Review 3: "Determinants of Timely Malaria Treatment among Under-Five Children Attending Public Health Facilities in Kisumu East Sub-County, Kenya: A Health Facility-Based Cross-Sectional Study"

Elisa Maria Maffioli

doi:doi:10.1162/2e3983f5.9af28dfb

Determinants of Timely Malaria Treatment among Under-Five Children Attending Public Health Facilities in Kisumu East Sub-County, Kenya: A Health Facility-Based Cross-Sectional Study

by Geofrey Ochieng, Mutale Sampa, Patricia Maritim, Adam Silumbwe, Joseph M Zulu, Joseph Kato, and Choolwe Jacobs

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Published on Jul 22, 2024
www.medrxiv.org

Description

ABSTRACT Evidence shows that most child malaria deaths occur at home shortly after symptom onset, highlighting the need for timely treatment. This study aimed to assess the determinants of timely malaria treatment among under-five children who receive care at public health facilities in Kisumu East sub-county, Kenya.A health facility-based cross-sectional study was conducted in Kisumu East sub-county, Kenya, between 5th April and 26th May 2023. The study employed a two-stage stratified-cluster sampling method, first selecting hospitals and then using systematic sampling to select caregivers. Data collection was done electronically using structured questionnaires. Associations at bivariable level were assessed using either the Chi-square or Fisher’s exact test based on assumptions. Multiple logistic regression with robust standard errors was applied at a 5% significance level to establish determinants of timely malaria treatment among under-five children. STATA version 16 (College Station, Texas 77845 USA) was used for all analyses.The sample included a total of 434 caregivers of under-five children. The study revealed that caregivers’ ability to recognize malaria symptoms was associated with higher odds of seeking timely malaria treatment for their children (AOR=2.92; 95% CI=1.36-6.25; p=0.006). Additionally, having health insurance cover was associated with higher odds of timely treatment (AOR=2.12; 95% CI=1.25-3.59; p=0.005). Those who visited herbalists before seeking care were less likely to seek timely treatment (AOR=0.13; 95% CI=0.05-0.34; p<0.0001). Fear of drugs’ side effects reduced the odds of timely treatment (AOR=0.50; 95% CI=0.29-0.87; p=0.013).Timely malaria treatment was linked to the ability to tell symptoms and having health insurance, while delayed malaria treatment was related to herbalist visits and fear of malaria, among others. There is need for relevant stakeholders to implement strategies that address misconceptions about drug side effects, offer affordable insurance, integrate the informal health sector, and educate caregivers about under-five malaria symptoms in order to promote timely malaria treatment.

RR\ID Evidence Scale rating by reviewer:

Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: Timely malaria treatment is important, especially for younger children. This study looks at the predictors of timely malaria treatment - defined as receiving treatment on the same day or day after the onset of symptoms- in one sub-county in Western Kenya. This paper makes a strong case for why exploring this research question is important in Kisumu, by providing a good description of the background and enough details on the context. However, there is large evidence on similar research questions in other African countries, and the authors mainly add to the current literature by providing evidence from a specific sub-county in Kenya, with a limited and selected sample from public health facilities. The analysis is a descriptive, but it is well-presented and supported by a conceptual framework which helps navigating the several determinants of the outcome. While the analysis is straightforward, it is unclear which table (2 or 3) the authors choose as their primary specification. Table 2 should be moved in the text and Table 3 should be mentioned when results are presented. The authors summarized the findings as that timely malaria treatment was associated with the ability to tell symptoms and having health insurance, while delayed malaria treatment was associated with herbalist visits and fear of malaria. However, the analysis and data draw a more complex picture of the determinants, which is well-described in the discussion and compared to past studies. The authors could better align the summary of the results as informed by the conceptual framework across the article. Overall, this article is valuable to add evidence on the determinants of timely malaria treatment from another setting in Africa.

Additional point to be addressed:

Figure 1 does not represent the distribution of timely malaria treatment. The proportion of people with timely malaria treatment (within/after 24 hours) could be reported in the text.
It would be helpful to report which are the six knowledge questions that were assessed and use to create the malaria knowledge index. This is particularly important considering the previous studies finding conflicting results on malaria knowledge being a predictor of timely malaria treatment.
Other clarifications: time to health facility (clarify which mode of transport); what is the hospital card.
Check for minor typos and align capital or small letters for words in tables.

Review 3: "Determinants of Timely Malaria Treatment among Under-Five Children Attending Public Health Facilities in Kisumu East Sub-County, Kenya: A Health Facility-Based Cross-Sectional Study"

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