Do poor people use poor quality providers? Evidence from the treatment of presumptive malaria in Nigeria

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

doi:10.1111/j.1365-3156.2011.02821.x

Cited by 39 publications

(38 citation statements)

References 24 publications

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“…This is reinforced by the fact that anti-malarial drugs are treated as OTC medicines and the use is not regulated as prescription, even though regulation of drug sales in Nigeria, as in most developing countries, is not enforced. Some patients undertake diagnostic tests for malaria in private laboratories before visiting the outlets for treatment, sometimes with prescriptions from laboratory attendants [31]. This study suggests a high level of presumptive malaria treatment, which encourages the use of wrong drugs, limiting the use of effective anti-malarial drugs.…”

Section: Discussionmentioning

confidence: 99%

Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

Ezenduka

Ogbonna

Ekwunife

et al. 2014

Malar J

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BackgroundMalaria treatment policy recommends regular monitoring of drug utilization to generate information for ensuring effective use of anti-malarial drugs in Nigeria. This information is currently limited in the retail sector which constitutes a major source of malaria treatment in Nigeria, but are characterized by significant inappropriate use of drugs. This study analyzed the use pattern of anti-malarial drugs in medicine outlets to assess the current state of compliance to policy on the use of artemisinin-based combination therapy (ACT).MethodsA prospective cross-sectional survey of randomly selected medicine outlets in Enugu urban, southeast Nigeria, was conducted between May and August 2013, to determine the types, range, prices, and use pattern of anti-malarial drugs dispensed from pharmacies and patent medicine vendors (PMVs). Data were collected and analyzed for anti-malarial drugs dispensed for self-medication to patients, treatment by retail outlets and prescription from hospitals.ResultsA total of 1,321 anti-malarial drugs prescriptions were analyzed. ACT accounted for 72.7%, while monotherapy was 27.3%. Affordable Medicines Facility-malaria (AMFm) drugs contributed 33.9% (326/961) of ACT. Artemether-lumefantrine (AL), 668 (50.6%) was the most used anti-malarial drug, followed by monotherapy sulphadoxine-pyrimethamine (SP), 248 (18.8%). Median cost of ACT at $2.91 ($0.65-7.42) per dose, is about three times the median cost of monotherapy, $0.97 ($0.19-13.55). Total cost of medication (including co-medications) with ACT averaged $3.64 (95% CI; $3.53-3.75) per prescription, about twice the mean cost of treatment with monotherapy, $1.83 (95% CI; $1.57-2.1). Highest proportion 46.5% (614), of the anti-malarial drugs was dispensed to patients for self-treatment. Treatment by retail outlets accounted for 35.8% while 17.7% of the drugs were dispensed from hospital prescriptions. Self-medication, 82%, accounted for the highest source of monotherapy and a majority of prescriptions, 85.6%, was adults.ConclusionFindings suggest vastly improved use of ACT in the retail sector after eight years of policy change, with significant contributions from AMFm drugs. However the use of monotherapy, particularly through self-medication remains significant with increasing risk of undermining treatment policy, suggesting additional measures to directly target consumers and providers in the sector for improved use of anti-malarial drugs in Nigeria.

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Section: Discussionmentioning

confidence: 99%

Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

Ezenduka

Ogbonna

Ekwunife

et al. 2014

Malar J

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“…However, poor families living in remote areas of Sub-Saharan Africa have less access to basic preventive measures for malaria control, and may live many kilometers away from the nearest healthcare facility (Onwujekwe et al, 2011). The long distance to a primary healthcare facility is among the impeding factors which delay the prompt diagnosis and timely treatment of malaria (Turuse et al, 2014).…”

Section: Articlementioning

confidence: 99%

Modelling homogeneous regions of social vulnerability to malaria in Rwanda

Bizimana¹,

Kienberger²,

Hagenlocher³

et al. 2016

Geospat Health

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Despite the decline in malaria incidence due to intense interventions, potentials for malaria transmission persist in Rwanda. To eradicate malaria in Rwanda, strategies need to expand beyond approaches that focus solely on malaria epidemiology and also consider the socioeconomic, demographic and biological/disease-related factors that determine the vulnerability of potentially exposed populations. This paper analyses current levels of social vulnerability to malaria in Rwanda by integrating a set of weighted vulnerability indicators. The paper uses regionalisation techniques as a spatially explicit approach for delineating homogeneous regions of social vulnerability to malaria. This overcomes the limitations of administrative boundaries for modelling the trans-boundary social vulnerability to malaria. The utilised approach revealed high levels of social vulnerability to malaria in the highland areas of Rwanda, as well as in remote areas where populations are more susceptible. Susceptibility may be due to the populations' lacking the capacity to anticipate mosquito bites, or lacking resilience to cope with or recover from malaria infection. By highlighting the most influential indicators of social vulnerability to malaria, the applied approach indicates which vulnerability domains need to be addressed, and where appropriate interventions are most required. Interventions to improve the socioeconomic development in highly vulnerable areas could prove highly effective, and provide sustainable outcomes against malaria in Rwanda. This would ultimately increase the resilience of the population and their capacity to better anticipate, cope with, and recover from possible infection. IntroductionDespite various interventions to reduce the burden of malaria, the disease persists in many countries of the developing world. In 2012 there were approximately 562,000 malaria deaths in Africa, despite a slow decline since 2004 (WHO, 2014. Malaria decrease in Sub-Saharan Africa was generally associated with intense interventions and reduced vector density due to changing rainfall patterns (Meyrowitsch et al., 2011). Although considerable progress has been made in many countries, the general malaria burden remains high, particularly in young children and pregnant women (Roll Back Malaria, 2005). The Plasmodium (P.) falciparum prevalence rates in Rwanda increased until the late 1990s and early 2000s, after which a marked decrease was noted (Stern et al., 2011). Since 2004, interventions to prevent and control malaria in Rwanda have resulted in a substantial decline in malaria transmission, particularly as a result of improved access to effective treatment, increased use of bed nets, and indoor residual spraying (Karema et al., 2012). However, malaria incidence increased again between 2011 and 2012, revealing the fragility of the gains achieved (WHO, 2013). The results of an entomological survey of more than 50% exophile entomological inoculation rate (EIR) around Kigali City is also an indicator of potential transmission ga...

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“…This may conform with the observation that communities’ care less about who is delivering services other than efficient services that are available at an affordable cost. [16]…”

Section: Discussionmentioning

confidence: 99%

Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy

Anyaehie¹,

Nwakoby²,

Dim³

et al. 2014

Ann Med Health Sci Res

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Background:In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership.Aim:The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects.Subjects and Methods:Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA).Results:Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215).Conclusion:PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.

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Do poor people use poor quality providers? Evidence from the treatment of presumptive malaria in Nigeria

Cited by 39 publications

References 24 publications

Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

Modelling homogeneous regions of social vulnerability to malaria in Rwanda

Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy

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