Abstract
IntroductionEnsuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups.MethodsA total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey.ResultsAmong the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups.ConclusionsThe quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind.
Highlights
Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government
These studies have found that those from poorer households attend low level and informal providers, or may not seek treatment at all [4,7,8]. These low level providers have often been associated with substandard practices including poor counselling, incorrect dosing, misdiagnosis and the use of less effective drugs [9,10]. While these studies offer an overall description of treatment seeking for febrile illness, little detail is known about the reasons for choice of treatment providers and the quality of care obtained for uncomplicated malaria across socioeconomic status groups
The study was undertaken at primary health centres (PHC), pharmacies and patent medicine dealers (PMDs) known as private medicine retailers
Summary
Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. These low level providers have often been associated with substandard practices including poor counselling, incorrect dosing, misdiagnosis and the use of less effective drugs [9,10] While these studies offer an overall description of treatment seeking for febrile illness, little detail is known about the reasons for choice of treatment providers and the quality of care obtained for uncomplicated malaria across socioeconomic status groups. While structural measures relate to those of the physical environment, process focuses on what happens in the interaction between the patient and the provider and outcomes typically include the consequences of care [14] Each of these dimensions is known to be important in the context of malaria [15,16,17] but few have explored this in relation to SES [18]. The process of care, in particular the patientprovider interaction, is the least well understood in the context of febrile illness and merits more enquiries due to its potential influence on the outcomes of care [19]
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