Review Objective
The objective of this systematic review is to establish what is best practice in home management of malaria among children under the age of five in developing countries.
More specifically, the review question(s) is/are:
To assess the acceptability of home management of malaria for under-five children by caregivers;
To assess the appropriateness of different diagnostic techniques used in home management of malaria;
To evaluate the different strategies of distribution of antimalarial drugs for home management of malaria;
To assess the extent to which antimalarial drugs are appropriately dispensed and utilized in home management of malaria; and
To assess the referral links designed with the health institutions for severely ill children in home management of malaria.
Background
Around 2.5 billion people (at least 40% of the world's population) are at risk of contracting malaria in over 90 to 110 countries. In 1990, 80 percent of cases occurred in Africa, with the remainder found in countries such as India, Brazil, Afghanistan, Sri Lanka, Thailand, Indonesia, Vietnam, Cambodia, China, and others1 2
Early recognition, and early appropriate treatment, of febrile illness in children is the basis of malaria control in endemic countries3 4,5,6
Several factors can influence the implementation of home management of malaria. Several studies have been conducted on home management of malaria and the feasibility, appropriateness and acceptability this strategy by caregivers and other stakeholders7,8,9
Criteria for considering studies for this review
Types of Studies This component of the review will consider any interpretive studies that draw on the experiences of home management of malaria in under-five children in developing countries including, but not limited to, designs such as phenomenology, grounded theory and ethnography. Additionally, research studies, other text such as opinion papers or commentaries and reports will be considered.
Types of participants This component of the review will consider studies that include children under five and those adults responsible for their home management in developing countries.
Types of interventions/Phenomena of Interest The systematic review will consider studies that examine the experiences involved in the home management of malaria.
Search Strategy for identification of studies
The search strategy aims to find both published and unpublished studies and papers. The search will be limited to English language reports published in the period from January 1985 to July 2008. A three-step search strategy will be utilised in each component of this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken. Thirdly, the reference lists or bibliographies of all identified reports and articles will be searched for additional relevant studies.
The databases and search engines to be searched include:
HINARI
LILACS (Latin American and Caribbean Health Sciences Literature)
Who/TDR Malaria Database
National Malaria Control Program's National Malaria Database
Joanna Briggs Institute
University of Adelaide databases:
Current Contents
PsycINFO
NLM Gateway
Psychology and Behavioral Sciences Collection
PsycARTICLES
PubMed
Sociological Abstracts
Scopus
TRIP (Turning Research into Practice)
Cochrane Library
Jimma University Library databases
HealthinForum Malaria
Malaria database - Monash University
RBM Global Malaria Database
The Vaccine Page: Vaccine News and Database
Scirus.com
GoogleScholar.com
Altavista.com
Lycos.com
Metacrawler.com
The search for unpublished studies will include:
WHO/TDR Programme of home management of Malaria
JBI/University of Adelaide databases
Grey Literature Report
Index to Theses
Digital Dissertations
Jimma University Library
WHOLIS: World Health Organization Library Database
Initial Keywords to be used for the three review components will be: Home management, home care, home nursing, malaria, marsh fever, paludism, plasmodium infection, childhood illness, malaria intervention, malaria control, chloroquine, Fansidar, Coartam.
Methods of review
Critical Appraisal Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI) (Appendix 1). Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Data Extraction Data will be extracted from papers included in the review using standardised data extraction tools from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI) (Appendix 2). Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Data Synthesis Where meta-synthesis is possible, qualitative research findings will be pooled using the Qualitative Assessment and Review Instrument (QARI). This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorising these findings on the basis of similarity in meaning (Level 2 findings). These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesised findings (Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.
Conflicts of Interest
No conflict of interest
Acknowledgements
Detailed acknowledgements will be included after completion of the review. We nonetheless acknowledge JBI and TDR.
References
1. Johns Hopkins Bloomberg School of Public Health, JHBPH, M.M.a.I.D., Malaria Research Institute. Background Information on Malaria. Accessed in 2007. URL:
http://www.jhsph.edu/Malaria/Malaria_Background.html .
2. Rowe A.K., Steketee R.W., Rowe S.Y., Snow R.W., Korenromp E.L., Schellenberg J.A., Stein C., Nahlen B., Bryce J., Black R.E. for the Child Health Epidemiology Reference Group (CHERG). Estimates of the burden of mortality directly attributable to malaria for children under 5 years of age in Africa for the year 2000: 2004. URL:
http://rbm.who.int/partnership/wg/wg_monitoring/docs/CHERG_final_report.pdf 3. Sodiomon Bienvenu Sirima, Amadou Konate, Alfred B. Tiono, Nathalie Convelbo, Simon Cousens, Franco Pagnoni. Early treatment of childhood fevers with pre-packaged antimalarial drugs in the home reduces severe malaria morbidity in Burkina Faso. Tropical Medicine and International Health 2003; 8(2): 133-139.
4. Gebreyesus Kidane, Richard H Morrow. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 2000; 356: 550-55.
5. Wakgari Deressa, Ali A., Enqusellassie F. Self-treatment of malaria in rural communities, Butajira, southern Ethiopia. Bulletin of the World Health Organization 2003; 81(4): 261-268.
6. Amadou Baïlo Diallo, Gaston De Serres, Abdoul Habib Béavogui, Claude Lapointe, Pierre Viens. Home care of malaria-infected children of less than 5 years of age in a rural area of the Republic of Guinea. Bulletin of the World Health Organization 2001; 79: 28-32.
7. Emmanuel A Makundi, Hamisi M Malebo, Paulo Mhame, Andrew Y Kitua, Marian Warsame. Role of traditional healers in the management of severe malaria among children below five years of age: the case of Kilosa and Handeni Districts, Tanzania. Malaria Journal 2006, 5:58: doi: 10.1186/1475-2875-5-58.
8. J. D. Njau, C. Goodman, S. P. Kachur, N. Palmer, R. A. Khatib, S. Abdulla, A. Mills, P. Bloland Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria. Tropical Medicine and International Health 2006;11(3): 299-313.
9. C. Comoro, S.E.D. Nsimba, M. Warsame, G. Tomson. Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district
* /implications for malaria control. Acta Tropica 2003:87: 305-313.
Appendix 1 JBI QARI Critical Appraisal Checklist for Interpretive & Critical Research
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Appendix 2 JBI QARI Data Extraction Form for Interpretive & Critical Research
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