Maternal responses to childhood febrile illnesses in an area of seasonal malaria transmission in rural Ethiopia.

Although malaria is the leading cause of illness and death among children less than 5 years of age, there is limited information on mother's response and experience about diagnosis and treatment of the disease in children in rural areas of Ethiopia. The objective of this study was to assess maternal responses and treatment seeking behaviour for children reported to have malaria. A community-based cross-sectional study was conducted between October and November 2003 in Adami Tulu District, south-central Ethiopia. Mothers/caretakers of children less than 5 years of age were interviewed about history of febrile illness suspected to be malaria for all under-five children and the actions taken in the 2 weeks prior to the survey. Of 3872 children identified in 2372 households, 817 (21.1%) had febrile illness reported to be malaria according to the mothers/caretakers. The main symptoms included fever (99%), shivering/chills (92.2%), vomiting (55.1%), sleeplessness/restlessness (12.9%) and refusal to feed (21.3%). Of the total febrile children, 27.3% sought the first care from a public health facility, 27% visited community health workers (CHWs), 25.7% taken to private clinics, 6.4% received home treatment, and 13.3% did not get any care. Among 710 children who reported to receive any type of anti-malarial treatment, 78.8% got it from one source, 19.4% visited two sources and 1.8% sought three sources. Only 28% of the children received any form of treatment within 24h of the onset of illness. Public facilities, private clinics and CHWs were the main sources of care sought by febrile children. Strengthening peripheral health services and community-based interventions using CHWs at village levels would improve the early diagnosis and treatment of malaria among children.