Open Access Open Badges Research article

Community referral in home management of malaria in western Uganda: A case series study

Karin Källander1*, Göran Tomson12, Jesca Nsungwa-Sabiiti1345, Yahaya Senyonjo6, George Pariyo3 and Stefan Peterson13

Author affiliations

1 Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden

2 Medical Management Centre (MMC), Karolinska Institutet, 17177 Stockholm, Sweden

3 Makerere University Institute of Public Health, Kampala, Uganda

4 Department of Pharmacology and Therapeutics, Makerere University, Kampala

5 Uganda Ministry of Health, Division of Child Health, Kampala, Uganda

6 Department of Paediatrics, Mulago Hospital, Kampala

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Citation and License

BMC International Health and Human Rights 2006, 6:2  doi:10.1186/1472-698X-6-2

Published: 16 March 2006



Home Based Management of fever (HBM) was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children <5 years. Persisting fever or danger signs are referred to the health centre. We assessed overall referral rate, causes of referral, referral completion and reasons for non-completion under the HBM strategy.


A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs) were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral.


Overall referral rate was 8% (117/1454). Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93%) "urgent referrals" accessed referral care but 8 (31%) delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50%) were urgently referred; most delayed ≥ 2 days before accessing referral care.


The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.