Abstract
BackgroundMalaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world. Poverty contributes to the malaria burden as it has the ability to affect integral aspects of malaria control. There have been renewed efforts in the global malaria control, resulting in reductions in the global malaria burden over the last decade. However, the development of resistance to artemisinin-based combination therapy threatens the sustainability of the present success in malaria control. Anti-malarial drug use practices/behaviours remain very important drivers of drug resistance. This study adopted a social epidemiological stance in exploring the underlying socioeconomic factors that determine drug use behaviours promoting anti-malarial drug resistance.MethodsA qualitative approach, involving the use of interviews, was used in this inquiry to explore the existing anti-malarial drug use practices in the Nigerian population; and the different socioeconomic factors influencing the behaviours.ResultsThe significant malaria treatment behaviours influenced by socioeconomic factors in this study were the practice of ‘mixing’ drugs for malaria treatment, presumptive treatment, sharing of malaria treatment course, and the use of anti-malaria monotherapies. All the rural dwellers in this study reported they have mixed drugs for malaria treatment. When symptoms were experienced, socio-economic factors, like type of settlement, income level and occupation, tended to determine the treatment behaviour and, therefore, informed and determined the experience of the illness.DiscussionSocial and economic contexts can influence behaviours as they contribute in shaping norms and in creating opportunities that promote certain behaviours. As shown in this study, income level and type of settlement, as structural factors, affect the decision on where to seek malaria treatment and whether or not a malaria diagnostic test will be used prior to treatment. One of the dangers of using the mixed anti-malarial drugs is that it offers a safe route for the sale of expired and fake anti-malarial drugs as the mixed drugs are not sold or dispensed in their original packets.Conclusions and recommendationsPopulation-wide improvements in income, education, environmental and structural conditions of rural dwellers in malaria-endemic settings will encourage behavioural change on how anti-malarial drugs are used.
Highlights
Malaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world
The social structures existing within societies and their socioeconomic indicators are usually based on characteristics that are valued in the society—educational level, income level, type of settlement, occupation, employment status, among others
The themes were developed around the anti-malarial drug use behaviours reported, and their associated socioeconomic factors
Summary
Malaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world. A global health issue, its burden is unevenly distributed to the disadvantage of the developing countries of the world [2, 3]. Africa is still the leading region in terms of malaria burden This region accounts for majority (80%) of the malaria cases as well as malaria-associated deaths (90%) globally [1]; with children under 5 years of age at most risk of malaria infection. A middle-income country in sub-Saharan Africa, is among the countries with the highest malaria burden in the world, with 32% of global malaria mortality occurring in this country and 97% of the population at risk of malaria infection [4]. Some factors that drive the persistence of malaria in the Nigerian population are: the availability of conducive environment for vector breeding [5]; the Nigerian healthcare system; and the high level of poverty in Nigeria [6], where about 46% of the population live below the World Bank poverty line of $1.25 per day [7]
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