Concern about HIV Testing on Early Presentation and Treatment of Malaria among Children in East Shewa Zone of Oromia Region, Ethiopia

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Addis Ababa University


Background:Malaria remains a major public health problem in the world with high burden of the disease in sub-Sahara Africa, mostly affecting children. Malaria accounts for high proportion of morbidity and mortality in Ethiopia and in East Shewa Zone of Oromia Region. To reduce this burden, early presentation and management is one of the priorityarea. Malaria diagnosis based on parasitological confirmation using microscopy/rapid diagnostic testing (RDT), which have similarity with human immune deficiency virus (HIV) test, is therefore increasingly advocated. However, concern of being tested for HIV can discourage community members from seeking biomedical solutions. Objectives:to assess concernsabout HIV testingin delaying early presentation and treatment seeking ofchildren with malaria. Methods: A facility-based cross-sectional design comprising mixed quantitative and qualitative research methods were conductedfrom October - November 2012 in five purposively selected health centers of East Shewa Zone. The source population were children under the age of 16 years with malaria symptoms in the districts and study population were < 16 years of age children who were suspected to have malaria and requested for malaria blood film test in the health center accompanied by caretakers. A total sample size of 836 (418 concerned and 418 unconcerned) mothers/caretakers and their childenwere included in the study. A pre-tested structured questionnairewas used and all clients were interviewed until the intended sample size was achieved. Data were entered using Epi-info version 3.5.3 and analysis was carried out using SPSS-16 statistical packages.Associations between dependent and independent variables were assessed and presented using odds ratios and 95% confidence intervals. Qualitative data were summarized manually and the result was triangulated across the groups. Results: Of 830(412 concerned and 418 unconcerned with HIV testing) interviewed mothers/caretakers, about90% had knowledge on malaria and HIV diagnosis/testing and prevention while misconception on the two tests was also high. Nearly all(98%) of the concerned group thought that health workers would do HIV testing for people who give their blood sample for malaria testing in the health facilitycompared with only 4% of those unconcerned about HIV testing.About half(48%) of the concerned respondents believed that fear of HIV testing was the reason for people to stay away from seeking early diagnosis and treatment while only 11%of unconcerned caretakers agreed with idea. About 48% of children presented to health centers after 2 days of illness.Laboratory confirmed prevalence of malariaamong study children was 20.5% with P.vivax constituting 57% and P.falciparum 41%. ix Mothers/caretakers concern about HIV testing was independent predictor of malaria treatmentdelay among sick children [Adjusted odds ratio (AOR) = 1.84; 95% CI= 1.40-2.44]. Conclusions:Concern about HIV testing among the mothers/caretakers was associated with delay in presentation and treatment of children at health centers,and nearly half of the children were brought after two days of illnesses onset. High knowledge of malaria and HIV testing observed,yet misconceptions was also high.Moderate malaria prevalence with P.vivaxwas observed in health facilities. Therefore, removing fear of HIV testing in the community and improving early treatment seeking behaviorfor malaria through delivery of appropriate and tailoredinformation, designing a better strategy and implementation by responsible bodies is recommended.



Malaria remains