
|
Rural
(n = 300)
|
Urban
(n = 329)
|
|
|
Overall knowledge of malaria
|
|
|
Chi Square
|
p-value
|
Good
|
54 (38.8)
|
85 (61.2)
|
5.9
|
0.05
|
Average
|
102 (48.8)
|
107 (51.2)
|
|
|
Poor
|
144 (51.3)
|
137 (48.7)
|
|
|
Malaria transmission route to humans
|
|
|
|
Bite of malaria infected mosquito
|
261 (87.0)
|
292 (88.8)
|
10.9
|
< 0.01
|
Do not know
|
30 (10.0)
|
15 (4.5)
|
|
|
Through contaminated water/foods
|
9 (3.0)
|
22 (6.7)
|
|
|
Malaria mosquito feeding time
|
|
|
|
|
Both day and night-time
|
73 (24.3)
|
44 (13.4)
|
89.2
|
< 0.01
|
Day time
|
11 (3.7)
|
4 (1.2)
|
|
|
Do not know
|
60 (20.0)
|
5 (1.5)
|
|
|
Night-time
|
156 (52.0)
|
276 (83.9)
|
|
|
Malaria diagnosis
|
|
|
|
|
Blood microscopy
|
47 (15.7)
|
48 (14.6)
|
37.8
|
< 0.01
|
Do not know
|
37 (12.3)
|
19 (5.8)
|
|
|
Symptomatically
|
58 (19.3)
|
134 (40.7)
|
|
|
Testing blood with malaria RDT
|
158 (52.7)
|
128 (38.9)
|
|
|
Malaria symptoms (Yes/No) reference, No
|
|
OR (95% C.I)
|
p-value
|
Fever
|
269 (89.7)
|
309 (93.9)
|
0.6 (0.3 – 1.0)
|
0.07
|
Headache
|
217 (72.3)
|
262 (79.6)
|
0.7 (0.5 – 0.9)
|
0.04
|
Vomiting
|
164 (54.7)
|
188 (57.1)
|
0.9 (0.7 – 1.2)
|
0.59
|
Shivering
|
162 (54.0)
|
119 (36.2)
|
2.1 (1.5 – 2.8)
|
< 0.01
|
Diarrhoea
|
50 (16.7)
|
38 (11.5)
|
1.5 (0.9 – 2.4)
|
0.08
|
Dizziness
|
44 (14.7)
|
115 (35.0)
|
0.3 (0.2 – 0.5)
|
< 0.01
|
Nausea
|
40 (13.3)
|
86 (26.1)
|
0.4 (0.3 – 0.7)
|
< 0.01
|
Loss of appetite
|
28 (9.3)
|
93 (29.2)
|
0.2 (0.1 - 0.4)
|
< 0.01
|
Malaria prevention (Yes/No) reference, No
|
|
|
|
Clearing of grasses/breeding sites
|
197 (65.7)
|
228 (69.3)
|
0.8 (0.6 - 1.2)
|
0.37
|
Use Long Lasting Insecticidal Nets
|
108 (36.0)
|
144 (43.8)
|
0.7 (0.5 - 1.0)
|
0.05
|
Use mosquito coil or repellent
|
51 (17.0)
|
90 (27.4)
|
0.5 (0.4 - 0.8)
|
< 0.01
|
Wearing long sleeve shirts
|
9 (3.0)
|
10 (3.04)
|
1 (0.4 - 2.5)
|
1.00
|
Indoor residual spray
|
1 (0.3)
|
66 (20.1)
|
0.01 (0.0 - 0.1)
|
< 0.01
|
Fever occurrence in U5 children and mothers’ care-seeking practice
Of the 441 (70.0%) U5 children with fever episode in previous two weeks before survey, mothers sought care within 48 hours of onset for 155 (35.2%). In Table 2, fever in previous two weeks in U5 children was more commonly reported by rural mothers 258/300 (86.0%) compared to 183/329 (55.6%) urban mothers. In contrast, fewer rural mothers 63/258 (24.4%) compared to 92/183 (50.3%) urban mothers sought care for fever within 48 hours of onset. Of the 155 mothers who sought care 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 vendor’s shop, 17 (11.0%) visited private hospitals and 5 (3.2%) sought advice from religious leaders and traditional/herbal treatment home. Among those that sought care, 70 (45.2%) were given artemisinin-based combination therapy (ACT) to treat fever, 48 (31.0%) U5 children had their blood tested for malaria parasite, and 94 (60.6%) was hospitalized (Table 2).
Table 2 Fever in U5 children and mothers’ care-seeking practice for fever, Igabi LGA, Kaduna Nigeria.
|
Rural
|
Urban
|
|
|
Characteristics
|
(n = 300)
|
(n = 329)
|
OR (95% C.I)
|
p value
|
Child had fever (n = 629)
|
|
|
|
|
Yes
|
258 (86.0)
|
183 (55.6)
|
4.9 (3.3 - 7.3)
|
< 0.01
|
No
|
42 (14.0)
|
146 (44.4)
|
Ref
|
|
Mother sought care < 48 hours (n = 441)
|
|
|
No
|
195 (75.6)
|
91 (49.7)
|
3.1 (2.1 - 4.7)
|
< 0.01
|
Yes
|
63 (24.4)
|
92 (50.3)
|
Ref
|
|
Had recommended care (n = 155)
|
|
|
|
Yes
|
28 (44.4)
|
20 (21.7)
|
2.9 (1.4 -5.8)
|
0.00
|
No
|
35 (55.6)
|
72 (78.3)
|
Ref
|
|
Child blood tested for malaria (n = 155)
|
|
|
|
Yes
|
28 (44.4)
|
20 (21.7)
|
2.9 (1.4 - 5.8)
|
0.01
|
No
|
35 (55.6)
|
72 (78.3)
|
Ref
|
|
Child given drugs (n = 155)
|
|
|
|
Yes
|
57 (90.5)
|
87 (94.6)
|
0.5 (0.2 -1.9)
|
0.51
|
No
|
6 (9.5)
|
5 (5.4)
|
Ref
|
|
Child hospitalised (n = 155)
|
|
|
|
Yes
|
36 (57.1)
|
58 (63.0)
|
0.8 (0.4 - 1.5)
|
0.57
|
No
|
27 (42.9)
|
34 (37.0)
|
Ref
|
|
Where care was sought for fever (n = 441)
|
|
Chi Square
|
p value
|
Health facility
|
28 (10.8)
|
38 (20.8)
|
36.5
|
< 0.01
|
Religious leaders, Herbal
|
2 (0.8)
|
8 (4.4)
|
|
|
Pharmacy store/Patent Med. Vendors
|
15 (5.8)
|
12 (6.5)
|
|
|
Self-treatment at home
|
18 (7.0)
|
34 (18.6)
|
|
|
Not seek help
|
195 (75.6)
|
91 (49.7)
|
|
|
Type of malaria drugs given (n = 155)
|
|
|
Artemisinin-based combination therapy
|
36 (57.1)
|
34 (37.0)
|
7.1
|
0.03
|
Sulphadoxine/pyrimethamine
|
22 (34.9)
|
52 (56.5)
|
|
|
No Antimalaria drugs
|
5 (8.0)
|
6 (6.5)
|
|
|
With reference to urban communities (Table 3), rural children were five times (OR: 4.9, 95% CI: 3.3-7.3, p <0.001) more likely to have fever episodes in previous two weeks, rural mothers were thrice more likely (OR: 3.1, 95% CI: 2.1-4.7, p <0.001) to delay (> 48 hours from fever onset) care-seeking for fever, and rural mothers were thrice more likely (OR: 2.9, 95% CI: 1.4-5.8, p = 0.001) to have the blood of their children tested for malaria before taking antimalaria medications.
Table 3 Factors associated with delayed care-seeking for fever by mothers of U5 children, Igabi LGA, Kaduna Nigeria. (N = 441)
Characteristics
|
Delayed care-seeking
|
|
|
|
Yes
|
No
|
OR (95% C.I)
|
p value
|
Mother’s age < 30 years
|
|
|
|
|
No
|
164 (69.2)
|
73 (30.8)
|
1.5 (1.0 - 2.2)
|
0.05
|
Yes
|
122 (59.8)
|
82 (40.2)
|
Ref
|
|
Type of community
|
|
|
|
|
Rural
|
195 (75.6)
|
63 (24.4)
|
3.1 (2.1 - 4.7)
|
0.00
|
Urban
|
91 (49.7)
|
92 (50.3)
|
Ref
|
|
Mother had formal education
|
|
|
|
No
|
150 (72.1)
|
58 (27.9)
|
1.8 (1.2 - 2.7)
|
0.00
|
Yes
|
136 (58.4)
|
97 (41.6)
|
Ref
|
|
Religion
|
|
|
|
|
Islam
|
275 (64.4)
|
152 (35.6)
|
0.5 (0.1 - 1.8)
|
0.40
|
Christianity
|
11 (78.6_
|
3 (21.4)
|
Ref
|
|
Household size < 5
|
|
|
|
|
Yes
|
127 (57.2)
|
95 (42.8)
|
0.5 (0.3 - 0.7)
|
0.00
|
No
|
159 (72.6)
|
60 (27.4)
|
Ref
|
|
Malaria, a major health problem
|
|
|
No
|
40 (81.6)
|
9 (18.4)
|
2.6 (1.2 - 5.6)
|
0.01
|
Yes
|
246 (62.8)
|
146 (37.2)
|
Ref
|
|
Mother knows mode of malaria transmission
|
|
|
No
|
27 (57.4)
|
20 (42.6)
|
0.7 (0.4 - 1.3)
|
0.30
|
Yes
|
259 (65.7)
|
135 (34.3)
|
Ref
|
|
Mother knows mosquitoes feeding time
|
|
|
No
|
111 (72.6)
|
42 (27.4
|
1.7 (1.1 - 2.6)
|
0.02
|
Yes
|
175 (60.8)
|
113 (39.2)
|
Ref
|
|
Mother knows malaria symptoms
|
|
|
No
|
54 (60.7)
|
35 (39.3)
|
0.8 (0.5 - 1.3)
|
0.40
|
Yes
|
232 (65.9)
|
120 (34.1)
|
Ref
|
|
Mother knows how to detect if fever is caused by malaria
|
|
No
|
97 (61.8)
|
60 (38.2)
|
0.8 (0.5 - 1.2)
|
0.40
|
Yes
|
189 (66.5)
|
95 (33.5)
|
Ref
|
|
Mother knows malaria prevention measures
|
|
No
|
142 (61.2)
|
90 (38.8)
|
0.7 (0.5 - 1.1)
|
0.10
|
Yes
|
144 (68.9)
|
65 (31.1)
|
Ref
|
|
Poor Malaria Knowledge
|
|
Yes
|
139 (69.9)
|
60 (30.2)
|
1.5 (1.0 - 2.2)
|
0.06
|
No
|
147 (60.7)
|
95 (39.3)
|
Ref
|
|
Total
|
286 (64.8)
|
155(35.2)
|
|
|
Factors associated with delayed care-seeking for fever in U5 children and obtaining a recommended care of fever for malaria
Factors associated with delayed care seeking for fever in U5 children was shown in Table 3. Delayed care-seeking for fever in U5 children was positively associated with no formal education for mothers (OR: 1.8, CI: 1.2-2.7, p = 0.003), perception of malaria as not a major health problem in the community (OR: 2.6, CI: 1.2-5.6, p = 0.01), and poor knowledge of mosquitoes’ feeding time (OR: 1.7, CI: 1.1-2.6, p = 0.02). Also, delayed care-seeking care for fever in U5 was negatively associated with household size of < 5 persons. Mothers in household size of < 5 persons were 50% less likely (OR: 0.5, 95% CI: 0.3-0.7, p <0.00) to delay care-seeking for fever. In Table 4, receiving a recommended care by testing blood for malaria parasite before antimalaria medications was associated with rural mothers. Rural mothers were thrice likely (OR: 2.9, 95% CI: 1.4-5.8, p = 0.00) to test blood for malaria parasite before antimalaria medications compared to their urban counterparts. However, mothers with no formal education were 70% (OR: 0.3, 95% CI: 0.1-0.7, p = 0.01) less likely to test U5 children’s blood for malaria parasite before antimalaria medications compared to mothers with formal education.
Table 4 Factors associated with caregivers of U5 children receiving a recommended care of testing fever for malaria before using antimalaria, Igabi LGA, Kaduna Nigeria. (N = 155)
Characteristics
|
Test blood for malaria parasite before taking antimalaria drugs
|
|
Yes
|
No
|
OR (95% C.I)
|
p value
|
Mother’s age < 30 years
|
|
|
|
|
No
|
22 (30.1)
|
51 (69.9)
|
0.9 (0.5 - 1.8)
|
0.97
|
Yes
|
26 (31.7)
|
56 (68.3)
|
|
|
Type of community
|
|
|
|
|
Rural
|
28 (44.4)
|
35 (55.6)
|
2.9 (1.4 - 5.8)
|
0.00
|
Urban
|
20 (21.7)
|
72 (78.3)
|
|
|
Mother’s had formal education
|
|
|
|
|
No
|
10 (17.2)
|
48 (82.8)
|
0.3 (0.1 - 0.7)
|
0.01
|
Yes
|
38 (39.2)
|
59 (60.8)
|
|
|
Religion
|
|
|
|
|
Islam
|
47 (30.9)
|
105 (69.1)
|
0.9 (0.1 -10)
|
1.00
|
Christianity
|
1 (33.3)
|
2 (66.7)
|
|
|
Household size < 5
|
|
|
|
|
Yes
|
24 (25.3)
|
71 (74.7)
|
0.5 (0.3 - 1.0)
|
0.08
|
No
|
24 (40.0)
|
36 (60.0)
|
|
|
Malaria, a major health problem
|
|
|
No
|
2 (22.2)
|
7 (77.8)
|
0.6 (0.1 - 3.1)
|
0.83
|
Yes
|
46 (31.5)
|
100 (68.5)
|
|
|
Mothers knows mode of malaria transmission
|
|
|
No
|
2 (10.0)
|
18 (90.0)
|
0.2 (0.1 - 1.0)
|
0.06
|
Yes
|
46 (34.1)
|
89 (65.9)
|
|
|
Mothers knows mosquitoes feeding time
|
|
|
No
|
15 (35.7)
|
27 (64.3)
|
1.3 (0.6 - 2.9)
|
0.55
|
Yes
|
33 (29.2)
|
80 (70.8)
|
|
|
Mothers knows malaria symptoms
|
|
|
No
|
11 (31.4)
|
24 (68.6)
|
1.0 (0.5 -2.3)
|
1.00
|
Yes
|
37 (30.8)
|
83 (69.2)
|
|
|
Mothers knows how to detect if fever is caused by malaria
|
|
|
No
|
16 (26.7)
|
44 (73.3)
|
0.7 (0.4 -1.4)
|
0.46
|
Yes
|
32 (33.7)
|
63 (66.3)
|
|
|
Mothers knows malaria prevention measures
|
|
|
No
|
21 (32.3)
|
44 (67.7)
|
1.1 (0.6 - 2.2)
|
0.89
|
Yes
|
27 (30.0)
|
63 (70.0)
|
|
|
Poor Malaria Knowledge
|
|
|
Yes
|
16 (26.7)
|
44 (73.3)
|
0.7 (0.4 -1.5)
|
0.46
|
No
|
32 (33.7)
|
63 (66.3)
|
|
|
Total
|
48 (31.0)
|
107 (69.0)
|
|
|
Table 5 shows the predictors of delayed care-seeking and blood testing for malaria before antimalaria medications. Although, rural mothers were thrice more likely to delay care-seeking for fever in U5 children (adjusted OR: 2.8, CI: 1.8-4.2, p <0.01) than urban mothers, but were 80% less likely to use antimalaria medications without blood testing for malaria parasite in U5 children with fever (adjusted OR: 0.2, 95% CI: 0.1-0.4, p <0.00). Mothers with no formal education were four times (adjusted OR: 4.0, 95% CI: 1.6-9.9, p <0.000) likely to received unrecommended care for malaria fever, i.e., use antimalaria medications without blood testing for malaria parasite in U5 children with fever, compared to those with formal education. On the other hand, mothers in households size of < 5 persons were 60% less likely to delay care-seeking compared to mothers in large household size of 5 or more persons (adjusted OR: 0.4, 95% CI: 0,3-0.7, p <0.000).
Table 5: Predictors of delayed care-seeking for fever and receiving a recommended care of testing blood for malaria parasite before using antimalaria, Igabi LGA, Kaduna Nigeria.
|
Delayed care-seeking
|
Term
|
Adjusted Odds Ratio (95% C.I)
|
Coefficient
|
P-Value
|
Mother's age > = 30 years
|
1.5 (1.0 - 2.4)
|
0.4122
|
0.072
|
Rural settlement
|
2.8 (1.8 - 4.2)
|
1.0181
|
0.000
|
Household size < 5 people
|
0.4 (0.3 - 0.7)
|
-0.8269
|
0.000
|
Poor malaria knowledge
|
1.4 (0.9 - 2.2)
|
0.3656
|
0.090
|
|
Unrecommended care of malaria fever
|
Term
|
Adjusted Odds Ratio (95% C.I)
|
Coefficient
|
P-Value
|
Not knowing route of malaria transmission to human
|
5.4 (1.1 - 26.7)
|
1.6925
|
0.040
|
Rural settlement
|
0.2 (0.1 - 0.4)
|
-1.6854
|
0.000
|
No formal education
|
4.0 (1.6 - 9.9)
|
1.3831
|
0.001
|