Abstract
BACKGROUND: Malaria remains the leading cause of morbidity in Guinea. Early diagnosis of malaria infections and prompt administration of appropriate treatment are two essential elements in reducing severe morbidity and mortality associated with malaria infection. This study aims to identify how community norms can shape caretakers' care-seeking behavior for fever in children under five in Guinea. METHODS: This study uses data from the 2021 Guinea malaria and anemia indicators survey to analyze the factors associated with mothers' access to care for children under five with fever in Guinea. The survey's results are representative at the national level, in urban and rural areas, and across each of Guinea's eight administrative regions. Each region was stratified into urban and rural areas, except for Conakry city, which is entirely urban. Three questionnaires-the Household Questionnaire, the Woman's Questionnaire, and the Biomarker Questionnaire-were used to collect data. This study uses information collected through the household and women's questionnaires only. Community norms were assessed through two statements (1) Whether the respondent agrees that people in the community usually take their children to a healthcare provider on the same day or the day after they develop a fever, and (2) Whether the respondent agrees that people in the community, who have a mosquito net usually sleep under it every night. Binary univariate and multivariate logistic regressions were used to identify factors associated with early care-seeking behaviour with crude and adjusted odds ratios. RESULTS: 921 children who had fever during the 2 weeks preceding the interview were included in the analysis: 110 from Conakry, 113 from Boke, 103 from Faranah, 188 from Kankan, 137 from Kindia, 113 from Labé, 55 from Mamou, and 102 from Nzerekoré. After controlling for all variables in the model, early care-seeking in children under-five with fever was positively associated with the mother's perception of community norms about care-seeking and the use of mosquito nets (OR: 1.98, [1.29-3.02]) as well as living in a household in the middle wealth quintile as compared to households in the lowest quintile OR: 1.87, [1.04-3.37]. It was negatively associated with living in Boké (OR 0.25, [0.10-0.66]), Kindia (OR: 0.42, [0.18-0.94]), and Labé (OR: 0.30, [0.13-0.70]) compared to living in Conakry. CONCLUSION: These findings suggest that interventions aimed at changing behaviour in Guinea can significantly benefit from reinforcing community norms around early care-seeking for children under five with fever. Using mothers who take their children to a health facility as soon as the fever develops as role models can encourage others in the community. More efforts are needed in Boké, Kindia and Labé.