Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022
Abstract Background Malaria is responsible for 580,000 deaths among children under 5, or 95% of all malaria deaths per year globally. Seasonal Malaria Chemoprevention (SMC) is a malaria control intervention in Togo and other African countries targeting children under 5 years old during the peak mala...
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BMC
2025-03-01
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| Series: | Tropical Medicine and Health |
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| Online Access: | https://doi.org/10.1186/s41182-025-00717-5 |
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| author | Endeshaw Degie Abebe Sikai Huang Kevin Baker Fantche Awokou Meseret Zelalem Tadesse Shiferaw Chekol Abebe Tilaye Weldemichael Sol Richardson |
| author_facet | Endeshaw Degie Abebe Sikai Huang Kevin Baker Fantche Awokou Meseret Zelalem Tadesse Shiferaw Chekol Abebe Tilaye Weldemichael Sol Richardson |
| author_sort | Endeshaw Degie Abebe |
| collection | DOAJ |
| description | Abstract Background Malaria is responsible for 580,000 deaths among children under 5, or 95% of all malaria deaths per year globally. Seasonal Malaria Chemoprevention (SMC) is a malaria control intervention in Togo and other African countries targeting children under 5 years old during the peak malaria transmission season. Delaying access to healthcare for children with malaria can result in serious health problems, including heightened morbidity and mortality, complications related to cerebral malaria and anemia, as well as impaired cognitive development. This study aimed to identify determinants of access to health facilities for children with caregiver-reported fever, in the context of SMC campaigns in Togo. Methodology We analyzed data from three representative annual end-of-round SMC surveys on SMC-eligible children aged 3–59 months residing in the provinces of Savanes, Central and Kara in Togo, conducted during 2020–2022. We performed a descriptive analysis and fitted logistic regression models to assess predictors of health facility access. Our sample included all children with a caregiver-reported fever in the month before the survey. Model variables included household distance to their local health facility, quintiles of household wealth, household visit by SMC distributors in the previous month, household nomad status, literacy of primary caregivers, and the age and sex of both eligible children and their primary caregivers. Results Our analytic sample included 6,252 SMC-eligible children, including 1,418 experiencing fevers. Most children with fever (62.6%, 95% CI 60.0–65.0%) accessed health facilities. Adjusted odds ratios and 95% confidence intervals obtained from the logistic regression analysis found a statistically significant linear relationship between children's adjusted odds of access to health facilities and their distance from the nearest facility, with 2% lower odds of access for each additional kilometer of distance (AOR = 0.98, 95% CI 0.97–0.99). Households with SMC distributor visits were significantly more likely to access health facilities (AOR = 2.20, 95% CI 1.22–3.96). Children of female primary caregivers had higher odds of access (AOR = 1.42, 95% CI 1.05–1.93). Conclusion Febrile children’s access to malaria testing and treatment in Northern Togo requires further improvement, particularly among those further from health facilities and with lower household wealth. |
| format | Article |
| id | doaj-art-202fadf03e7e4ed1a83326fcdfd9cdcd |
| institution | DOAJ |
| issn | 1349-4147 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj-art-202fadf03e7e4ed1a83326fcdfd9cdcd2025-08-20T03:01:39ZengBMCTropical Medicine and Health1349-41472025-03-015311910.1186/s41182-025-00717-5Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022Endeshaw Degie Abebe0Sikai Huang1Kevin Baker2Fantche Awokou3Meseret Zelalem4Tadesse Shiferaw Chekol5Abebe Tilaye Weldemichael6Sol Richardson7Vanke School of Public Health, Tsinghua UniversityVanke School of Public Health, Tsinghua UniversityMalaria Consortium UK, the Green HouseMalaria Consortium Togo, Malaria ConsortiumAddis ECD Centre for Excellence, Learning and InnovationArmauer Hansen Research InstituteMinistry of HealthVanke School of Public Health, Tsinghua UniversityAbstract Background Malaria is responsible for 580,000 deaths among children under 5, or 95% of all malaria deaths per year globally. Seasonal Malaria Chemoprevention (SMC) is a malaria control intervention in Togo and other African countries targeting children under 5 years old during the peak malaria transmission season. Delaying access to healthcare for children with malaria can result in serious health problems, including heightened morbidity and mortality, complications related to cerebral malaria and anemia, as well as impaired cognitive development. This study aimed to identify determinants of access to health facilities for children with caregiver-reported fever, in the context of SMC campaigns in Togo. Methodology We analyzed data from three representative annual end-of-round SMC surveys on SMC-eligible children aged 3–59 months residing in the provinces of Savanes, Central and Kara in Togo, conducted during 2020–2022. We performed a descriptive analysis and fitted logistic regression models to assess predictors of health facility access. Our sample included all children with a caregiver-reported fever in the month before the survey. Model variables included household distance to their local health facility, quintiles of household wealth, household visit by SMC distributors in the previous month, household nomad status, literacy of primary caregivers, and the age and sex of both eligible children and their primary caregivers. Results Our analytic sample included 6,252 SMC-eligible children, including 1,418 experiencing fevers. Most children with fever (62.6%, 95% CI 60.0–65.0%) accessed health facilities. Adjusted odds ratios and 95% confidence intervals obtained from the logistic regression analysis found a statistically significant linear relationship between children's adjusted odds of access to health facilities and their distance from the nearest facility, with 2% lower odds of access for each additional kilometer of distance (AOR = 0.98, 95% CI 0.97–0.99). Households with SMC distributor visits were significantly more likely to access health facilities (AOR = 2.20, 95% CI 1.22–3.96). Children of female primary caregivers had higher odds of access (AOR = 1.42, 95% CI 1.05–1.93). Conclusion Febrile children’s access to malaria testing and treatment in Northern Togo requires further improvement, particularly among those further from health facilities and with lower household wealth.https://doi.org/10.1186/s41182-025-00717-5MalariaAccess to health servicesSeasonal malaria chemopreventionTogo |
| spellingShingle | Endeshaw Degie Abebe Sikai Huang Kevin Baker Fantche Awokou Meseret Zelalem Tadesse Shiferaw Chekol Abebe Tilaye Weldemichael Sol Richardson Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 Tropical Medicine and Health Malaria Access to health services Seasonal malaria chemoprevention Togo |
| title | Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 |
| title_full | Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 |
| title_fullStr | Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 |
| title_full_unstemmed | Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 |
| title_short | Determinants of access to health facilities among under-five children with caregiver-reported fever in the context of seasonal malaria chemoprevention in Togo, 2020–2022 |
| title_sort | determinants of access to health facilities among under five children with caregiver reported fever in the context of seasonal malaria chemoprevention in togo 2020 2022 |
| topic | Malaria Access to health services Seasonal malaria chemoprevention Togo |
| url | https://doi.org/10.1186/s41182-025-00717-5 |
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