AUTHOR=Lee Tristan T. , Omoluabi Elizabeth , Ayodeji Kazeem , Yusuf Ocheche , Okon Charles , Brunner Nina C. , Delvento Giulia , Signorell Aita , Lambiris Mark J. , Kwiatkowski Marek , Burri Christian , Lengeler Christian , Emedo Emmanuel , Cheshi Fatima , Fashanu Chizoba , Wiwa Owens , Hetzel Manuel W. 

TITLE=Treatment-Seeking for Children with Suspected Severe Malaria Attending Community Health Workers and Primary Health Centres in Adamawa State, Nigeria

JOURNAL=International Journal of Public Health

VOLUME=Volume 70 - 2025

YEAR=2025

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2025.1607697

DOI=10.3389/ijph.2025.1607697

ISSN=1661-8564

ABSTRACT=ObjectivesIn the context of introducing pre-referral rectal artesunate for children with severe malaria in Adamawa State, Nigeria, case fatality was 19% among severely sick children visiting primary health centres (PHCs), and 6% among those visiting community health workers (CORPs). To understand this difference, we investigated illness severity, treatment-seeking, and background characteristics of these patients.Methods589 children <5 years of age with fever and danger signs indicative of severe malaria attending CORPs (N = 314) and PHCs (N = 275) were enrolled. After 28 days, caregivers were interviewed about background characteristics, symptom severity, and treatment seeking practices; children attending CORPs and PHCs were compared.ResultsCompared to children attending CORPs, those attending PHCs were more likely to live in urban areas, have ≥4 clinical danger signs (50% vs. 39%, p = 0.02) and signs of central nervous system involvement (90% vs. 74%, p < 0.01), and more often received initial home treatment (42% vs. 33%, p = 0.04).ConclusionPHCs may see sicker children due to community assumptions of their professional capacity. Health system strengthening is required to capacitate PHCs to handle severe conditions and save lives in rural communities.