Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries

• Published in: Malaria Journal
• Main Authors: Littrell Megan, Gatakaa Hellen, Evance Illah, Poyer Stephen, Njogu Julius, Solomon Tsione, Munroe Erik, Chapman Steven, Goodman Catherine, Hanson Kara, Zinsou Cyprien, Akulayi Louis, Raharinjatovo Jacky, Arogundade Ekundayo, Buyungo Peter, Mpasela Felton, Adjibabi Cherifatou, Agbango Jean, Ramarosandratana Benjamin, Coker Babajide, Rubahika Denis, Hamainza Busiku, Shewchuk Tanya, Chavasse Desmond, O'Connell Kathryn A
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2011
• Subjects: Malaria; ACT; diagnosis; treatment-seeking behaviour; public sector; private sector; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/1475-2875-10-327; https://doaj.org/article/05dfd6a561984f5f96406fbfb9b90589

Abstract Background Access to artemisinin-based combination therapy (ACT) remains limited in high malaria-burden countries, and there are concerns that the poorest people are particularly disadvantaged. This paper presents new evidence on household treatment-seeking behaviour in six African countries. These data provide a baseline for monitoring interventions to increase ACT coverage, such as the Affordable Medicines Facility for malaria (AMFm). Methods Nationally representative household surveys were conducted in Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia between 2008 and 2010. Caregivers responded to questions about management of recent fevers in children under five. Treatment indicators were tabulated across countries, and differences in case management provided by the public versus private sector were examined using chi-square tests. Logistic regression was used to test for association between socioeconomic status and 1) malaria blood testing, and 2) ACT treatment. Results Fever treatment with an ACT is low in Benin (10%), the DRC (5%), Madagascar (3%) and Nigeria (5%), but higher in Uganda (21%) and Zambia (21%). The wealthiest children are significantly more likely to receive ACT compared to the poorest children in Benin (OR = 2.68, 95% CI = 1.12-6.42); the DRC (OR = 2.18, 95% CI = 1.12-4.24); Madagascar (OR = 5.37, 95% CI = 1.58-18.24); and Nigeria (OR = 6.59, 95% CI = 2.73-15.89). Most caregivers seek treatment outside of the home, and private sector outlets are commonly the sole external source of treatment (except in Zambia). However, children treated in the public sector are significantly more likely to receive ACT treatment than those treated in the private sector (except in Madagascar). Nonetheless, levels of testing and ACT treatment in the public sector are low. Few caregivers name the national first-line drug as most effective for treating malaria in Madagascar (2%), the DRC (2%), Nigeria (4%) and Benin (10%). Awareness is higher in Zambia (49%) and ...