Malaria in pregnancy, risk perceptions and care seeking practices among adolescents in Mukono district Uganda.
ABSTRACT Malaria in pregnancy is a serious health problem that contributes greatly to maternal morbidity and mortality. This study investigated risk perceptions and care seeking practices for malaria in pregnancy among adolescents. Data were collected using focus group disusions(FGDs) and key informant interviews (KIIs). Results showed that malaria was perceived as the leading cause of morbidity and mortality among pregnant women. However, adolescent girls did not consider themselves at risk of malaria even when pregnant. Anaemia and low birth weight were not well understood and not related to malaria in pregnancy. Self-medication was common including over the counter drugs, herbs or a combination of both. When this failed, several options were taken such as seeking care at health units. People preferred to visit heath units with laboratory facilities, since investigations were valued and perceived useful. These investigations were locally known as okukebera omusayi, which translates to examining blood This local term is non-specific and used when patients are referred to laboratories to investigate diseases like HIV, syphilis and malaria. The use of this term however, discourages some people who are afraid of knowing their HIV status. Similarly, the notion that HIV/AIDS is spread thorough contaminated needles and syringes discourages people from giving blood for laboratory tests. In addition, the cost of investigations, fear of pain due to pricking, and the rudeness of laboratory technicians negatively influence seeking laboratory tests. Implications of these findings include developing a health promotion package that explains the dangers of self medication and advocates prompt seeking for malaria treatment especially for adolescents and primigravidae. Policy decisions to introduce rapid diagnostic kits (RDTs) in primary care units including drug shops are required in order to improve effective treatment of malaria.
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ABSTRACT: National malaria control programmes and international agencies are keen to scale-up the use of effective rapid diagnostic tests (RDTs) for malaria. The high proportion of the Ugandan population seeking care at drug shops makes these outlets attractive as providers of malaria RDTs. However, there is no precedent for blood testing at drug shops and little is known about how such tests might be perceived and used. Understanding use of drug shops by communities in Uganda is essential to inform the design of interventions to introduce RDTs. We conducted a qualitative study, with 10 community focus group discussions, and 18 in-depth interviews with drug shop attendants, health workers and district health officials. The formative study was carried out in Mukono district, central Uganda an area of high malaria endemicity from May-July 2009. Drug shops were perceived by the community as important in treating malaria and there was awareness among most drug sellers and the community that not all febrile illnesses were malaria. The idea of introducing RDTs for malaria diagnosis in drug shops was attractive to most respondents. It was anticipated that RDTs would improve access to effective treatment of malaria, offset high costs associated with poor treatment, and avoid irrational drug use. However, communities did express fear that drug shops would overprice RDTs, raising the overall treatment cost for malaria. Other fears included poor adherence to the RDT result, reuse of RDTs leading to infections and fear that RDTs would be used to test for human immune deficiency virus (HIV). All drug shops visited had no record on patient data and referral of cases to health units was noted to be poor. These results not only provide useful lessons for implementing the intervention study but have wide implications for scaling up malaria treatment in drug shops.Malaria Journal 01/2010; 9:367. · 3.19 Impact Factor