Promptness of health-seeking behaviour among children under five years with fever in Malawi: evidence from the 2017 Malawi Malaria Indicator Survey

Fever in malaria-endemic countries may be caused by malaria. Malaria infection is a major public health problem with substantial risks for severe morbidity and mortality. It is the leading cause of hospital admissions in children under five years of age worldwide. Despite being managed successfully if diagnosed in a timely way, facilitation of prompt health-seeking behaviour remains a challenge with many children reaching a health facility too late or not at all. We aimed to determine factors associated with prompt health-seeking behaviour among caregivers of children under five with fever in Malawi. We used data from the 2017 Malawi Malaria Indicator Survey (MMIS). Survey records for 2314 children aged under five years were identified of which 794 had fever in the past two weeks. Multivariable logistic regression analysis was carried out to identify factors associated with prompt health-seeking behaviour, defined as seeking health care the same day or day after the onset of fever. This study reveals that 40.1% of the children under five years presented with fever in the previous two weeks out of which 30.5% were taken for treatment promptly. Public facilities are the most visited places for under five child treatment (68.1%), followed by private drug sellers/pharmacies (17.4) and private/religious facilities (14.5%). Muslims (adjusted odds ratio, aOR=0.54, 95% confidence interval, CI=0.31-0.94) and children aged four years (aOR=0.56, CI=0.34-0.93) were less likely to be taken for treatment promptly compared to Christians and those less than 1 year, respectively. In contrast, children aged two years (aOR=1.71, CI=1.02-2.86) were more likely to be taken for prompt treatment compared to those less than 1 year. Age and religion are factors associated with prompt health-seeking behaviour in Malawi. Health education programs should be intensified to raise awareness among caregivers of the importance of early treatment-seeking regardless of the child’s age. Qualitative studies should be done in Malawi to explore different religious beliefs and their influence on health-seeking behaviours.