EFFECT OF ROLE MODEL CAREGIVERS IN IMPROVING KNOWLEDGE AND HOME MANAGEMENT OF MALARIA IN UNDER-FIVE CHILDREN IN TWO RURAL COMMUNITIES OF RIVERS STATE

Abstract

Health education of mothers/caregivers to improve home management of uncomplicated malaria by trained community-oriented resource persons such as Role Model Caregivers (RMCs) is a strategy to reduce malaria burden in under-five children in malaria endemic countries such as Nigeria.
The aim of this study was to determine the effect of training mothers/caregivers of under-five children in Obonoma (intervention community) as RMCs in improving knowledge and home management of malaria. A quasi-experimental study design with a pre-and post-intervention survey was used. It was also a community intervention study. Eight (8) RMCs were selected from the intervention community using certain criteria. A systematic sampling method was used to select 368 mothers/caregivers; 184 each in the intervention community and in the control community. The intervention was a health education training for the 8 RMCs in the intervention community on knowledge and home management of malaria in children under-five years old. The RMCs later trained the selected mothers/caregivers in the intervention community. A total of 342 mothers/caregivers completed the study at the end of 4 months; 173 in the intervention community and 169 in the control community. Data were collected with pre-tested semi-structured questionnaires and analysed with EPI info version 7.
The result showed that most of the caregivers were females (97.3%), married (85.6%) and mothers (90.2%) of the children. The mean age was 33.7±8.8 years (intervention community) and 34.4±19.4 years (control community). The mean age of the children was 31±14.7months (intervention community) and 31.4±14.2 months (control community). There were statistically significant improvements in knowledge of the cause of malaria, seasonal variations, prevention and practice of prevention in the intervention community at post-intervention (P=0.000) but no improvement in knowledge in the control community at post-intervention. There were also statistically significant improvements in knowledge of symptoms/signs of uncomplicated malaria (X2=13.30, P=0.000) and also of complicated malaria (X2=99.25, P=0.000) in the intervention community at post-intervention unlike in the control community with no improvement in knowledge.
Mothers/caregivers who took the first correct actions within 24hours of the onset of fever in the intervention community improved significantly from 68 (37.0%) at pre-intervention to 131 (75.7%) at post-intervention (x2=101.51,df=3,P=0.000). Patent medicine vendors/drug hawkers were the first and second sources of treatment for malaria in the control community at pre-and post-interventions while the health care facility was the second source of treatment in the intervention community at post-intervention. Paracetamol, aspirin and chloroquine were the commonest drugs given at home for malaria fever at pre-intervention in both communities. The use of arthemether-lumefantrine improved in the intervention community; 7.1% at pre-intervention to 81.5% at post-intervention because of the improvement in the knowledge of its use, safety, effectiveness, its availability and affordability (given free to caregivers). In the control community, there was not much improvement in the use of arthemether-lumefantrine (9.2% at pre-intervention and 9.5% at post-intervention). Drug adherence (correct dose, frequency and duration of treatment) improved significantly at post-intervention in the intervention community. There was also an improvement in patients’ referral by RMCs as well as patient follow-up and the use of the treatment guideline for arthemether-lumefantrine. Most of the children (94.2%) treated with the arthemether-lumefantrine reported no drug reaction while a few reported mild side effects such as weakness (4.0%) and nausea (1.7%).
This study concludes that health education training on malaria for community members is effective in improving knowledge and home management of malaria in under-five children. It is recommended that the Rivers State primary health care management board in collaboration with the local government primary health care authorities should initiate and fund health education trainings for caregivers on early recognition and management of malaria. The trained caregivers should be provided with the appropriate pre-packaged anti-malarial drugs and treatment guidelines and be supervised by the health workers especially the community health extension workers.

EFFECT OF ROLE MODEL CAREGIVERS IN IMPROVING KNOWLEDGE AND HOME MANAGEMENT OF MALARIA IN UNDER-FIVE CHILDREN IN TWO RURAL COMMUNITIES OF RIVERS STATE