Rural-urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria

Abstract

Background Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers’ recognition is an entry point for fever treatment, including malaria. This study describes rural-urban disparity in fever prevalence in U5, mothers’ malaria knowledge, care-seeking, testing for malaria before antimalaria medication and the associated factors.Methods A cross-sectional survey was conducted among 630 mother-child pairs (rural (300) and urban (330)) selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before antimalaria use, and delayed care seeking defined as care sought for fever >48 hours of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥75th, 50th-74th, and <50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value <0.05. Results The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI: 1.8-4.2, p <0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times likely to receive antimalaria medications without testing fever for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI: 1.6-9.9, p <0.000).Conclusions Rural-urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before antimalaria medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than ‘one-size-fits-all’ approach.

Estimating the Fraction of Severe Malaria among Malaria-Positive Children: Analysis of Household Surveys in 19 Malaria-Endemic Countries in Africa

“…21 These types of healthcare service providers commonly practice presumptive malaria treatment or prescribe unrecommended drugs. [22][23][24] Other reasons could be attributed to self-treatment at home. 23,24 However, more exploration is needed into these patterns.…”

“…[22][23][24] Other reasons could be attributed to self-treatment at home. 23,24 However, more exploration is needed into these patterns. In addition, the country was highly significant in the model.…”

Incidence, pattern and determinants of self-medication for fevers in children: A survey of caregivers in an emergency unit in Benin City, Nigeria

“…This study discovered a high prevalence of self-medication for childhood febrile illnesses, with a quarter of the participants administering drugs to children for self-diagnosed illnesses in the previous weeks; this is consistent with reports by Iribhogbe et al 17 and Omale et al, 6 both from Nigeria, that many caregivers selfmedicate for fever before presentation in health facilities. Similarly, Babalola et al 5 reported a high prevalence (33.5%) of home treatment for under-five children with fever in Kaduna, north-west Nigeria. Again, in their surveys, Mensah et al 18 Ghana and Bogale et al 19 in Ethiopia found a high prevalence of self-medication, 40.8% and 67.3%, respectively.…”

“…Nonetheless, poor health-seeking behavior, such as delayed presentation to health facilities and self-treatment at home, is prevalent in our environment. 5,27,29 In our setting, this is a significant contributor to childhood morbidity and mortality. 30,31 Our primary health care system's limited functionality also impedes timely access to health facilities, as does indiscriminate access to prescription drugs in chemist stores, supermarkets, and sometimes from hawkers.…”

“…In Kaduna, Babalola et al 5 found that 52 (33.5%) of mothers who immediately considered treating their febrile under-five children self-medicate at home. Similarly, Omale et al 6 discovered in a recent household survey in Ebonyi state, Nigeria, that the majority of febrile children in rural communities did not receive diagnostic testing before seeking treatment from medicine stores, drug hawkers, or traditional practitioners.…”