Malaria treatment perceptions, practices and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria

Abstract

BackgroundPeople seek treatment for malaria from a wide range of providers ranging from itinerant drug sellers to hospitals. However, there are lots of problems with treatment provision. Hence, factors influencing treatment provision in hospitals and non-hospitals require further investigation in order to remedy the situation.ObjectivesTo examine the knowledge, pattern of treatment provision and factors influencing the behaviour of hospitals and non-hospitals in the treatment of malaria, so as to identify loci for interventions to improve treatment of the disease.MethodsA pre-tested structured questionnaire was used to collect data from 225 providers from hospitals and non-hospitals about their malaria treatment practices and factors that influence their provision of malaria treatment services in south-east Nigeria. The data from hospitals and other providers were compared for systematic differences.Results73.5% of hospitals used microscopy to diagnose malaria and only 34.5.1% of non-hospitals did (p < 0.05). Majority of the respondents considered ability to pay bills (35.2%), already existing relationship (9.4%) and body mechanism (35.2%) of the patient before they provided malaria treatment services. Pressure from wholesalers to providers to repay the cost of supplied drugs was the major influence of the type of drugs provided to patients.ConclusionThere are many challenges to appropriate provision of malaria treatment services, although challenges are less in hospitals compared to other types of non-hospitals. Improving proper diagnosis of malaria and improving the knowledge of providers about malaria are interventions that could be used to improve malaria treatment provision.

Supportive supervision: An effective intervention in achieving high quality malaria case management at primary health care level in Jos, Nigeria

“…[17] Similarly, a cross-sectional study of malaria treatment practices and perceptions in Southeast Nigeria also observed good knowledge among PHC workers. [18] This good knowledge did not show in the management practices of the PHC worker as has been observed by other researchers. [19] In this study mean score for malaria case management of under-fives was rather low with minimal changes recorded at post-intervention.…”

“…This finding is consistent with other findings on healthcare workers treatment patterns. [18,24] In the review of case management among PHC workers in Sokoto, 86.2% of respondents commonly prescribed CQ as the first line drug and 4.6% prescribed ACT's with wrong drug dosages in 63.6% of the time. [24] In this study dosages were wrong in 67.3% of cases.…”

Why Don’t Medical Practitioners Treat Malaria Rationally? A Qualitative Study from Pakistan

“…This might be due to patient's inability to afford malaria parasite diagnostic test which is quite expensive. The results of the present study are in line with the study conducted in Nigeria where the use of presumptive malaria diagnosis without laboratory support, was a common diagnostic procedure for malaria and inclined to poor quality of malaria diagnosis and treatment [14]. However, it was observed that prescribing of anti-malarial drugs after laboratory confirmation only decreased the total number of malaria prescriptions significantly in Malawi [15].…”

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

“…Social relationships are often based on a perceived or real demand from patients for antimalarials (Chandler et al, 2008b;Onwujekwe et al, 2009) as well as habitual practice built on observation and expectations from colleagues within communities of practice (Chandler et al, 2008a;Chandler et al, 2010). Undertaking qualitative studies to understand local conceptualisations of malaria treatment and diagnosis is essential in order to design supporting interventions for the introduction of new technologies such as RDTs in different settings.…”