Abstract
BackgroundThe evidence on determinants of individuals’ choices for anti-malarial drug treatments is scarce. This study sought to measure the strength of preference for adult antimalarial drug treatment attributes of heads of urban, rural and peri-urban households in a resource-limited malaria-endemic area of sub-Saharan Africa.MethodsDiscrete choice experiments were conducted with 508 heads of household interviewed face-to-face for a household population survey of health-seeking behavior in Zomba District, Malawi. The interviews were held in Chichewa and the choice experiment questions were presented with cartoon aids. The anti-malarial drug attributes included in the stated preference experiment were: speed of fever resolution, side effects (pruritus) risk, protection (duration of prophylactic effect), price, duration of treatment course and recommendation by a health professional. Sixteen treatment profiles from a fractional factorial design by orthogonal array were paired into choice scenarios, and scenarios were randomly assigned to participants so that each participant was presented with a series of eight pairwise choice scenarios. Respondents had the option to state indifference between the two profiles or decline to choose. Data were analysed in a mixed logit model, with normally distributed coefficients for all six attributes.ResultsThe sex ratio was balanced in urban areas, whereas 63% of participants in rural areas were male. The proportion of individuals with no education was considerably higher in the rural group (25%) than in the urban (5%) and peri-urban (6%) groups. All attributes investigated had the expected influence, and traded-off in most respondents’ choices. There were heterogeneous effects of price, pruritus risk, treatment recommendation by a professional, and duration of prophylaxis across respondents, only partly explained by their differences in education, household per capita expenditure, sex and age. Individuals´ demand elasticity (simulated median, inter-quartile range) was highest (most responsive) to speed of symptom resolution (0.88, 0.80-0.89) and pruritus risk (0.25, 0.08-0.62).ConclusionsMost adult antimalarial users are willing to use treatments without recommendation from health professional, and may be influenced by price. Future studies should investigate the magnitude of differences in price and treatment attribute sensitivity between adult anti-malarial drug users in rural, peri-urban and urban areas in order to determine optimal price subsidies.
Highlights
The evidence on determinants of individuals’ choices for anti-malarial drug treatments is scarce
In summary, this study found that use of cartoon aids to convey magnitudes of risk and other clinical attributes facilitates the implementation of discrete choice experiments in populations with high levels of illiteracy
Head of households in a malaria endemic area of sub-Saharan Africa are willing to use antimalarial treatments that while conveniently addressing their symptoms may not be those endorsed by health professionals
Summary
The evidence on determinants of individuals’ choices for anti-malarial drug treatments is scarce. Identification of factors that are seen as desirable by consumers of antimalarials would help to inform the design of interventions to improve the management of cases presenting with malaria-like symptoms in the community and would allow policy-makers to design more effective strategies for the implementation of anti-malarial treatment policy in the region. Such information is important at a time when artemisinin combination therapy (ACT) is used as first-line therapy throughout much of Africa and is increasingly available in the informal sector across Africa
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