Case management of malaria in under‐fives at primary health care facilities in a Tanzanian district

OBJECTIVE: To study case management of malaria in children under 5 years of age at primary health care facilities in Kibaha district, Tanzania and to evaluate the accuracy of self-reported mothers'/guardians' information on chloroquine use in children. METHOD: A random sample of 652 mothers/guardians with sick children under 5 years of age attending 10 primary health care facilities was observed and interviewed. Blood samples for determination of chloroquine levels were taken from all children and thick smears for detection of malaria parasites were taken from the children who were prescribed chloroquine. Information on diagnoses and prescriptions was collected from recording books. RESULTS: Fever and respiratory problems were the most common complaints and accounted for 75% and 46% of the presenting conditions, respectively (some complained of both). Fifty-four per cent of the children received medication at home, most commonly antipyretics and chloroquine, 20% had been taken to another health facility and 3% to traditional healers before coming to the health facilities. There was a significantly higher use of antipyretics among home treated children compared with those taken previously to health facilities (P or= 1000 nmol/l). Of those prescribed chloroquine, 16% already had high blood concentrations of the drug. CONCLUSION: Health care services, i.e. presumptive malaria diagnosis, consultation time and procedure for physical examination need to be improved.