Treatment for clinical malaria is sought promptly during an epidemic in a highland region of Uganda

Early diagnosis of malaria followed by appropriate treatment can help reduc e related morbidity and mortality as well as interrupt transmission. Previo us studies of household responses to malaria have tended to focus on endemi c areas where the burden of this disease is greatest. With the apparent inc reasing frequency of epidemics in African highlands, a better understanding of treatment behaviours in areas of unstable transmission may be important tu future public health interventions. This study was undertaken following a serious epidemic of malaria in the highlands of south-western Uganda. Ou r objectives were to characterize actions taken by both adults and caretake rs of children less than or equal to5 years old during their most recent ep isode of self-diagnosed malaria, and to identify factors that were associat ed with prompt treatment at a health facility. A survey of 300 households s elected in a 2-stage cluster sampling procedure produced 453 adult responde nts and 133 caretakers of children less than or equal to5 years old. We fou nd that almost 65% of adults and 62% of children who had experienced an epi sode of malaria in the last year (most Juring the epidemic) had sought trea tment from a health facility first as opposed to self-treatment. Most of th ese people had visited the health facility within 1 day of symptom onset. B y the end of their malaria episode, over 87% of adults and 80% of children had visited a health facility at least once. Factors associated with prompt presentation at a health facility included severity of illness, household proximity to a health facility and knowledge of malaria prevention methods. Our results indicate that there is an important role for the formal health care system in mitigating morbidity and mortality and reducing transmissio n during malaria epidemics in Uganda.