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Malar J. 2019 Jan 3;18(1):3. doi: 10.1186/s12936-018-2636-3.

Measuring malaria diagnosis and treatment coverage in population-based surveys: a recall validation study in Mali among caregivers of febrile children under 5 years.

Author information

1
MEASURE Evaluation, Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA. rashton@tulane.edu.
2
Info-Stat, Bamako, Mali.
3
MEASURE Evaluation, ICF, Bamako, Mali.
4
Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
5
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
6
President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA.
7
The DHS Program, ICF, Rockville, MD, USA.
8
President's Malaria Initiative, United States Agency for International Development, Bamako, Mali.
9
Programme National de Lutte contre le Paludisme, Bamako, Mali.

Abstract

BACKGROUND:

Nationally-representative household surveys are the standard approach to monitor access to and treatment with artemisinin-based combination therapy (ACT) among children under 5 years (U5), however these indicators are dependent on caregivers' recall of the treatment received.

METHODS:

A prospective case-control study was performed in Mali to validate caregivers' recall of treatment received by U5s when seeking care for fever from rural and urban public health facilities, community health workers and urban private facilities. Clinician-recorded consultation details were the gold standard. Consenting caregivers were followed-up for interview at home within 2 weeks using standard questions from Demographic and Health Surveys and Malaria Indicator Surveys.

RESULTS:

Among 1602 caregivers, sensitivity of recalling that the child received a finger/heel prick was 91.5%, with specificity 85.7%. Caregivers' recall of a positive malaria test result had sensitivity 96.2% with specificity 59.7%. Irrespective of diagnostic test result, the sensitivity and specificity of caregivers' recalling a malaria diagnosis made by the health worker were 74.3% and 74.9%, respectively. Caregivers' recall of ACT being given had sensitivity of 43.2% and specificity 90.2%, while recall that any anti-malarial was given had sensitivity 59.0% and specificity 82.7%. Correcting caregivers' response of treatment received using a combination of a visual aid with photographs of common drugs for fever, prescription documents and retained packaging changed ACT recall sensitivity and specificity to 91.5% and 71.1%, respectively.

CONCLUSIONS:

These findings indicate that caregivers' responses during household surveys are valid when assessing if a child received a finger/heel prick during a consultation in the previous 2 weeks, and if the malaria test result was positive. Recall of ACT treatment received by U5s was poor when based on interview response only, but was substantially improved when incorporating visual aids, prescriptions and drug packaging review.

KEYWORDS:

Artemisinin-based combination therapy; Malaria; Population survey; Recall validation

PMID:
30602376
PMCID:
PMC6317217
DOI:
10.1186/s12936-018-2636-3
[Indexed for MEDLINE]
Free PMC Article

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