Dataset Information

Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.

ABSTRACT: This study assesses malaria prevention and treatment behaviour among people living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria bears one of the world's largest burdens of both malaria and HIV, there is almost no research studying how co-infected patients manage their care. We systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital and the Federal Medical Centre in Owerri to complete a structured, pre-tested questionnaire on malaria care-seeking behaviour. Descriptive statistics were reported and chi-square tests and multivariate logistic regressions were also used. The majority of HIV-infected patients (78.9%) reported having had an episode of suspected malaria quarterly or more often. There was a large variation in care-seeking patterns: on suspicion of malaria, 29.1% of participants engaged in self-medication; 39.2% went to drug shops, and only 22.6% visited HIV/AIDS care centres. Almost 40% waited more than 24 hours before initiating treatment. Most (60.3%), reported taking recommended artemisinin-based combination treatments (ACT) but a significant minority took only paracetamol (25.6%) or herbal remedies (3.5%). Most (80%) finished their chosen course of treatment; and completion of treatment was significantly associated with the frequency of suspected malaria occurrence (p = 0.03). Most (62.8%) did not take anti-malaria medication while taking antiretroviral treatment (ART) and almost all (87.6%) reported taking an ACT regimen that could potentially interact with Nigeria's first-line ART regimen. Our findings suggest the need to pay more attention to malaria prevention and control as a crucial element in HIV/AIDS management in this part of Nigeria and other areas where malaria and HIV/AIDS are co-endemic. Also, more research on ART-ACT interactions, better outreach to community-level drug shops and other private sector stakeholders, and clearer guidelines for clinicians and patients on preventing and managing co-infection may be needed. This will require improved collaboration between programmes for both diseases.

SUBMITTER: Chukwuocha UM

PROVIDER: S-EPMC6508638 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.

Chukwuocha Uchechukwu M UM Iwuoha Gregory N GN Nwakwuo Geoffrey C GC Egbe Peter K PK Ezeihekaibe Chidinma D CD Ekiyor Christopher P CP Dozie Ikechukwu N S INS Burrowes Sahai S

PloS one 20190509 5

This study assesses malaria prevention and treatment behaviour among people living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria bears one of the world's largest burdens of both malaria and HIV, there is almost no research studying how co-infected patients manage their care. We systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital and the Federal Medical Centre in Owerri to complete a structured, pre-tested questionnaire on malaria care-seeki ...[more]

PMID: 31071091

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Project description:BackgroundA good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria.MethodsA cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the "postestimation test" command in Stata.ResultsA total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis.ConclusionsAmong the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

Project description:BackgroundIn Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions.MethodsThe study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10.ResultsFindings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditional medicine, particularly that provided by traditional birth attendants who are long-term residents in the community. The patriarchal c influenced health-seeking behaviour in pregnancy. Economic factors contributed to the delay in access to appropriate services. There was a consistent concern regarding the cost barrier in accessing health services. The challenges of accessing services were well recognised and these were greater when referral was to a higher level of care which in most cases attracted unaffordable costs.ConclusionWhile the high cost of care is a deterrent to health seeking behaviour, the cost of death of a woman or a child to the family and community is immeasurable. The use of innovative mechanisms for health care financing may be beneficial for women in these communities to reduce the barrier of high cost services. To reduce maternal deaths all stakeholders must be engaged in the process including policy makers, opinion leaders, health care consumers and providers. Underlying socio-cultural factors, such as structure of patriarchy, must also be addressed to sustainably improve maternal health.Trial registrationNCT01911494.

Project description:IntroductionThe World Health Organization recommends seeking medical treatment within 24 hours after transmission of malaria to reduce the risk of severe complications and its onwards spread. However, in some parts of Indonesia, including East Nusa Tenggara Province (ENTP), this adherence is not achieved for a range of reasons including delays in visiting health centres. This study aims to determine factors related to the poor understanding of appropriate malaria treatment-seeking behaviour (AMTSB) of rural adults in ENTP. AMTSB was defined as seeking treatment at professional health facilities within 24 hours of the onset of malaria symptoms.MethodsA cross-sectional study was conducted in the East Sumba, Belu, and East Manggarai district of ENTP between October and December 2019. A multi-stage cluster sampling procedure was applied to enrol 1503 participants aged between 18 and 89 years of age. Data were collected through face-to-face interviews. Multivariable logistic regression analyses were used to assess significant factors associated with the poor understanding of AMTSB.ResultsEighty-six percent of participants were found to be familiar with the term malaria. However, poor understanding level of AMTSB in rural adults of ENTP achieved 60.4% with a 95% confidence interval (CI): 56.9-63.8. Poor understanding of AMTSB was significantly higher for adults with no education (adjusted odds ratio (AOR) 3.42, 95% CI: 1.81, 6.48) compared to those with a diploma or above education level; having low SES (AOR: 1.87, 95% CI: 1.19, 2.96) compared to those having high SES; residing at least three kilometres (km) away from the nearest health facilities (AOR: 1.73, 95% CI: 1.2, 2.5) compared to those living within one km from the nearest health service; and working as farmer (AOR: 1.63, 95% CI: 1.01-2.63) compared to those working at government or non-government sector. Whilst, other factors such as ethnicity and family size were not associated with the poor understanding of AMTSB.ConclusionThe proportion of rural adults having a poor understanding of AMTSB was high leading to ineffective implementation of artemisinin-based combination therapies as the method to treat malaria in ENTP. Improving awareness of AMTSB for rural adults having low level education, low SES, working as a farmer, and living at least three km from the nearest health facilities is critical to support the efficacy of malaria treatment in ENTP. This method will support the Indonesian government's objective to achieve malaria elimination by 2030.

Project description:ObjectivesTo examine the health-seeking behaviour and cost of fever treatment to households in Ghana.DesignCross-sectional household survey conducted between July and September 2015.SettingKassena-Nankana East and West districts in Upper East region of Ghana.ParticipantsIndividuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents.ResultsOut of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1-GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled.ConclusionsPrompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.

Dataset Information

Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.

Publications

Malaria care-seeking behaviour among HIV-infected patients receiving antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.

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