Abstract
BackgroundAppropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design.MethodsThe study used in-depth interviews (IDIs) (N = 16) and focus group discussions (FGDs) (N = 12) with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software.ResultsFindings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful.ConclusionsTreatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected malaria and challenging patients’ misconceptions about the effectiveness of cocktails. Given the importance of the patient-provider interaction and the pivotal role that providers play in ensuring the delivery of appropriate malaria care, future research and interventions should also focus on the supply side factors influencing provider behaviour.
Highlights
Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region
The Cambodian Ministry of Health estimates that 83,777 outpatient and 4,045 inpatient malaria cases were reported in 2009, with this disease accounting for 0.6% of all outpatient cases and 3.5% of all inpatient cases in the same year [2]
To expand the limited evidence base, this study uses qualitative methods to explore the demand-side factors that influence malaria treatment-seeking behaviours and patient-provider interactions among Cambodian patients. It aims to shed light on findings from quantitative research studies and offer programmatic recommendations to increase the uptake of appropriate malaria case management in Cambodia. It asks three key questions: 1) Why do people first treat at home and what types of medicines are used? 2) Why do patients take drug cocktails for malaria and what are their perceptions of these medicines? and 3) Why do some patients with malaria fever receive a diagnostic test while others do not? The study findings aim to provide a more nuanced understanding of the patient-provider interaction at a health facility or outlet where malaria treatment is sought, including a patient’s perception of the provider
Summary
Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. Malaria transmission is relatively high; the reported annual incidence rate lies between 11 to 50 cases per 1,000 habitants and Plasmodium falciparum, the deadliest strain of malaria, predominates [4]. Unlike many areas of sub-Saharan Africa, the highest burden of malaria infection afflicts adults who work and stay overnight in the forests
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
