# Determinants of timely malaria treatment among under-five children attending public health facilities in Kisumu East sub-county, Kenya: a health facility-based cross-sectional study

## TL;DR

The study identifies factors influencing timely malaria treatment for children under five in Kenya, showing that symptom recognition and health insurance increase prompt treatment, while herbalist visits and fear of side effects delay it.

## Contribution

This study empirically identifies novel determinants of timely malaria treatment in a resource-limited setting, including the role of health insurance and misconceptions about drug side effects.

## Key findings

- Caregivers who recognize malaria symptoms are nearly three times more likely to seek timely treatment.
- Having health insurance increases the odds of timely treatment by over two times.
- Visiting herbalists before seeking care significantly reduces the likelihood of timely treatment.

## Abstract

Despite evidence that most child malaria deaths occur at home shortly after symptom onset, receiving timely malaria treatment remains a significant challenge. Timely malaria treatment, defined as early diagnosis and prompt administration of appropriate anti-malarial medication within 24 h of symptom onset, is crucial for reducing mortality. However, factors influencing timely treatment among under-five children in resource-limited settings remain inadequately explored. This study aimed to assess the determinants of timely malaria treatment among under-five children, who receive care at public health facilities in Kisumu East sub-county, Kenya.

A health facility-based cross-sectional study was conducted in Kisumu East sub-county, Kenya, between 5th April and 26th May 2023. The study employed a two-stage stratified-cluster sampling method, first selecting hospitals and then using systematic sampling to select caregivers. Data collection was done electronically using structured questionnaires. Associations at bivariable level were assessed using either the Chi-square or Fisher's exact test based on assumptions. Multiple logistic regression with robust standard errors was applied at a 5% significance level to establish determinants of timely malaria treatment among under-five children. STATA version 16 (College Station, TX 77845 USA) was used for all analyses.

The sample included a total of 434 caregivers of under-five children. The study revealed that caregivers' ability to recognize malaria symptoms was associated with higher odds of seeking timely malaria treatment for their children (AOR = 2.9; 95% CI 1.4–6.3; p = 0.006). Belief in use of appropriate malaria drugs was associated with higher odds of timely treatment (AOR = 6.9, 95% CI 2.5–18.9, p < 0.0001). Additionally, having health insurance cover was associated with higher odds of timely treatment (AOR = 2.1; 95% CI 1.3–3.6; p = 0.005). Those who visited herbalists before seeking care were less likely to receive timely treatment (AOR = 0.1; 95% CI 0.1–0.3; p < 0.0001). Fear of drugs' side effects reduced the odds of timely treatment (AOR = 0.5; 95% CI 0.3–0.9; p = 0.013).

Timely malaria treatment was linked to the ability to tell symptoms and having health insurance, while delayed malaria treatment was related to herbalist visits and fear of malaria, among others. There is need for relevant stakeholders to implement strategies that address misconceptions about drug side effects, offer affordable insurance, integrate the informal health sector, and educate caregivers about under-five malaria symptoms in order to promote timely malaria treatment.