Treatment Paths and Referral Patterns Among Caretakers of Under Fives Admitted with Malaria at a Regional and a District Hospital in Kilimanjaro Region, Tanzania

Objective: To determine, in caretakers hospitalised with children suspected of malaria, what action was taken at home, which health facility caretakers selected and the reasons for the choice made.
Methods: This was a hospital-based descriptive cross- sectional study. A random sample of 561 caretakers of children under five years admitted with a clinical diagnosis of malaria in a regional and district hospital in Tanzania from April to June 2002 was interviewed using a structured questionnaire.
Results: Only 5% of caretakers gave antimalarials at home prior to contacting a health unit. Of 561 children admitted to hospital level, 60.4% had not been referred from first care level (by-passers). Main reasons for by-passing primary health care units (PHCUs) given at the regional hospital by caretakers were no faith in treatment given and lack of laboratory services within these facilities. In the rural district hospital, the caretakers mentioned lack of near by health facilities as a main reason. Among those referred, lack of laboratory facilities was main reason for referral in both regional and district hospital.
Conclusion: For treatment of malaria in underfives, most caretakers did not give antimalarials at home and by-passed PHCUs. Improvement in trust in treatment and laboratory services at primary care level is essential and in the case of the district hospital also long distances to PHCUs. This means equipping the PHCUs with necessary equipments and skilled entrusted staff and equitable distribution of these facilities in rural area is essential.

Keywords
Childhood malaria, home treatment, referral system, laboratory services, quality care, Tanzania.