| dc.description.abstract | Severe malarial anaemia (SMA) in young children is the most common presentation of P. falciparum in western Kenya and accounts for 20% of inpatient admissions. The high morbidity and mortality caused by severe malaria has led to the scaling up of effective malaria interventions especially in endemic regions like western Kenya. In areas of high malaria transmission, infants and young children <5 years carry the biggest disease burden. Immunity against malaria develops with cumulative exposure as the person ages. Development of acquired immunity could be hampered by the development and implementation of malaria control strategies leading to a possibility of a shift in age of severe malaria infection from younger to older children. The practices of caregivers of SMA children towards their treatment also have an effect on the severity of malaria and could differ by the child’s age. Therefore, the general objective of the study was to investigate the age trend of pediatric patients under 10 years old suffering from severe malarial anaemia and their caregivers’ associated factors. Specific objectives were to evaluate the age trend of SMA in children <10 years, evaluate the care-givers' knowledge on recognition of SMA, assess the health care seeking behavior of the caregivers, determine the household and health care provider costs in management of SMA, and assess the clinical outcome of children <10 years with SMA in western Kenya. A cross-sectional survey was conducted at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) from September 2014 to July 2015. 271 children with SMA and their caretakers were enrolled and data collected through structured questionnaires. Chi-square test was used to determine differences between categorical data; Welch's t–test was used to compare means, and correlation analysis was used to evaluate relationships between continuous variables. SMA was found to be common in children <5 years 203(74.9%) than those > 5 years 68(25.1%) with a mean age of 39 months, thus a shift in age of children with SMA was not evident. Caregiver knowledge on recognition of signs and symptoms of SMA was found to be wanting for both <5 and those >5 years old. On health seeking behavior, majority of the caregivers gave some remainder drugs before presenting to a health facility, which was more common among children <5 years, followed by buying drugs from nearby stores. The average total household cost in treating SMA was $23.52. The average household cost per child was higher for children >5 years compared to their <5 group ($28.48 vs $18.55, p=0.01). However, the health care provider spent more on the children <5 compared to >5 ($13.56 vs $17.41, p=0.01). A total of 4 (1.5%) study participants had a fatal outcome, with equal percentages of deaths in the <5 and >5 age groups. In conclusion, a shift in age of SMA occurrence from younger to older children was not observed. It is however important to continue monitoring the trends as the malaria prevention methods continue to evolve and especially with the planned introduction of the malaria vaccine. The government should also educate caregivers on how to identify early signs of SMA and to avoid giving medication or other forms of delay prior to presenting in hospital. The government should also ensure that there are no stock outs of medicines and consumables used in SMA management for <5 years and consider introducing subsidies for those > 5 years also. The rate of death from SMA has also reduced, but children <5 and >5 have equal chances of death from SMA. | en_US |
