Rural–urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria

Abstract

Background: Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers' recognition is an entry point for fever treatment, including malaria. This study describes rural-urban disparity in fever prevalence in U5, mothers' malaria knowledge, care-seeking, testing for malaria before anti-malarial medication and the associated factors. Methods: A cross-sectional survey was conducted among 630 mother-child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before anti-malarial use, and delayed care-seeking defined as care sought for fever > 48 h of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥ 75th, 50th-74th, and < 50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05. Results: The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI 1.8-4.2, p < 0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times more likely to receive anti-malarial medications without testing for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI 1.6-9.9, p < 0.000). Conclusions: Rural-urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than 'one-size-fits-all' approach.

Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

“…This study shows that more than half of participants delay in seeking treatment for their malaria. This finding is consistent with studies in Myanmar [15], Nigeria [43], Uganda [52],…”

“…This study shows that more than half of participants delay in seeking treatment for their malaria. This finding is consistent with studies in Myanmar [15], Nigeria [43], Uganda [52], and South-Eastern Nigeria [53]. However, our finding contrasted with studies in Cabo Verde [54] and South Africa [55], revealing that the high awareness of the community to seek treatment within 24 hours.…”

“…Socio-demographic and environmental covariates that have shown the association with careseeking malaria treatment were gender [42], age group [42][43][44][45]; education level [42,46,47]; social-economic status (SES) [46,48]; occupation [46]; income [49]; family size [43]; types of health facilities [41], distance to the health facilities [16,49,50]; and ethnicities [48,51]. In this study, gender was classified as males or females.…”

Estimating the Fraction of Severe Malaria among Malaria-Positive Children: Analysis of Household Surveys in 19 Malaria-Endemic Countries in Africa

“… 22 – 24 Other reasons could be attributed to self-treatment at home. 23 , 24 However, more exploration is needed into these patterns. In addition, the country was highly significant in the model.…”

The Impact of the Private Sector Co-Payment Mechanism (PSCM) on the Private Market for ACTs in Nigeria: Results of the 2018 Cross-sectional Outlet and Household Market Surveys.

“…Interestingly, the improvements in availability were among PPMVs as opposed to pharmacies among which availability remained steady, suggesting the scheme had a particular impact in reaching PPMVs. This is important since PPMVs were most frequently visited by lower income HHs and by HHs in rural areas, where the prevalence of malaria is expected to be higher [22][23][24].…”