Malaria Knowledge and Treatment Practices in Enugu State, Nigeria: A Qualitative Study

Document Type: Original Article

Authors

1 Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria

2 Health Policy and Research Group Enugu, Enugu State, Nigeria

3 Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria

4 Department of Community Medicine, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Nigeria

Abstract

Background
Malaria accounts for 60% of outpatient visits in Nigeria. The aim of the study was to assess the knowledge of malaria and its treatment practices in Enugu state, Nigeria.

 
Methods
Qualitative data was collected through the use of focus group discussions (FGDs), from six villages three each from urban and rural areas of Enugu state, Nigeria. A total of 18 FGDs involving 189 participants were conducted and data on place of treatment for malaria and drug of choice for malaria treatment were collected.

 
Results
Most discussants had a good knowledge of the signs and symptoms of malaria. They reported late for treatment when they had symptoms suggestive of malaria. Treatment timing was affected by financial capability and perceived severity of disease. There was preference for patent medicine dealers (PMDs) and pharmacies for malaria treatment. The reasons included drug affordability, obtaining preferred drug, short waiting time and polite treatment from the providers. Treatment in most cases was without proper malaria diagnosis. Cost was an important factor in determining the drug of choice for malaria treatment. This could explain why people were not aware of the use of artemisininbased combination therapy while preferring mono-therapies and herbal drugs. Public hospitals were considered as good sources of treatment for malaria although they remain the last resort when treatment from these drug outlets failed.

 
Conclusion
The community members preferred PMDs and pharmacies for malaria treatment. Unfortunately, these drug outlets do not encourage the use of artemisinin combination therapy (ACT). This makes it necessary that pharmacists and PMDs are trained on management of malaria. Also, improving the knowledge of the public on the need for malaria diagnosis before treatment and use of artemisinin-based combination therapy will improve the control of malaria. The populace should be instructed to seek treatment early while also discouraging the use of herbal drugs for malaria treatment. There is also the need to improve service delivery at public health facilities.

Keywords

Main Subjects


  1. World Health Organization. World Malaria Report. Geneva: World Health Organization; 2017.
  2. National Population Commission, ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria. Rockville, Maryland, USA: NPC and ICF International; 2014.
  3. Noland GS, Graves PM, Sallau A, et al. Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria. BMC Infect Dis. 2014;14:168. doi:10.1186/1471-2334-14-168
  4. World Health Organization. Progress and impact series: focus on Nigeria. Geneva: World Health Organization; 2012.
  5. Awoleye OJ, Thron C. Improving access to malaria rapid diagnostic test in Niger State, Nigeria: an assessment of implementation up to 2013. Malar Res Treat. 2016;2:1-13. doi:10.1155/2016/7436265
  6. Kyabayinze DJ, Asiimwe C, Nakanjako D, Nabakooza J, Counihan H, Tibenderana JK. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda. Malar J. 2010;9:200. doi:10.1186/1475-2875-9-200
  7. Federal Ministry of Health. National Antimalarial Treatment Guidelines. Abuja, Nigeria: National Malaria and Vector Control Division; 2005.
  8. Okeke TA, Okeibunor JC. Rural-urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy. 2010;95(1):62-68. doi:10.1016/j.healthpol.2009.11.005
  9. Orimadegun AE, Ilesanmi KS. Mothers' understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control. J Family Med Prim Care. 2015;4(2):226-231. doi:10.4103/2249-4863.154655
  10. Ezenduka CC, Ogbonna BO, Ekwunife OI, Okonta MJ, Esimone CO. Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy. Malar J. 2014;13:243. doi:10.1186/1475-2875-13-243
  11. Tobin-West CI, Adeniji FO. Knowledge of patent medicine vendors in Rivers state, Nigeria: implications for malaria control in rural and sub-urban communities. Indian J Pharm Pract. 2012;5(1):34-39.
  12. Onwujekwe O, Uzochukwu B, Dike N, Uguru N, Nwobi E, Shu E. Malaria treatment perceptions, practices and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria. Malar J. 2009;8:246. doi:10.1186/1475-2875-8-246
  13. Uzochukwu BS, Chiegboka LO, Enwereuzo C, et al. Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria. BMC Public Health. 2010;10:486. doi:10.1186/1471-2458-10-486
  14. Okonkwo AD, Okonkwo UP. Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria. Afr Health Sci. 2010;10(3):253-265.
  15. Anyika EN. Regulatory uncertainties in the pharmaceutical sector: perceptions among Nigerian pharmacists and policy implications for decision making. J Hosp Adm. 2016;5(3):48-55. doi:10.5430/jha.v5n3p48
  16. Onwujekwe O, Uzochukwu B, Eze S, Obikeze E, Okoli C, Ochonma O. Improving equity in malaria treatment: relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria. Malar J. 2008;7:5. doi:10.1186/1475-2875-7-5
  17. Afolabi AO. Factors influencing the pattern of self-medication in an adult Nigerian population. Ann Afr Med. 2008;7(3):120-127.
  18. Amoran OE. Impact of health education intervention on malaria prevention practices among nursing mothers in rural communities in Nigeria. Niger Med J. 2013;54(2):115-122. doi:10.4103/0300-1652.110046
  19. Tobin-West CI, Briggs N. Effectiveness of trained community volunteers in improving knowledge and management of childhood malaria in a rural area of Rivers State, Nigeria. Niger J Clin Pract. 2015;18(5):651-658. doi:10.4103/1119-3077.158971
  20. Fatungase KO, Amoran OE, Alausa KO. The effect of health education intervention on the home management of malaria among the caregivers of children aged under 5 years in Ogun State, Nigeria. Eur J Med Res. 2012;17:11. doi:10.1186/2047-783x-17-11
  21. Ojurongbe TA, Ishola IA, Ojurongbe O. Perception and treatment practices of malaria among tertiary institution students in Oyo and Osun states, Nigeria. J Nat Sci Res. 2014;4(5):33-42.
  22. Asante KP, Abokyi L, Zandoh C, et al. Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy. BMC Public Health. 2010;10:409. doi:10.1186/1471-2458-10-409
  23. Singh R, Musa J, Singh S, Ebere UV. Knowledge, attitude and practices on malaria among the rural communities in aliero, northern Nigeria. J Family Med Prim Care. 2014;3(1):39-44. doi:10.4103/2249-4863.130271
  24. Lawal AM, Balogun SK, B, Bada BV. Knowledge of transmission, malaria belief and health-seeking behavior in Oye-Ekiti local government area of Ekiti state, Nigeria. American Journalof Rural Development. 2014;2(1):8-12. doi:10.12691/ajrd-2-1-2
  25. Oyekale AS. Assessment of Malawian mothers' malaria knowledge, healthcare preferences and timeliness of seeking fever treatments for children under five. Int J Environ Res Public Health. 2015;12(1):521-540. doi:10.3390/ijerph120100521
  26. Edet-Utan O, Ojediran TE, Usman SO, et al. Knowledge, perception and practice of malaria management among non-medical students of higher institutions in Osun state, Nigeria. Am J Biotech Med Res. 2016;1(1):5-9. doi:10.5455/ajbmr.20151226010533
  27. Ansah EK, Narh-Bana S, Affran-Bonful H, et al. The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial. BMJ. 2015;350:h1019. doi:10.1136/bmj.h1019
  28. Danquah DA, Buabeng KO, Asante KP, Mahama E, Bart-Plange C, Owusu-Dabo E. Malaria case detection using rapid diagnostic test at the community level in Ghana: consumer perception and practitioners' experiences. Malar J. 2016;15:34. doi:10.1186/s12936-016-1086-z
  29. World Health Organization. Global technical strategy for malaria (2016-2030). Geneva, Switzerland: World Health Organization; 2015.
  30. Sangowawa AO, Amodu OK, Olaniyan SA, Amodu FA, Olumese PE, Omotade OO. Factors associated with a poor treatment outcome among children treated for malaria in Ibadan, southwest Nigeria. Epid Res Int. 2014;2014:974693. doi:10.1155/2014/974693
  31. National Bureau of Statistics. Nigeria Poverty Profile Report 2010. http://www.nigeriastat.gov.ng. Accessed October 30, 2017.
  32. Uzochukwu BS, Ughasoro MD, Etiaba E, Okwuosa C, Envuladu E, Onwujekwe OE. Health care financing in Nigeria: Implications for achieving universal health coverage. Niger J Clin Pract. 2015;18(4):437-444. doi:10.4103/1119-3077.154196
  33. Oyibo PG. Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi State, south east Nigeria. Afr Health Sci. 2011;11(3):481-485.
  34. Onyeonoro UU, Ogah OS, Ukegbu AU, Chukwuonye, II, Madukwe OO, Moses AO. Urban-Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs. Health Serv Insights. 2016;9:29-36. doi:10.4137/hsi.s31865
  35. Onwujekwe O, Obikeze E, Uzochukwu B, Okoronkwo I, Onwujekwe OC. Improving quality of malaria treatment services: assessing inequities in consumers' perceptions and providers' behaviour in Nigeria. Int J Equity Health. 2010;9:22. doi:10.1186/1475-9276-9-22
  36. Oyeyemi  AS, Ogunnowo BE, Odukoya OO. Patent medicine vendors in rural areas of Lagos Nigeria: compliance with regulatory guidelines and implications for malaria control. Trop J Pharm Res. 2014;13(1):163-169. doi:10.4314/tjpr.v13i1.23
  37. Oyeyemi A, Ogunnowo B, Odukoya O. Response of patent medicine vendors in rural areas of Lagos state Nigeria to antimalarial policy change. Afr Health Sci. 2015;15(2):420-428. doi:10.4314/ahs.v15i2.15
  38. Mangham-Jefferies L, Hanson K, Mbacham W, Onwujekwe O, Wiseman V. What determines providers' stated preference for the treatment of uncomplicated malaria? Soc Sci Med. 2014;104:98-106. doi:10.1016/j.socscimed.2013.12.024
  39. Isiguzo C, Anyanti J, Ujuju C, et al. Presumptive treatment of malaria from formal and informal drug vendors in Nigeria. PLoS One. 2014;9(10):e110361. doi:10.1371/journal.pone.0110361
  40. Uzochukwu B, Ezeoke O, Emma-Ukaegbu U, Onwujekwe O, Sibeudu F. Malaria treatment services in Nigeria: A review. Niger Med J. 2010;51(3):114-119.
  41. Onwujekwe O, Hanson K, Uzochukwu B, Ezeoke O, Eze S, Dike N. Geographic inequities in provision and utilization of malaria treatment services in southeast Nigeria: diagnosis, providers and drugs. Health Policy. 2010;94(2):144-149. doi:10.1016/j.healthpol.2009.09.010
  42. Olorunniyi OF, Morenikeji OA. The extent of use of herbal medicine in malaria management in Ido/Osi local government area of Ekiti state, Nigeria. J Med Plant Res. 2013;7(42):3171-3178.