Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria

Abstract

Objectives

To identify the differences in health-seeking for childhood malaria treatment, between urban and rural communities in Nigeria, with a view to providing information to policy makers that will be used to improve malaria control.

Methods

Quantitative and qualitative research methods were employed in eliciting information. A pre-tested structured questionnaire was administered to 1200 caretakers of children under 5 years who had malaria 2 weeks prior to the survey period. Focus group discussions were held with mothers and in-depth interviews with health care providers.

Results

Health-seeking for malaria, differed significantly between rural and urban mothers. While majority (64.7%) of urban caretakers patronized private/government health facilities, most (62%) of their rural counterparts resorted to self-treatment with drugs bought over-the-counter, from patent medicine vendors. Hospitals were geographically more accessibility to urban than rural dwellers. Rural mothers only go to hospital when the problem persists or becomes worse, which results in delay in seeking appropriate and timely care.

Conclusion

Urban and rural mothers differed in their responses to childhood fevers. Training drug vendors and caretakers are important measures to improve malaria control. Health facilities with good quality services and readily available drugs should be provided.

Introduction

In Nigeria, malaria remains a major public health problem, it is highly endemic and over 80% of malaria infections are caused by P. falciparum, which is responsible for severe infections and deaths. Malaria is one of Nigeria's leading causes of morbidity and mortality and is responsible for 30% of childhood mortality, 11% of maternal deaths and 50% of outpatient consultations/visits [1]. Malaria illness accounts for more than 45% of all the curative health care costs incurred by households in Nigeria [2].

Gross inequality in health status and gross inequity in access to health services particularly between the rich and poor, and between urban and rural dwellers have been identified as a major defect in health services organization [3].

In sub-Saharan Africa (SSA) rural and urban populations differ demographically, in socio-economic and cultural composition, and in proximity to formal and informal sources of health care. These rural–urban differences imply that urban residents use biomedical (or ‘modern’) services and drugs more often and at an earlier stage than rural residents, and that rural residents more readily turn to bio-cultural (or ‘traditional’) therapy [4].

It has been estimated that in SSA about 40% of fever episodes are caused by malaria [5]. Many studies have shown that the majority of early treatments for childhood fever occur through self-medication, using drugs bought over-the-counter (OTC) from drug sellers [6], [7], [8], [9], [10].

Treatment-seeking behaviour is influenced by access to treatment sources, costs of services, attitude towards providers, perceived severity of the illness, educational status and cultural beliefs about the cause and cure of illness [6], [11], [12], [13].

Access to health services is influenced by many behavioural, cost and distance factors [14], [15] and utilization of health services is increasingly being viewed as a function of accessibility [16], [17]. To achieve the target of substantially reducing malaria morbidity and mortality, Roll Back Malaria (RBM) has recognized access to prompt diagnosis and treatment of malaria as a key strategy of achieving the target of halving malaria incidence by the year 2015, as outlined in the Millennium Development Goal (MDG) [18].

There is undoubtedly a paucity of knowledge about rural–urban differences in care-seeking for malaria treatment in Nigeria. This underscores the need for a study to determine the various factors that influence health-seeking behaviour for childhood fever between rural and urban mothers with a view to providing information to policy makers and programme managers that will be used to improve malaria control.

It is noteworthy, many febrile illnesses mimic malaria and parasitologic confirmation of diagnosis is often either not available or unreliable, in endemic countries including Nigeria. Since most diagnosis is presumptive, for the purpose of this study, malaria is defined as fever in a child under 5 years.