Abstract
BackgroundMalaria is a leading cause of illness and death in Nigeria, but access of poor people to quality anti-malarial services remains low especially in the rural areas. Patent and proprietary medicine vendors (PPMVs) provide the majority of malaria treatment in rural areas, but little is known about their knowledge of malaria testing and treatment of uncomplicated malaria as recommended in the 2011 National Malaria Control Programme policy.MethodsA cross-sectional survey was conducted in two purposively selected states (Oyo and Bayelsa) in Nigeria with each state representing a different geographic and linguistic–ethnic region in the southern part of the country. Two rural LGAs were randomly selected from each state and data were collected from 160 randomly selected PPMVS (40 per LGA) using a structured questionnaire. Data were analysed using descriptive statistics.ResultsThe 2011 National Policy on Malaria Diagnosis and Treatment is mostly unknown to PPMVs. Although most PPMVs (89%) knew that artemisinin-based combination therapy (ACT) is recommended in the national policy, 91% also thought non-ACT were endorsed. The proportion of PPMVs who stated they would treat a malaria case with an artemisinin-based combination at the correct dose was 33% for a child under five, 47% for an adult male and 14% for a pregnant woman in her second trimester. The proportion of PPMVs who reported they would diagnose a case of malaria prior to treatment using a malaria rapid diagnostic test (RDT) kit was 1.9% for children under five, 7.5% for adult males and 3.1% for pregnant women in their first trimester due to lack of knowledge. Almost two-thirds (65.6%) would correctly refer children with severe malaria to health facility.ConclusionsSubstantial knowledge gaps on the use of RDTs and treatment with artemisinin-based combinations exist among rural PPMVs. Given existing evidence regarding the effectiveness of private retail outlets in malaria case management, PPMVs should be provided with competency-based training and supervision to improve the quality of care they provide.
Highlights
Malaria is a leading cause of illness and death in Nigeria, but access of poor people to quality antimalarial services remains low especially in the rural areas
Data collection In order to determine patent and proprietary medicine vendors (PPMV) knowledge of malaria diagnosis and treatment, PPMVs were asked about their knowledge of anti-malarial policies, PPMV demographics Table 1 depicts the PPMV characteristics in the four local government area (LGA)
This study demonstrates that while the majority of PPMV members were unaware of the 2011 National Policy on Malaria Diagnosis and Treatment, 82.5% knew that artemisinin-based combination therapy (ACT) was a government recommended treatment for malaria and over 58% would recommend artemisinin-based combinations for a child or adult male with malaria
Summary
Malaria is a leading cause of illness and death in Nigeria, but access of poor people to quality antimalarial services remains low especially in the rural areas. Malaria is a leading cause of death among low-income countries [1] and remains a major public health problem worldwide. Africa accounts for 91% of all malaria deaths and, with an estimated 57.5 million cases and 225,000 deaths per year. Nigeria accounts for 27% of the total African malaria burden [3]. Within Nigeria, malaria is a major cause of illness, death, and poverty, and a significant drain on the economy and wellbeing of the nation. It is estimated that 50% of Nigeria’s adult population will have at least one episode of malaria each year and children under five will have 2–4 attacks annually [4]
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