Quality of care for the treatment for uncomplicated malaria in South-East Nigeria: how important is socioeconomic status?

Introduction: Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups. Methods: A total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey. Results: Among the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups. Conclusions: The quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind

Patent medicine dealers and irrational use of medicines in children: the economic cost and implications for reducing childhood mortality in southeast Nigeria.

This study assessed the economic costs of irrational medicine use by Patent Medicine Dealers (PMDs) for malaria, acute respiratory infection (ARI) and diarrhea diseases (DD) in Nigeria. Exit interviews were conducted with 395 respondents who sought care for their children from 15 PMDs in Abakpa district of Enugu state Nigeria. Of the total respondents, 80.0% received treatment for malaria while 12.0% and 8.0% received treatment for DD and ARI respectively. The average number of drugs dispensed per patient was 6.8, average percentage of patients given injections was 72.5%, average percentage of patients given one or more antibiotics was 59.7%, while the percentage of patients given non essential drugs was 45.9%. The additional costs to the standard treatment in Naira was 255, 350 and 175 for malaria, ARI and DD respectively. The losses attributable to irrational dispensing was 4,500 Naira. However, more than half of the drugs were on essential drug list, implying some cost savings for the consumers, but the high number of drugs (6.8) on average/patient is likely to increase the total cost of drugs cancelling out the cost savings to consumers arising from dispensing essential drugs

Additional costs to the standard treatment for the different ailments (Naira).

<p>The mean values are in Naira, 150 Naira = I US Dollars.</p

Drug dispensing pattern as practiced by the patent medicine dealers.

<p>Drug dispensing pattern as practiced by the patent medicine dealers.</p

Socio demographic variables of respondents.

<p>Socio demographic variables of respondents.</p

Tobacco use.

<p>*Multiple responses</p><p>Tobacco use.</p

SES differences in cigarette use and expenditure among male household members.

<p>*1 stick of cigarette (cost of lowest brand tax inclusive) = ₦200 per pack of 20 @₦10 ($0.06) per stick⁷. [Currency exchange rate = 1dollar = 160 naira] (2012)</p><p>SES differences in cigarette use and expenditure among male household members.</p