Prevalence, Diagnosis, and Prompt Treatment of Children with Fever

Percentage of children with fever in the 2 weeks preceding the survey; and among children with fever, percentage for whom advice or treatment was sought, percentage for whom advice or treatment was sought the same or next day following the onset of fever, and percentage who had blood taken from a finger or heel for testing, and percentage who were diagnosed with malaria by a healthcare provider

Definition

1)      Percentage of children under age 5 years with fever in the 2 weeks preceding the survey.

2)      Among children under age 5 years with fever in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought.

3)      Among children under age 5 years with fever in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought the same or next day following the onset of fever.

4)      Percentage of children under age 5 years with fever in the 2 weeks preceding the survey who had blood taken from a finger or heel for testing.

5)      Percentage of children under age 5 years with fever in the 2 weeks preceding the survey who were diagnosed with malaria by a healthcare provider.

Coverage:

Population base: Living children under age 5 years (KR file)

Time period: Two weeks preceding the interview

Numerators:

1)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview (b5 = 1 & b19 < 60 & h22 = 1)

2)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview for whom advice or treatment was sought (b5 = 1 & b19 < 60 & h22 = 1 & any of h32a – x = 1 except traditional practitioner (usually h32t))

3)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview for whom advice or treatment was sought the same day or next day following the onset of fever (b5 = 1 & b19 < 60 & h22 = 1 & any of h32a – x = 1 excluding advice or treatment from a traditional practitioner (usually h32t) & h46b in 0:1)

4)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview who had blood taken from a finger or heel for testing (b5 = 1 & b19 < 60 & h22 = 1 & h47 = 1)

5)       Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview who were diagnosed with malaria by a healthcare provider (b5 = 1 & b19 < 60 & h22 = 1 & h71 = 1)

Denominators:

a)       Numerator 1: Number of living children under age 5 years (b5=1 & b19 < 60)

b)      Numerators 2, 3, 4, and 5: Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the survey (b5 = 1 & b19 < 60 & h22 = 1)

Variables: KR file.

Calculation

Numerator divided by denominator, multiplied by 100.

Handling of Missing Values

Missing data or “don’t know” responses on the question on fever are excluded from numerator 1, and from numerators and denominators 2, 3, 4 and 5, assuming no illness.

Missing data or “don’t know” responses for whether sought advice or treatment and who from are excluded from numerators 2 & 3, assuming no treatment sought from a health facility or provider.

Missing data or “don’t know” responses for whether blood was taken from the child’s finger or heel and for whether the child was diagnosed with malaria are excluded from numerator 4 and 5, assuming no blood was taken and no diagnosis provided, respectively.

Notes and Considerations

As fever is an important symptom of malaria, this indicator provides a useful measure of the proportion of children under age 5 years who might require diagnosis or treatment for malaria. The number of children under age 5 years with recent fever is the denominator for several care seeking indicators. The limitations of the indicator are that it is based on mother’s or caregiver’s information, which may not provide reliable estimates of fever episodes in the 2 weeks preceding the survey and may miss fostered children or others living in a household without a parent/caregiver. Additionally, a fever may not have been the result of a malaria infection. Trends in this indicator may be biased by the season of data collection.

Indicators 2 & 3 include advice or treatment from the public sector, private medical sector, shops, market, and itinerant drug sellers, but excludes advice or treatment from a traditional practitioner.

The possibility exists that the percentage of children who were diagnosed with malaria is greater than the percentage who had blood from their finger or heel tested. The two questions are asked independently of one another (WQ619 and WQ620). The diagnosis of malaria is based on the woman’s recall and is not confirmed with a healthcare provider.

Changes over Time

For surveys prior to DHS-7, care seeking was defined differently. The indicator measured care seeking from a medical source or provider, and excluded pharmacy, shop, market, itinerant drug seller and traditional practitioner.

In DHS-8, NGO medical sector was added as a separate source category. Previously, it was lumped in with private medical sector.

References

Johansson, E.W., P.W. Gething, H. Hildenwall, B. Mappin, M. Petzold, S.S. Peterson, and K.E. Selling. 2014. “Diagnostic testing of pediatric fevers: meta-analysis of 13 national surveys assessing influences of malaria endemicity and source of care on test uptake for febrile children under five years.” PLoS One, 9(4), p.e95483. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0095483

Johansson, E.W., P.W. Gething, H. Hildenwall, B. Mappin, M. Petzold, S.S. Peterson, and K.E. Selling. 2015. “Effect of diagnostic testing on medicines used by febrile children less than five years in 12 malaria-endemic African countries: a mixed-methods study.” Malaria journal, 14(1), p.194. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-0709-0

Prasad, N., Sharples, K.J., Murdoch, D.R. and Crump, J.A., 2015. “Community prevalence of fever and relationship with malaria among infants and children in low-resource areas.” The American journal of tropical medicine and hygiene, 93(1), pp.178-180. https://www.ncbi.nlm.nih.gov/pubmed/25918207

Uggla, C. and Mace, R., 2016. “Parental investment in child health in sub-Saharan Africa: a cross-national study of health-seeking behaviour.” Royal Society open science, 3(2), p.150460.

http://rsos.royalsocietypublishing.org/content/3/2/150460

Rutstein, S.O., S. Staveteig, R. Winter, and J. Yourkavitch. 2016. Urban child poverty, health, and survival in low- and middle-income countries. DHS Comparative Reports No. 40. Rockville, Maryland, USA: ICF International. https://www.dhsprogram.com/publications/publication-CR40-Comparative-Reports.cfm

Resources

DHS-8 Tabulation plan: Table 12.10 and Table 10.8

API Indicator IDs:

ML_FEVR_C_FEV, ML_FEVT_C_ADV, ML_FEVT_C_ADS, ML_FEVT_C_BLD

(API link, STATcompiler link)

Household Survey Indicators for Malaria Control Indicator 9: Proportion of children under five years old with fever in the last two weeks who had a finger or heel stick

Household Survey Indicators for Malaria Control Indicator 10: Proportion of children under five years old with fever in the last two weeks for whom advice or treatment was sought

MICS6 Indicator TC.26: Care-seeking for fever

MICS6 Indicator TC.27: Malaria diagnostics usage

MICS6 Indicator TC.28: Antimalarial treatment of children under age 5

Percentage of children under age 5 with fever in the 2 weeks preceding the survey for whom advice or treatment was sought from specific sources; and among children under age 5 with fever in the 2 weeks preceding the survey for whom advice or treatment was sought, the percentage for whom advice or treatment was sought from specific sources

Definition

1)      Among children under age 5 years with fever in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought.

2)      Among children under age 5 years with fever in the 2 weeks preceding the survey for whom advice or treatment was sought, the percentage for whom advice or treatment was sought from specific sources.

Coverage:

Population base: Living children under age 5 years (KR file)

Time period: Two weeks preceding the interview

Numerators:

1)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview (b5 = 1 & b19 < 60 & h22 = 1) by source of advice or treatment sought (h32a – x)

2)      Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview for whom advice or treatment was sought (b5 = 1 & b19 < 60 & h22 = 1 & any of h32a – x = 1) by source of advice or treatment sought (h32a –x)

Denominators:

a)       Number of living children under age 5 years with a fever at any time during the 2 weeks preceding the interview (b5 = 1 & b19 < 60 & h22 = 1)

b)      Number of children under age 5 who were ill with a fever in the 2 weeks preceding the interview and for whom advice or treatment was sought (b5 = 1 & b19 < 60 & h22 = 1 & h32y = 0)

Variables: KR file.

Calculation

Numerator divided by denominator, multiplied by 100.

Handling of Missing Values

Missing values for fever status and whether advice or treatment was sought for children with fever are not included in the denominator. Missing values for sources of advice or treatment for children with fever are treated as “no” responses.

Notes and Considerations

The limitations of the indicator are that it is based on mother’s or caregiver’s information, which may not provide reliable estimates of fever episodes in the 2 weeks preceding the survey and may miss fostered children or others living in a household without a parent/caregiver. The mother of a child does not always know the exact qualifications of or the type of provider and, thus, may not be able to tell the interviewer this information.

Changes over Time

There may be survey-specific changes over time to the response options for sources of care for fever.

References

Battle, K.E., D. Bisanzio, H.S. Gibson, S. Bhatt, E. Cameron, D.J. Weiss, B. Mappin, U. Dalrymple, R.E. Howes, S.I. Hay, and P.W. Gething. 2016. “Treatment-seeking rates in malaria endemic countries.” Malaria journal, 15(1), p.20. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-1048-x

Shah, J.A., J.B. Emina, E. Eckert, and Y. Ye,.2015. “Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data.” Malaria journal, 14(1), p.329. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-0844-7

Resources

DHS-8 Tabulation plan: Table 12.11

API Indicator IDs:

ML_FEVS_C_PUB, ML_FEVS_C_GHS, ML_FEVS_C_GHC, ML_FEVS_C_GHP, ML_FEVS_C_GMC, ML_FEVS_C_GFW, ML_FEVS_C_GOT, ML_FEVS_C_PRV, ML_FEVS_C_PHS, ML_FEVS_C_PPH, ML_FEVS_C_PDR, ML_FEVS_C_PMC, ML_FEVS_C_PFW, ML_FEVS_C_POT, ML_FEVS_C_OSR, ML_FEVS_C_SHP, ML_FEVS_C_TRD, ML_FEVS_C_MKT, ML_FEVS_C_OTH, ML_FEVA_C_PUB, ML_FEVA_C_GHS, ML_FEVA_C_GHC, ML_FEVA_C_GHP, ML_FEVA_C_GMC, ML_FEVA_C_GFW, ML_FEVA_C_GOT, ML_FEVA_C_PRV, ML_FEVA_C_PHS, ML_FEVA_C_PPH, ML_FEVA_C_PDR, ML_FEVA_C_PMC, ML_FEVA_C_PFW, ML_FEVA_C_POT, ML_FEVA_C_OSR, ML_FEVA_C_SHP, ML_FEVA_C_TRD, ML_FEVA_C_MKT, ML_FEVA_C_OTH

(API link, STATcompiler link)