Equity and seeking treatment for young children with fever in Nigeria: a cross-sectional study in Cross River and Bauchi States

Infectious Diseases of Poverty

Neil Andersson⁴  Anne Cockcroft³  Robbinson Yusuf¹  Iyam Ugot⁵  Hajara Isa²  Steven Mitchell⁴  Bikom Patrick Odu² 

[1] State Ministry of Health, Bauchi, Bauchi State, Nigeria;CIET Trust, 71 Oxford Road, Saxonwold, Johannesburg 2196, South Africa;CIET Trust Botswana, PO Box 1240, Gaborone, Botswana;CIET/PRAM, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC H3Z 1Z1, Canada;Community Health Department and Roll Back Malaria Program, Calabar, Cross River State, Nigeria

关键词: Nigeria;    Access to care;    Equity;    Malaria;    Severe fever;   

Others  :  1133675
DOI  :  10.1186/2049-9957-4-1

 received in 2014-07-20, accepted in 2014-11-18,  发布年份 2015

【 摘 要 】

Background

Poor children have a higher risk of contracting malaria and may be less likely to receive effective treatment. Malaria is an important cause of morbidity and mortality in Nigerian children and many cases of childhood fever are due to malaria. This study examined socioeconomic factors related to taking children with fever for treatment in formal health facilities.

Methods

A household survey conducted in Bauchi and Cross River states of Nigeria asked parents where they sought treatment for their children aged 0–47 months with severe fever in the last month and collected information about household socio-economic status. Fieldworkers also recorded whether there was a health facility in the community. We used treatment of severe fever in a health facility to indicate likely effective treatment for malaria. Multivariate analysis in each state examined associations with treatment of childhood fever in a health facility.

Results

43% weighted (%wt) of 10,862 children had severe fever in the last month in Cross River, and 45%wt of 11,053 children in Bauchi. Of these, less than half (31%wt Cross River, 44%wt Bauchi) were taken to a formal health facility for treatment. Children were more likely to be taken to a health facility if there was one in the community (OR 2.31 [95% CI 1.57–3.39] in Cross River, OR 1.33 [95% CI 1.0–1.7] in Bauchi). Children with fever lasting less than five days were less likely to be taken for treatment than those with more prolonged fever, regardless of whether there was such a facility in their community. Educated mothers were more likely to take children with fever to a formal health facility. In communities with a health facility in Cross River, children from less-poor households were more likely to go to the facility (OR 1.30; 95% CI 1.07-1.58).

Conclusion

There is inequity of access to effective malaria treatment for children with fever in the two states, even when there is a formal health facility in the community. Understanding the details of inequity of access in the two states could help the state governments to plan interventions to increase access equitably. Increasing geographic access to health facilities is needed but will not be enough.

【 授权许可】

   
2015 Odu et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organisation: World Malaria Report 2012. Summary and key points. Available from: http://www.who.int/malaria/publications/world_malaria_report_2012/wmr2012_summary_and_keypoint.pdf webcite [accessed 10 January 2015]
• [2]World Health Organisation: World Malaria Report 2012. Fact sheet. Available from: http://www.who.int/malaria/publications/world_malaria_report_2012/wmr2012_factsheet.pdf webcite [accessed 10 January 2015]
• [3]Snow RW, Omumbo JA: Malaria. In Disease and Mortality in Sub-Saharan Africa. 2nd edition. Edited by Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, Rogo KO. Washington (DC): World Bank; 2006. Chapter 14. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2286/ webcite
• [4]Tusting LS, Willey B, Lucas H, Thompson J, Kafy HT, Smith R, Lindsay SW: Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis. Lancet 2013, 382:963-972.
• [5]Mathanga DP, Bowie C: Malaria control in Malawi: are the poor being served? Int J Equit Hlth 2007, 6:22.
• [6]Barat LM, Palmer N, Basu S, Worrall E, Hanson K, Mills A: Do malaria control interventions reach the poor? A view through the equity lens. Am J Trop Med Hyg 2004, 71(suppl 2):174-178.
• [7]Filmer D: Fever and its treatment among the poor and less poor in sub-Saharan Africa. Health Policy Planning 2005, 20:337-346.
• [8]Littrell M, Gatakaa H, Evance I, Poyer S, Njogu J, Solomon T, Munroe E, Chapman S, Goodman C, Hanson K, Zinsou C, Akulayi L, Raharinjatovo J, Arogundade E, Buyungo P, Mpasela F, Adjibabi CB, Agbango JA, Ramarosandratana BF, Coker B, Rubahika D, Hamainza B, Shewchuk T, Chavasse D, O’Connell KA: 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. Malaria J 2011, 10:327. BioMed Central Full Text
• [9]Gething PW, Kirui VC, Alegana VA, Okiro EA, Noor AM, Snow RW: Estimating the number of paediatric fevers associated with malaria infection presenting to Africa’s public health sector in 2007. PLoS Med 2010, 7(7):e1000301.
• [10]World Health Organisation: Guidelines for the treatment of malaria. 2nd edition. Geneva: WHO; 2010. Available from: http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf webcite [accessed 10 January 2015]
• [11]Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G: Medicine sellers and malaria treatment in Sub-Saharan Africa: what do they do and how can their practice be improved? Trop Med Int Health 2007, 77:203-218.
• [12]Okeke TA, Okeibunor JC: Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy 2010, 95:62-68.
• [13]National Population Commission (NPC), National Malaria Control Programme (NMCP), and ICF International: Nigeria Malaria Indicator Survey 2010. Abuja, Nigeria: NPC, NMCP, and ICF International; 2012.
• [14]National Bureau of Statistics, UNICEF, UNFPA: Nigeria Multiple Indicator Cluster Survey 2011. Abuja, Nigeria: NBS, UNICEF, UNFPA; 2013.
• [15]Federal Ministry of Health: National Antimalarial Treatment Policy. Abuja, Nigeria: Federal Ministry of Health National Malaria and Vector Control Division; 2005.
• [16]Andersson N, Omer K, Caldwell D, Dambam M, Maikudi A, Effiong B, Ikpi E, Udofia E, Khan A, Ansari A, Ansari N, Hamel C: Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian States. BMC Health Serv Res 2011, 11(Suppl 2):S7. BioMed Central Full Text
• [17]The CIET group: A Health Information and Planning System for Bauchi and Cross River (2008–2014). Nigeria; http://www.ciet.org/en/project/nigeria-a-health-information-and-planning-system-for-bauchi-and/ webcite [accessed 10 January 2015]
• [18]National Population Commission: National Population Census, 2006. Figures for state populations available from: http://www.population.gov.ng/index.php/state-population webcite [accessed 10 January 2015]
• [19]Centers for Disease Control and Prevention: Epi Info 6: a Word Processing, Database and Statistics Program for Epidemiology on Microcomputers. [http://wwwn.cdc.gov/epiinfo/ webcite]
• [20]Andersson N, Mitchell S: Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. Int J Health Geogr 2006, 5:1. BioMed Central Full Text
• [21]Mantel N, Haenszel W: Statistical aspects of disease. J Natl Cancer Inst 1959, 22:719-748.
• [22]Lamothe G: Adjusting the Mantel Haenszel test statistic and odds ratio for cluster sampling. BMC Health Serv Res 2011, 11(Suppl 2):S15 (statistical annex). BioMed Central Full Text
• [23]Mantel N: Chi-square tests with one degree of freedom: extensions of the Mantel Haenszel procedure. J Amer Stat Assoc 1963, 58:690-700.
• [24]Uzochukwu BSC, Onwujekwe EO, Onoka CA, Ughasoro MD: Rural–urban differences in maternal responses to childhood fever in South East Nigeria. PLoS ONE 2008, 3(3):e1788.
• [25]Muller O, Traore C, Becher H, Kouyate B: Malaria morbidity, treatment-seeking behaviour, and mortality in a cohort of young children in rural Burkina Faso. Trop Med Int Health 2003, 8:290-296.
• [26]Malik ME, Kamal H, Salah HA, Eldirdieri SA, Khalid AM: Treatment-seeking behaviour for malaria in children under five years of age: implication for home management in rural areas with high seasonal transmission in Sudan. Malaria J 2006, 5:60. BioMed Central Full Text
• [27]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. Malaria J 2008, 7:5. BioMed Central Full Text
• [28]Cockcroft A, Andersson N, Omer K, Ansari NM, Khan A, Chaudhry UU, Ansari U: One size does not fit all: local determinants of measles vaccination in four districts of Pakistan. BMC Int Health Human Rights 2009, 9(Suppl 1):S4. BioMed Central Full Text
• [29]Hwang J, Graves PM, Jima D, Reithinger R, Kachur SP: Knowledge of malaria and its association with malaria-related behaviors—results from the malaria indicator survey, Ethiopia, 2007. PLoS ONE 2010, 5(7):e11692.
• [30]Makinen M, Waters H, Rauch M, Almagambetova N, Bitran R, Gilson L, McIntyre D, Pannarunothai S, Prieto AL, Ubilla G, Ram S: Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition. Bull World Health Organ 2000, 78:55-65.
• [31]Mitchell S, Cockcroft A, Lamothe G, Andersson N: Equity in HIV testing: evidence from a cross-sectional study in ten Southern African countries. BMC Int Health Human Rights 2010, 10:23. BioMed Central Full Text
• [32]Cockcroft A, Khan A, Ansari NM, Omer K, Hamel C, Andersson N: Does contracting of health care in Afghanistan work? Public and service-users' perceptions and experience. BMC Health Serv Res 2011, 11(suppl 2):S11. BioMed Central Full Text
• [33]Mitchell S, Andersson N, Ansari NM, Omer K, Legorreta-Soberanis J, Cockcroft A: Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC Int Health Human Rights 2009, 9(Suppl 1):S7. BioMed Central Full Text