Determinants of Malaria Treatment Seeking Behaviour among Urban and Rural Households in North Central Nigeria

Background: Malaria is a major cause of morbidity and mortality in Nigeria accounting for a significant proportion of household expenditure in treatment and prophylaxis. Nigeria account for 25% of global clinical cases and mortality and also has the highest malaria burden in sub Saharan Africa. In most cases of malaria illness, treatment takes place at the community level and only few serious cases are taken to healthcare facilities. A number of cultural, socioeconomic, patient related and health service provider variables often in a complex interplay are known to influence treatment seeking behaviour, though the relative importance of variables differ widely between settings.

Objectives: To identify where households receive malaria treatment services as well as prevalence of malaria related hospitalization. Also to identify the most common factor(s) that most influence malaria treatment behaviour.

Methods: This is a cross section study using multistage sampling method for household survey. This study was carried out during the rainy months of June and July 2016. Six towns with high urban and rural population density in Benue State were purposely selected for survey. A total of 1705 completed household administered questionnaires were found usable for analysis. The data was entered into SPSS version 20 for descriptive and inferential analysis. Factor analysis using principal component analysis, varimax rotation with KMO normalization was carried out. Factor loadings lower than 0.4 was suppressed. Mean item scores with high factor loading and mean total extracted component score were used for further analysis. P values ≤ 0.05 was considered significant.

Ethical Issues: Ethical approval was sought and obtained from health research ethic department of Benue State Ministry of health and human services (Ref.no.MED/261/VOL./540).

Results and Discussion: The average malaria prevalence in rural areas was twice that of urban areas, though the rates of hospitalization were similar. About 50% of households in both rural and urban areas reported at least one episode of malaria within the study period reflecting persistence of high malaria transmission. Many variables have been shown to influence treatment behaviour.

Conclusion: Malaria cases and malaria related hospitalization remain high and while public health facilities play more dominant roles, while in rural areas private providers dominates the landscape. Treatment seeking behaviour is largely influenced by many variables relating to availability, accessibility, affordability and perceptions of household healthcare decision makers.