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Societal factors that predispose children under five years to severe malaria in developing countries: a systematic review of qualitative evidence

Adjei, George BSc, MSc; Enuameh, Yeetey MD, MSc, DrPH; Osei-Kwakye, Kingsley MD, MPH; Abokyi, Livesy BA, MPH; Tchum, Samuel Kofi BSc, MPhil; Koku, Emmanuel BA, MA, PhD

JBI Database of Systematic Reviews and Implementation Reports: December 2014 - Volume 12 - Issue 12 - p 141–209
doi: 10.11124/jbisrir-2014-1707

Background Over 40% of the world's population live in malaria endemic regions. While malaria is transmitted by mosquitoes, some communities have different beliefs to this effect. These beliefs coupled with other societal factors lead to parents not having the appropriate health seeking behaviors and not getting prompt treatment of malaria for their children, a situation that could make their conditions severe, which may lead to death. Children below the age of five years and pregnant women mostly bear the brunt of the disease. Although malaria is a disease that is life threatening, it is preventable and curable. Malaria occurs in the poorest regions of the world where sanitation and hygienic conditions are far from optimal.

Objectives To synthesize the best available evidence on the societal contexts and experiences that predispose children less than five years of age in developing countries to severe malaria.

Inclusion criteria Types of participants

Participants were children below the ages of five years living in low and middle income countries.

Phenomena of interest

Societal contexts and experiences of communities; traditional healers', health workers' and caregivers' perceptions that predispose children below five years of age to severe malaria; and also communities' perceptions about the causes and symptoms of severe malaria and management strategies.

Types of studies

Studies that were based on qualitative study designs.

Search strategy Studies published in the English language from 1966 to 2013 were to be included in the review.

Methodological quality Papers selected were assessed by two independent reviewers for methodological quality using critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

Data collection The Joanna Briggs Institute data extraction tool was used for extraction of data.

Data synthesis The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to pool findings based on their similarity of meaning.

Results Eleven studies generated 54 study findings that were aggregated into 40 categories to come up with eight synthesized findings. One of the synthesized findings was on the causes and symptoms of severe malaria, another was on management strategies of severe malaria and six others were about predisposition to the condition.

Conclusions Findings place in context how knowledge, belief systems, health facility factors, gender roles of the home environment, access, traditional healers, and management strategies guide care providers' care-seeking behaviors when their wards are taken ill with severe malaria.

Implications for practice 
  • Educate community members on the causes, symptoms, manifestations and danger signs of severe malaria.
  • Ensure affordable and accessible care to the population.
  • Educate healthcare providers to respect the rights of clients.
  • Institute measures to reduce out of pocket expenditure.
  • Ensure liaison between the orthodox healthcare system and traditional healers so the latter see themselves as stakeholders in healthcare delivery to the community, and they feel their contribution to the health system is recognized.

Implications for research Research is required to access the efficacy and safety of herbs and traditional medicaments as they are being used in communities and it is imperative to safeguard the health of people using them. Study approaches that bring together traditional healers and orthodox practitioners to collaborate in care delivery would also be beneficial.

1 The Kintampo Health Research Centre (KHRC): an Affiliate Center of the Joanna Briggs Institute, Kintampo, Ghana

2 Drexel University, Philadelphia, USA

Corresponding author:

George Adjei

© 2014 by Lippincott williams & Wilkins, Inc.
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