Abstract:
BACKGROUND: Malaria kills. A single rectal dose of artesunate before referral can
reduce mortality and prevent permanent disability. However, the success of this
intervention depends on caretakers' adherence to referral advice for follow-up
care. This paper explores the dilemma facing caretakers when they are in the
process of deciding whether or not to transit their child to a health facility
after pre-referral treatment with rectal artesunate.
METHODS: Four focus group discussions were held in each of three purposively
selected villages in Mtwara rural district of Tanzania. Data were analysed
manually using latent qualitative content analysis.
RESULTS: The theme "Caretakers dilemma in deciding whether or not to adhere with
referral advice after pre-referral treatment with rectal artesunate" depicts the
challenge they face. Caretakers' understanding of the rationale for going to
hospital after treatment--when and why they should adhere--influenced adherence.
Caretakers, whose children did not improve, usually adhered to referral advice.
If a child had noticeably improved with pre-referral treatment however,
caretakers weighed whether they should proceed to the facility, balancing the
child's improved condition against other competing priorities, difficulties in
reaching the health facilities, and the perceived quality of care at the health
facility. Some misinterpretation were found regarding the urgency and rationale
for adherence among some caretakers of children who improved which were
attributed to be possibly due to their prior understanding.
CONCLUSION: Some caretakers did not adhere when their children improved and some
who adhered did so without understanding why they should proceed to the facility.
Successful implementation of the rectal artesunate strategy depends upon
effective communication regarding referral to clinic.
