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Responses of caregivers to children under the age of five with fever and living in areas where malaria is endemic: a systematic review of qualitative studies

Purpose The aim of this systematic review of qualitative studies was to provide a concise description of caregivers' responses to fever in children under the age of five and identify important factors that influence those responses. Methods The review considered English language qualitative studies published between 1997 and 2007 which examined responses of caregivers to fever in children under the age of five and living in malaria endemic countries. We searched the following electronic databases: Pub Med, Social Sciences Citation Index, Academic search premier, Biomedical central, Direct Open Access Journals, Helsinki, Plos one, Scielo, Astmh, Blackwell Synergy, Elsevier, Oxford journals and popline using the following keywords or terms: "malarial fever", "under five children", responses, "prompt treatment", parents, "parental response", "treatment response", fever, malarial, "children under five", caregivers, guardians, "guardian response", parents, factors, malaria, and endemic. This process was complemented by searching Google Scholar and following up expert referrals. Findings In areas where malaria is endemic, most cases of fevers are managed outside the formal health sector either in the homes or community. Caregivers, (generally parents, most often the mothers) are pivotal and play a critical role in provision of medical care for children with fevers. Responses of caregivers to fever in children under the age of five years are multiple but can broadly be categorised into two groups depending on the how soon after fever onset caregivers seek treatment for their children: early treatment seekers and late treatment seekers. Within each group, the specific actions taken by caregivers are variable and dynamic and commonly do not lead to the child with fever illness getting prompt and effective antimalarial treatment. In addition, numerous social, cultural and economic factors interact in complex ways and influence caregivers' responses to children with fever. Conclusion A concise and holistic understanding of context specific caregivers responses and a host of social, economic, cultural conceptual, gender and physical factors that influence those responses is essential to inform the design of appropriate, acceptable and effective behaviour change communication strategies to promote early and effective treatment of malaria fevers in children under the age of five years and living in areas where malaria is endemic.