Effect of Concerns about HIV Testing in Delaying Early Presentation and Treatment of Malaria among Adults in East Shewa Zone of Oromia Regional State, Ethiopia

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Addis Abeba Universty


Background: Early diagnosis and prompt treatment of malaria has been a key component of the global malaria control strategy. However, community members might be concerned that blood samples taken from finger-pricks for malaria diagnosis could also be used for HIV testing which has never been studied. Such concern and perception can cause delay in presentation for diagnosis and treatment which in turn can lead to the progress of severe and fatal malaria. Objective: The objective of this study was to assess effect concerns about HIV testing in delaying early presentation and treatment for malaria among adults in East Shewa Zone of Oromia Regional State. Methods: A facility-based comparative cross-sectional study design including both quantitative and qualitative data was used in five purposively selected health centres (Modjo, Meki, Batu, Bulbula and Shashemene) in the zone. Quantitative data were collected from October to November 2012 from HIV testing concerned (n=406) and unconcerned (n=404) suspected adult malaria patients (16 years or above). The sample size was allocated to the five health centres proportional to the number of patients tested for malaria at each facility during the preceding three months. Quantitative data collected using structured interview questions were supplemented with focus group discussions and in-depth interviews. Data entry, data cleaning and coding was performed using the Epi info version 3.5.1 Software, and exported to SPSS version 16 for analysis. Initial analysis was done by Chi-squared testing and subsequent analysis by binary logistic regression after adjustment for potential confounding variables. Associations between dependent and independent variables was assessed and presented using odds ratios and 95% confidence intervals. Qualitative data analysis was done based on the thematic approach and triangulated with the results of the quantitative result. Results: Of 810 study participants, 56.4% (52.7% HIV testing concerned vs 47.3% unconcerned), were presented to the health centres after two days of the onset of illness. Regarding knowledge about malaria; 45.4% (45.6% HIV testing concerned vs 45.3% unconcerned) had low, followed by medium (32.6%), and good (22.0%) knowledge about malaria. Moreover 37.2% (41.2% HIV testing concerned vs 33.2% unconcerned) had low, 32.7% (31.1% HIV testing concerned vs 34.2% unconcerned) had good, and the rest had medium knowledge about HIV prevention and testing. The overall malaria positivity rate of this study VI was 25.2% of which P. vivax accounts for 54.4%, P. falciparum 45.1% and mixed infection only accounts 0.5%. Out of the total 406 respondents who were concerned majority (39.4%) were very sure, followed by somewhat sure (34.7%). regarding the degree to which they are sure that they would get an HIV test if they give their blood sample for malaria testing at health facility. Patients who were concerned are more likely to delay than those who were unconcerned [AOR=1.4; 95%CI (1.1, 1.9)]. Having ever sought advice or treatment from any source before coming to the health centre [AOR=4.9; 95%CI (2.4, 10.0)], having good knowledge about HIV prevention and testing [AOR=1.4; 95%CI (1.1, 1.9)], and having ever visited health facility in the prior twelve months [AOR=1.4; 95%CI (1.1, 1.9)] to their concurrent illness were also associated with delay in presentation to health centres for malaria diagnosis and treatment The main reasons cited for the delay in this study were mild illness, lack of time, being concerned about HIV testing, and lack of money. Conclusion and Recommendation: Patients who were concerned about HIV testing from blood taken from finger-pricks for malaria diagnosis were more likely to delay than those who were not concerned. Accordingly health education on malaria and HIV testing should be provided in order to minimize the concern about HIV testing thereby improving the community’s awareness and attitude towards early diagnosis and treatment for malaria.



Effect of Concerns about HIV Testing in Delaying