Home Treatment of Childhood Illnesses Prior to Seeking Formal Care: A Cross-Sectional Study at Different Health Care Levels in Ghana.

Abstract

Background: Many caregivers in Sub-Saharan Africa attempt to manage childhood illnesses at home, which can delay or complicate later diagnosis and treatment at a health facility. Understanding home treatment practices among children could help characterise treatment history when information is unavailable or unreliable. We investigated these practices among children seeking care at three levels of a healthcare system in Ghana.

Methods: Children under 15 years of age and their caregivers were recruited from Community-based Health Planning and Services, outpatient departments and inpatient departments in Agogo and Assin Foso, Ghana. Demographic, clinical, socioeconomic and home treatment data were collected via interviews. Urine samples from children were tested for antibiotic use. Hierarchical log-binomial regression models were calculated to estimate risk ratios and control for confounding.

Results: Caregivers of 1503 children were interviewed. Forty-six percent (n = 689) reported any home treatment prior to the visit: 37% (n = 560) reported antipyretic use, 11% (n = 167) antimalarial use and 7% (n = 103) antibiotic use. Home medication was lower at Community-based Health Planning and Services (30%, n/N = 148/500) compared to the outpatient departments (61%, n/N = 308/509) and inpatient departments (47%, n/N = 233/494). Children treated at home had longer delays in seeking treatment (median 3 days, IQR: 1, 3) compared to those not treated at home (median 2 days, IQR: 1, 3). In regression models, illness severity and specific symptoms were more strongly associated with antimalarial use than with antibiotic use. For most samples where antibiotic inhibition was detected, no prior antibiotic use had been reported (n/N = 33/46), indicating undisclosed or unrecognised antibiotic intake.

Conclusions: The discrepancy between self-reported antibiotic use and antibiotic inhibition suggests a lack of awareness about medication identification and appropriate use. This presents a challenge for clinicians in obtaining an accurate treatment history, which is highly relevant to the timely diagnosis and treatment of the illness in the facility.