MATERNAL DIAGNOSIS AND TREATMENT OF CHILDRENS FEVER IN AN ENDEMIC MALARIA ZONE OF UGANDA - IMPLICATIONS FOR THE MALARIA CONTROL PROGRAM

A mother's ability to suspect malaria in the presence of fever has imp ortant consequences for child survival in malaria-endemic areas. This paper presents results of a clinic-based study of mothers' abilities t o suspect malaria in the event of recognizing fever and other physiolo gical and behavioral changes associated with the disease. The study po pulation consisted of all (439) women or mothers who had accompanied c hildren 5 years and below to the Old Murago Hospital, Kampala, Uganda over a IO day period during the malaria season of 1992. The children w ere those who had fever as a major complaint at the time of the visit or those who had fever in the last 7 days and were visiting the clinic for the first time for the current illness. The children were physica lly examined and their brood tested for malaria parasites. Mothers' di agnosis was compared with clinical and laboratory diagnosis of malaria . Mothers associated the presence of fever with several types of illne ss and malaria was often not suspected. Only 40% of the mothers suspec ted malaria in their children. The mothers were poor at recognizing ma laria when, in fact, it was present. The sensitivity of the mothers' d iagnosis of malaria was found to be 37%; 63% of malaria cases were mis classified as other conditions. The doctors classified most (92%) of t he cases presenting with fever as having malaria, but laboratory tests indicated that only 64% of the children really had malaria. The sensi tivity of clinical diagnosis was 98% but the specificity was only 18%. Ninety percent of the mothers gave some medicines before visiting the health centre; and, of these, 76% gave modern drugs exclusively, incl uding antimalarials, antipyretics, antibiotics and other drugs. Among the modern drugs given to children suspected of having malaria, 50% we re antimalarials. The most commonly used antimalarial was chloroquine tablets. Mothers indiscriminately administered antimalarials to childr en irrespective of the perceived cause of the fever. There is need to educate mothers to suspect malaria first in every case of febrile illn ess, just like the doctors do, and about the first line drugs for the treatment of malaria. (C) 1997 Elsevier Science B.V.