A new study spanning three African countries sheds light on why parents sometimes delay seeking treatment for children with fevers, a symptom often linked to malaria, the leading cause of child mortality in Côte d’Ivoire, the Democratic Republic of Congo (DRC) and Benin.
An international team led by Albert Casella, a researcher who conducted the work at the Johns Hopkins Center for Communication Programs, used findings from the Malaria Behavior Survey in those countries to better understand the disconnect between knowing that fever in children under five could be a warning sign of malaria and seeking treatment in the first 24 hours.
“Does it have to do with people’s perceptions about malaria as a disease?” Casella asks. “Does it have to do with people’s knowledge? Does it have to do with their access to local care?”
The findings appear in Malaria Journal.
The study found that the most important factors influencing whether parents seek care for children with fever are not simply knowledge or perceptions about malaria’s severity, but structural factors such as their access to local health facilities, as well as whether the behavior was considered normal in their community.
If taking a feverish child to the health facility is what appears to be common among neighbors and friends, parents are more likely to seek care, the study shows.
The same is true about interpersonal communication.
Talking about malaria with others also significantly increased the likelihood that a caregiver would seek prompt care for a child with a fever. “If in the last six months, the respondent talked about malaria with their spouse or their friends or their family, they were much more likely to do this behavior,” Casella says.
The findings are based on the Malaria Behavior Surveys, conducted 15 times in 13 countries in Africa from 2018 through 2024 under the CCP-led Breakthrough ACTION project. This rigorous research has helped countries where malaria is endemic to better understand what malaria-related behaviors are being practiced, what factors may facilitate those behaviors, and where actionable improvements can be made.
CCP staff are available to conduct future Malaria Behavior Surveys. CCP researchers also offer support for MBS data analysis, visualization and evidence-informed strategy development.
According to the World Health Organization’s latest world malaria report, there were an estimated 263 million cases and 597,000 malaria deaths worldwide in 2023, the last year for which there is global data. Malaria is most dangerous to children under the age of 5 and pregnant women in sub-Saharan Africa.
This new CCP-led research focused on three countries: Côte d’Ivoire, DRC and Benin. Each country had similarities in what drove people to seek care and differences.
The study stands out for its rigor and scope. “It’s a multi-country, large scale quantitative study that uses the same approach in each country. Rarely do you find that when it comes to behavioral science,” Casella says.
The researchers suggest that, to increase rapid care-seeking for febrile children, interventions should be tailored to each country and community; malaria communication must become part of routine maternal and child health care; frame malaria as a family health issue and get men involved; and promote prompt care-seeking as the community norm.
Ultimately, the researchers concluded that, in the fight against malaria, “knowledge isn’t everything. It’s not necessarily the key,” Casella says. “I can know something. I know soda is bad for me, but I might still want it, and I don’t care. You know, that’s not a lack of knowledge. It’s about attitudes and perception.”
“Ideational factors associated with appropriate care-seeking for fever among caregivers of children under five years of age: a multi-country analysis in sub-Saharan Africa” was written by Albert Casella, Michael Bride, Gabrielle C. Hunter, Michael Toso, Grace N. Awantang, Alain K. Koffi, Jayme Hughes, Thérèse Bleu, Bolanle Olapeju, Abdul Dosso, Florence Mpata, Eric Sompwe Mukomena and Stella Babalola.
