Abstract
BackgroundThe proportion of individuals who seek treatment for fever is an important quantity in understanding access to and use of health systems, as well as for interpreting data on disease incidence from routine surveillance systems. For many malaria endemic countries (MECs), treatment-seeking information is available from national household surveys. The aim of this paper was to assemble sub-national estimates of treatment-seeking behaviours and to predict national treatment-seeking measures for all MECs lacking household survey data.MethodsData on treatment seeking for fever were obtained from Demographic and Health Surveys, Malaria Indicator Surveys and Multiple Cluster Indicator Surveys for every MEC and year that data were available. National-level social, economic and health-related variables were gathered from the World Bank as putative covariates of treatment-seeking rates. A generalized additive mixed model (GAMM) was used to estimate treatment-seeking behaviours for countries where survey data were unavailable. Two separate models were developed to predict the proportion of fever cases that would seek treatment at (1) a public health facility or (2) from any kind of treatment provider.ResultsTreatment-seeking data were available for 74 MECs and modelled for the remaining 24. GAMMs found that the percentage of pregnant women receiving prenatal care, vaccination rates, education level, government health expenditure, and GDP growth were important predictors for both categories of treatment-seeking outcomes. Treatment-seeking rates, which varied both within and among regions, revealed that public facilities were not always the primary facility type used.ConclusionsEstimates of treatment-seeking rates show how health services are utilized and help correct reported malaria case numbers to obtain more accurate measures of disease burden. The assembled and modelled data demonstrated that while treatment-seeking rates have overall increased over time, access remains low in some malaria endemic regions and utilization of government services is in some areas limited.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-1048-x) contains supplementary material, which is available to authorized users.
Highlights
The proportion of individuals who seek treatment for fever is an important quantity in understanding access to and use of health systems, as well as for interpreting data on disease incidence from routine surveillance systems
Treatment coverage has been assessed across Africa [7], but understanding how access to treatment varies throughout the malaria endemic world is essential to evaluating the true public health impact of treatment coverage
This is all the more significant during the current transition from control of clinical disease towards regional focuses on malaria elimination and the post-2015 future is shaped as progress towards the Millennium Development Goals is evaluated [8]
Summary
The proportion of individuals who seek treatment for fever is an important quantity in understanding access to and use of health systems, as well as for interpreting data on disease incidence from routine surveillance systems. Treatment coverage has been assessed across Africa [7], but understanding how access to treatment varies throughout the malaria endemic world is essential to evaluating the true public health impact of treatment coverage This is all the more significant during the current transition from control of clinical disease towards regional focuses on malaria elimination and the post-2015 future is shaped as progress towards the Millennium Development Goals is evaluated [8]. We aim to improve the evidence-base of the first parameter to enable refined estimates of the true clinical burden of malaria disease
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