Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study

Abstract

This study assesses malaria prevention and treatment behaviour among people living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria bears one of the world’s largest burdens of both malaria and HIV, there is almost no research studying how co-infected patients manage their care. We systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital and the Federal Medical Centre in Owerri to complete a structured, pre-tested questionnaire on malaria care-seeking behaviour. Descriptive statistics were reported and chi-square tests and multivariate logistic regressions were also used. The majority of HIV-infected patients (78.9%) reported having had an episode of suspected malaria quarterly or more often. There was a large variation in care-seeking patterns: on suspicion of malaria, 29.1% of participants engaged in self-medication; 39.2% went to drug shops, and only 22.6% visited HIV/AIDS care centres. Almost 40% waited more than 24 hours before initiating treatment. Most (60.3%), reported taking recommended artemisinin-based combination treatments (ACT) but a significant minority took only paracetamol (25.6%) or herbal remedies (3.5%). Most (80%) finished their chosen course of treatment; and completion of treatment was significantly associated with the frequency of suspected malaria occurrence (p = 0.03). Most (62.8%) did not take anti-malaria medication while taking antiretroviral treatment (ART) and almost all (87.6%) reported taking an ACT regimen that could potentially interact with Nigeria’s first-line ART regimen. Our findings suggest the need to pay more attention to malaria prevention and control as a crucial element in HIV/AIDS management in this part of Nigeria and other areas where malaria and HIV/AIDS are co-endemic. Also, more research on ART-ACT interactions, better outreach to community-level drug shops and other private sector stakeholders, and clearer guidelines for clinicians and patients on preventing and managing co-infection may be needed. This will require improved collaboration between programmes for both diseases.

Determinants of Timely Malaria Treatment among Under-Five Children Attending Public Health Facilities in Kisumu East Sub-County, Kenya: A Health Facility-Based Cross-Sectional Study

“…A structured questionnaire, adapted from prior studies on a similar topic (13,14,(20)(21)(22)27,31,32), was administered to participants by trained community health volunteers (CHVs). The questionnaire was initially prepared in English, translated into the local language, Luo, and then back translated to English for consistency.…”

“…Evidence shows that most of the malaria deaths occur at home without receiving proper medical care, and in case care is sought, it is often delayed (11,12). Several studies have investigated the determinants influencing the timely treatment of malaria among children under five children and have unveiled a spectrum of predictors of timely malaria treatment spanning socio-cultural, physical, and economic dimensions (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Despite all these efforts, the proportion of under-five children in Kisumu East Sub-county receiving timely malaria treatment remains low as evidenced in Kenya Malaria Indicator Survey (KMIS) of 2020 which reported that only 36% of children with recent fever received timely treatment on the same or next day following fever onset (4).…”

“…Additionally, while studies have investigated the determinants of timely malaria treatment, there are limited studies concerning this health issue in Kisumu East sub-county. Moreover, the existing studies have produced conflicting findings (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), adding a layer of complexity to the understanding of the factors influencing timely malaria treatment. For example, studies done in Northwest Ethiopia showed that malaria knowledge was a significant determinant of malaria treatment (20,23) while another study done in southwest Ethiopia showed that malaria knowledge was not a significant determinant of timely malaria treatment among under-five.…”

HIV status of individuals who underwent pre-employment medical screening at a federal tertiary health institution in southeast Nigeria

“…The first two cases reported by the Federal Ministry of Health were a 13-year-old sexually active child and a female commercial sex worker from a neighboring West African country (1,10). Nigeria, the most populous nation in Africa, has the third-highest HIV burden and the highest number of orphans due to AIDS in sub-Saharan Africa (11)(12)(13)(14). According to Mitsunaga et al, (15), heterosexual transmission is the main method of transmission for the AIDS epidemic in Nigeria.…”

HIV/malaria co-infection and its determinants among people living with HIV/AIDS in Yenagoa, Bayelsa state, Nigeria

“…The primary causes of morbidity and mortality in underdeveloped countries are HIV and malaria(Yibeltal et al, 2020). Each disease may become more severe and possibly more contagious through co-infection(Chukwuocha et al, 2019;Gumel et al, 2021;Jemikalajah et al, 2021). HIV therapy reduces the effectiveness of antimalarial medications and may exacerbate side effects(Ssentongo et al, 2020).…”