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Kolozsvár, 1869-194

Individual and Household Risk Factors for Severe Acute Malnutrition among Under-Five Children in the Analamanga Region, Madagascar

Background and Objectives: Despite some progress made in the fight against malnutrition in Madagascar, hospitals’ mortality due to severe acute malnutrition (SAM) remains high. This study explores the risk factors for SAM among children hospitalized with SAM in the Analamanga region of Madagascar. Methods: We conducted an interview based qualitative study of 14 mothers of under-five children with SAM admitted to the hospital’s pediatric unit and living in the Analamanga region. Data were analyzed using thematic analysis method. Results: There were direct, intermediate and basic causes of malnutrition shared with other health care settings. Low health literacy such as limited knowledge and optimistic perception of malnutrition, and lack of health service information resulted in delayed hospital visit for care of SAM. Vulnerable working mothers do not benefit from available community support structure. Mothers are unable to practice what they learned because financial difficulties at the household level occupy their time. Conclusions and Global Health implications: Consideration of vulnerable working mothers’ access to existing health services and interventions to address health literacy are important to prevent SAM at the community level. Study findings would be of interest to practitioners and policy makers in the region and perhaps in other resource limited settings. Key words: Severe Acute Malnutrition (SAM), • Health Literacy • Utilization of Health Services • Working Mothers • Madagascar Copyright © 2018 Harimbola and Mizumoto. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Antimalarial drug prescribing by healthcare workers when malaria testing is negative: a qualitative study in Madagascar

Abstract Background Despite the World Health Organization and the National Malaria Program of Madagascar recommending that antimalarial drugs only be prescribed for patients with positive results on malaria rapid diagnostic tests, healthcare workers continue to prescribe these drugs for cases with negative test results. We explored why and how primary healthcare workers in Madagascar continue to prescribe antimalarial drugs despite this guidance. Methods We purposively selected 14 medical doctors and 2 nurses from 11 primary health facilities (6 public, 5 private) in Toliara, Madagascar, and interviewed them regarding their antimalarial prescribing behaviors. Semi-structured interviews were conducted, focusing on why and how antimalarials were prescribed for clients with negative rapid diagnostic test results. Interviews were audio-recorded and transcribed verbatim, and the responses were manually coded until consistent themes emerged. Results The narrative of healthcare workers regarding their continued prescribing of antimalarials despite negative test results revealed the following: (1) they prescribe antimalarials without positive test results due to their faith to give top priority to clients including the ethical value of beneficence, hope to maintain clinician’s independence, and belief in drug effectiveness; (2) they use antimalarials despite negative test results due to the availability of alternative ways to procure antimalarials; and (3) they carefully select cases to prescribe and determine specific antimalarials despite negative test results by considering the client’s physical condition, preference, and economic status. Our results indicate that healthcare workers prioritized clinician autonomy to give the best care they believed for each client they received, which led to conflict with policy administrators that urged clinicians to follow the national policy and guidelines. Moreover, healthcare workers had access to multiple sources of antimalarial drugs, and there was a lack of consistency in the program provisions that allowed alternative routes for prescribing outside of official policy. Conclusions We have shown how a national malarial treatment policy was translated into practice in Madagascar and have highlighted the barriers that may prevent policy success. We must attend to each of these barriers if we are to promote optimal use of antimalarial drugs