Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Abstract

Introduction The World Health Organization recommends seeking medical treatment within 24 hours after transmission of malaria to reduce the risk of severe complications and its onwards spread. However, in some parts of Indonesia, including East Nusa Tenggara Province (ENTP), this adherence is not achieved for a range of reasons including delays in visiting health centres. This study aims to determine factors related to the poor understanding of appropriate malaria treatment-seeking behaviour (AMTSB) of rural adults in ENTP. AMTSB was defined as seeking treatment at professional health facilities within 24 hours of the onset of malaria symptoms. Methods A cross-sectional study was conducted in the East Sumba, Belu, and East Manggarai district of ENTP between October and December 2019. A multi-stage cluster sampling procedure was applied to enrol 1503 participants aged between 18 and 89 years of age. Data were collected through face-to-face interviews. Multivariable logistic regression analyses were used to assess significant factors associated with the poor understanding of AMTSB. Results Eighty-six percent of participants were found to be familiar with the term malaria. However, poor understanding level of AMTSB in rural adults of ENTP achieved 60.4% with a 95% confidence interval (CI): 56.9–63.8. Poor understanding of AMTSB was significantly higher for adults with no education (adjusted odds ratio (AOR) 3.42, 95% CI: 1.81, 6.48) compared to those with a diploma or above education level; having low SES (AOR: 1.87, 95% CI: 1.19, 2.96) compared to those having high SES; residing at least three kilometres (km) away from the nearest health facilities (AOR: 1.73, 95% CI: 1.2, 2.5) compared to those living within one km from the nearest health service; and working as farmer (AOR: 1.63, 95% CI: 1.01–2.63) compared to those working at government or non-government sector. Whilst, other factors such as ethnicity and family size were not associated with the poor understanding of AMTSB. Conclusion The proportion of rural adults having a poor understanding of AMTSB was high leading to ineffective implementation of artemisinin-based combination therapies as the method to treat malaria in ENTP. Improving awareness of AMTSB for rural adults having low level education, low SES, working as a farmer, and living at least three km from the nearest health facilities is critical to support the efficacy of malaria treatment in ENTP. This method will support the Indonesian government’s objective to achieve malaria elimination by 2030.

Malaria diagnosis in rural healthcare facilities and treatment-seeking behavior in malaria endemic settings in western Kenya

“…More than a half of these febrile cases were treated with antimalarial drugs obtained from a local chemist. This is similar to studies in in Indonesia [16], Ghana [5], India [50], Myanmar [53], and Bangladesh [2] where majority of febrile patients reportedly preferred self-medication over hospital-based treatment. In the current study, key predictors of self-treatment included knowledge of malaria symptoms, severity of symptoms, and age of febrile patients.…”

“…Access to healthcare facilities, ability to pay hospital bills, severity of symptoms, and age of fever patients were factors that predicted treatment-seeking at healthcare facilities. The ease of access to healthcare facilities has been reported in previous studies to encourage treatment-seeking at healthcare facilities [16,25,37,60]. Easily accessible health facilities may not require transportation or may require only a small amount of money; as a result, the majority of people find it easy to access them.…”

“…Microscopy confirmed cases, however, accounted for less than 20% of all cases during the same time period. For example, during the month of October 2019, the proportion of suspected malaria which were confirmed by microscopy was16.2% (39/241) compared 38% (23/62) clinically confirmed cases (p = 0.0005). During the month of November 2019, the proportion of microscopy confirmed cases was 15% (70/466) compared to 30.1% (34/113) cases confirmed clinically (p = 0.0003).…”

Determinants of health seeking behaviours for malaria treatment in Cameroon

“…These results again contrast with the results of a recent study in Indonesia showing that 84.3% of communities seek care at modern health facilities (of which public: 82.4% and private: 1.9%), 7.9% at traditional healers, 4.3% at selfmedication and 3.4% at informal vendors in kiosks. 4 Thus, the study shows that a high proportion of households sought treatment for malaria outside health facilities. This result is in contradiction with studies conducted in India, Ghana, but they are consistent with findings from Saudi Arabia and Zambia, which indicate that a high proportion of the community seeks treatment at health facilities.…”

“…An analysis of the global malaria treatment database showed that treatment uptake rates differ both within and between regions. 4 Early treatment uptake plays an important role in the effective management of malaria. For this reason, WHO recommends that malaria treatment should be provided within 24 hours of the onset of malaria symptoms to prevent the progression of infection.…”