Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020-2022.

Background: Malaria is responsible for 580,000 deaths among children under 5, or 95% of all malaria deaths per year globally. Seasonal Malaria Chemoprevention (SMC) is a malaria control intervention in Togo and other African countries targeting children under 5 years old during the peak malaria transmission season. Delaying access to healthcare for children with malaria can result in serious health problems, including heightened morbidity and mortality, complications related to cerebral malaria and anemia, as well as impaired cognitive development. This study aimed to identify determinants of access to health facilities for children with caregiver-reported fever, in the context of SMC campaigns in Togo.

Methodology: We analyzed data from three representative annual end-of-round SMC surveys on SMC-eligible children aged 3-59 months residing in the provinces of Savanes, Central and Kara in Togo, conducted during 2020-2022. We performed a descriptive analysis and fitted logistic regression models to assess predictors of health facility access. Our sample included all children with a caregiver-reported fever in the month before the survey. Model variables included household distance to their local health facility, quintiles of household wealth, household visit by SMC distributors in the previous month, household nomad status, literacy of primary caregivers, and the age and sex of both eligible children and their primary caregivers.

Results: Our analytic sample included 6,252 SMC-eligible children, including 1,418 experiencing fevers. Most children with fever (62.6%, 95% CI 60.0-65.0%) accessed health facilities. Adjusted odds ratios and 95% confidence intervals obtained from the logistic regression analysis found a statistically significant linear relationship between children's adjusted odds of access to health facilities and their distance from the nearest facility, with 2% lower odds of access for each additional kilometer of distance (AOR = 0.98, 95% CI 0.97-0.99). Households with SMC distributor visits were significantly more likely to access health facilities (AOR = 2.20, 95% CI 1.22-3.96). Children of female primary caregivers had higher odds of access (AOR = 1.42, 95% CI 1.05-1.93).

Conclusion: Febrile children's access to malaria testing and treatment in Northern Togo requires further improvement, particularly among those further from health facilities and with lower household wealth.