Incidence and management of malaria in two communities of different socio-economic level, in Accra, Ghana

Two adjacent communities of differing socio-economic levels were selected, in Accra, Ghana, for the study of the home management of malaria. The young est child in each selected household, each of which had a child aged <5 yea rs, was recruited for weekly follow-up, following informed consent. Malaria was the most common condition reported by the 'caregivers' (mothers of the subjects and others caring for the subjects) in each community, with 2.0 e pisodes of clinical malaria/child during the 9-month study. Most (89%) of the caregivers in the better-off community had been educated beyond primary-school level, but 55% of the caregivers in the poorer commun ity had either received no formal education or only primary-school educatio n. This difference was also reflected by the educational facilities provide d to the children studied: 52% of the those in the better-off community att ended nurseries, kindergartens or cre Aches, compared with 8% of the childr en investigated in the poorer community. The proportion of caregivers who purchased drugs without prescription or us ed left-over drugs to treat clinical malaria in the children was higher in the poorer community (82% v. 53%), and a child from the poorer community wa s less likely to have been taken to a clinic or hospital to be treated for malaria than a child from the better-off community (27% v. 42%). During the follow-up period two children died, one from each community. Treatment of malaria in young children is likely to be less effective in th e poorer community, where a lack of economic access to health services was demonstrated.