Where do people from different socio–economic groups receive diagnosis and treatment for presumptive malaria, in south–eastern Nigeria?

Abstract

The relationship between the socio-economic status (SES) of a household and its sources of malaria diagnosis and treatment was explored in south-eastern Nigeria. One aim was to see if, as seems likely, the poorest people generally seek care from 'low-level' providers, such as traditional healers and community-based healthworkers, because of their severe budget constraints. Interviewer-administered questionnaires were used to collect information from 1197 randomly selected respondents from four villages where malaria is holo-endemic. An index was used to categorize the study households into SES quartiles. The self-diagnosis of presumptive malaria and the use of patent-medicine dealers for treatment were very common among all the SES groupings. Compared with the other interviewees, however, the least-poor were significantly more likely to rely on laboratory tests for diagnosis and to visit hospitals when seeking treatment for presumptive malaria. The most-poor, in contrast, were significantly more likely to seek treatment from traditional healers or community-based healthworkers. Thus, even though the use of low-level providers was so common, there was still evidence of wealth-related inequity--in terms of the probabilities of the good diagnosis and treatment of malaria. Improvements in the quality of malaria diagnosis and treatment by the providers patronised by the most-poor villagers would help to redress this inequity, at least in the short- to medium-term.

Care-seeking at patent and proprietary medicine vendors in Nigeria

“…Yet, customers tended to spend more when purchasing drugs to treat fever and cough/cold symptoms. Further, while most fevers were associated with the purchase of anti-malarial drugs, not all were artemisinin-based combination therapies (ACTs) recommended by national treatment guidelines [49]. And since PPMVs are not allowed to perform diagnostics [17, 53], whether febrile and non-febrile illnesses were treated correctly cannot be determined [51, 54].…”

Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria

“…In addition to the government providers, healthcare is provided by various private providers that range from patent medicine dealers (PMDs) to large scale hospitals. The private sector provides over 65% of healthcare delivery in Nigeria [9]. As a general policy, healthcare consumers are expected to pay for curative services, but preventive services are often subsidized.…”

Rational Choice Theory and the Choice of Healthcare Services in the Treatment of Malaria in Nigeria

“…(Onwujekwe, et al, 2005). There are many public and private healthcare providers of malaria treatment in Nigeria ranging from formal to informal healthcare providers located in urban and rural areas round the country but prompt and appropriate treatment of malaria remains a challenge in the country.…”

“…The rural dwellers possibly perceived higher quality of treatment because they may have lower quality expectations and so were satisfied with the treatment they chosen or received. Some authors showed that poor people bear a disproportionate burden of the disease and have poor health-seeking behaviour, thus leading them to seek treatment from "low-level" providers and avoid any form of laboratory-based formal diagnosis, (Goodman, et al, 2001;Onwujekwe, et al, 2005;Worrall, et al, 2005;Filmer, 2005), which consequently increases the burden of the disease on them, (Obinna and Onwujekwe, 2010). This means that the community setting invariably affected the socio-economic status decided to a large extent the perception of quality of treatment (utility function) and hence influenced the most preferred alternative which in turn determined the choices made.…”