Care-seeking behaviour among febrile children under five in Togo.

BACKGROUND: Fever is one of the warning signs of poor health in children. Care-seeking in febrile children is importance in reducing child deaths and morbidity. This care-seeking by parents in children with fever is however relatively low in sub-Sahara Africa. The aim of this study is to improve understanding of the behaviour of caregivers in seeking care for children under five with fever and to identify associated modifiable risk factors in Togo. METHODS: Data from a 2013-2014 cross-sectional nationally representative malaria indicator survey was used. Advice or care-seeking is defined as any child under 5 years of age with fever in the two weeks prior to the interview for whom advice or treatment was sought in a public medical area, private medical area, store, market, or from an itinerant medicine seller. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. RESULTS: A total of 1359 febrile children out of 6529 children under five were enrolled. Care had been sought in 38.9% of cases. In multivariate analysis, independent risk factors associated with formal care seeking were accessibility to the nearest health center (aOR = 1.52, 95% CI [1.18-1.95], mother's education level secondary and above (aOR = 1.85, 95% [1.32-2.59]), mothers who identified as belonging to animist/traditionalist religions compared to mothers who belonged to a formal religion (catholic (aOR = 2. 28, 95% [1.55-3.37]), Muslim (aOR = 2.41, 95% [1.67-3.47]), and Protestant (aOR = 1.9, 95% [1.37-2.65]), Maritime region (aOR = 0.49, 95% [0.29-0.82]) compared to Lome commune. CONCLUSION: Interventions should specifically target women with limited education, not identifying as part of an official church and at longer distance from health center.

Regional heterogeneity of malaria prevalence and associated risk factors among children under five in Togo: evidence from a national malaria indicators survey.

BACKGROUND: Malaria remains a major cause of morbidity and death among children less than 5 years of age. In Togo, despite intensification of malaria control interventions, malaria remained highly prevalent, with significant heterogeneity from one region to another. The aim of this study is to explore further such regional differences in malaria prevalence and to determine associated risk factors. METHODS: Data from a 2017 cross-sectional nationally representative malaria indicator survey was used. Children aged 6-59 months in selected households were tested for malaria using a rapid diagnostic test (RDT), confirmed by microscopy. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. RESULTS: A total of 2131 children aged 6-59 months (1983 in rural areas, 989 in urban areas) were enrolled. Overall 28% of children tested positive for malaria, ranging from 7.0% in the Lomé Commune region to 4% 7.1 in the Plateaux region. In multivariate analysis, statistically significant differences between regions persisted. Independent risk factors identified were higher children aged (aOR = 1.46, 95% CI [1.13-1.88]) for those above 24 months compared to those below; households wealth quintile (aOR = 0.22, 95% CI [0.11-0.41]) for those richest compared to those poorest quintiles; residence in rural areas (aOR = 2.02, 95% CI [1.32-3.13]). CONCLUSION: Interventions that target use of combined prevention measures should prioritise on older children living in poorest households in rural areas, particularly in the regions of high malaria prevalence.