Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.

Background: In the Democratic Republic of Congo (DRC), fewstudies have focused on treatment-seeking paths selected by caretakers for themanagement of severe childhood malaria in an urban environment. The presentstudy aims at describing the treatment-seeking paths according to thecharacteristics of households, and the subsequent impact on pre-hospitalisationdelay and malarial fatality, as well as on the main syndromes associated withsevere childhood malaria. Methods: This descriptive study included data collected in nine hospitals ofKinshasa between January and November 2011. A total of 1,350 children, under 15years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households directly wentto the health centre or hospital while 68.5% of them opted for self-medication,church and/or traditional healing therapy. The most frequent first-line optionwas self-medication, adopted by more than 61.5% of households. Nevertheless,rational self-medication relying on the use of antimalarial drugs recommendedby the WHO (artemisinin-based combinations), was only reported for 5.5% ofchildren. Only 12.5% of households combined 2 or 3 traditional options. Thefollowing criteria influenced the choice of a modern vs. a traditional path: household socioeconomic level, residentialenvironment, mother educational level and religious beliefs. When caretakersopted for traditional healing therapy, the pre-hospitalisation delay was longerwhile the occurrence of respiratory distress, severe anaemia and mortality wasmore frequent. Conclusion: The implementation of a malaria action plan  in the Democratic Republic of Congo shouldtake into account the diversity and pluralistic character of treatment-seekingbehaviours, in order to promote the most appropriate options (hospital andrational self-medication) and avoid the deadliest severe forms.