Abstract
BackgroundDespite policies that recommend parasitological testing before treatment for malaria, presumptive treatment remains widespread in Nigeria. The majority of Nigerians obtain antimalarial drugs from two types of for-profit drug vendors—formal and informal medicine shops—but little is known about the quality of malaria care services provided at these shops.AimsThis study seeks to (1) describe the profile of patients who seek treatment at different types of drug outlets, (2) document the types of drugs purchased for treating malaria, (3) assess which patients are purchasing recommended drugs, and (4) estimate the extent of malaria over-treatment.MethodsIn urban, peri-urban, and rural areas in Oyo State, customers exiting proprietary and patent medicine vendor (PPMV) shops or pharmacies having purchased anti-malarial drugs were surveyed and tested with malaria rapid diagnostic test. A follow-up phone survey was conducted four days after to assess self-reported drug administration. Bivariate and multivariate regression analysis was conducted to determine the correlates of patronizing a PPMV versus pharmacy, and the likelihood of purchasing an artemisinin-combination therapy (ACT) drug.ResultsOf the 457participants who sought malaria treatment in 49 enrolled outlets, nearly 92% had diagnosed their condition by themselves, a family member, or a friend. Nearly 60% pharmacy customers purchased an ACT compared to only 29% of PPMV customers, and pharmacy customers paid significantly more on average. Multivariate regression results show that patrons of PPMVs were younger, less wealthy, waited fewer days before seeking care, and were less likely to be diagnosed at a hospital, clinic, or laboratory. Only 3.9% of participants tested positive with a malaria rapid diagnostic test.ConclusionsPoorer individuals seeking care at PPMVs are more likely to receive inappropriate malaria treatment when compared to those who go to pharmacies. Increasing accessibility to reliable diagnosis should be explored to reduce malaria over-treatment.
Highlights
Nigeria bears one of the world’s highest burdens of malaria, accounting for a quarter of all cases in Africa [1]
Poorer individuals seeking care at proprietary and patent medicine vendor (PPMV) are more likely to receive inappropriate malaria treatment when compared to those who go to pharmacies
This study aims to better characterize the practice of presumptive treatment of malaria in Nigeria and determine where interventions for malaria treatment delivery should be targeted
Summary
Nigeria bears one of the world’s highest burdens of malaria, accounting for a quarter of all cases in Africa [1]. It is estimated that over half of Nigeria’s population experiences at least one episode of malaria each year, accounting for approximately 20% of all hospital admission, 30% of outpatient visits, and 10% of hospital deaths [2]. This burden of disease strains the resources of the health system as spending on malaria treatment and prevention accounts for nearly 50% of all health expenditures in Nigeria [3]. Many health care providers in Nigeria continue to prescribe less-effective drugs, such as chloroquine (CQ) and sulfadoxine-pyrimethamine (SP), for uncomplicated cases of malaria [6]. The majority of Nigerians obtain antimalarial drugs from two types of for-profit drug vendors—formal and informal medicine shops—but little is known about the quality of malaria care services provided at these shops
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