Treatment seeking for malaria in Mwea Division, Kirinyaga District, Kenya

Abstract

A descriptive cross-sectional study conducted in four-phases that utilized both qualitative and quantitative techniques for data collection and analysis was carried out in Mwea Division, Central Province,Kenya, to describe the treatment seeking behavior for malaria as its main objective. The study focused on t he sources 0 f treatment available for Malarial illness, t he treatment rates, the pattern of treatment seeking for a malarial illness and individuals, households and health resource provider factors that influence the choice and utilization of the various health service options. The study was carried out in theYear 2001. Malaria was cited and ranked to be a common health problem causing enormous morbidity and mortality,both in qualitative and quantitative phases of the study. Among 416 households studied in the quantitative component of the study, a malarial illness was identified in 50.2% of the households. Although 8(3.8%)did not seek treatment, majority (96.2 %) of the households with malaria reported having used some form of treatment during the period of illness. Sixty six percent of those seeking treatment used single treatments while 30.1% used multiple treatments. Majority of the households sought treatment for malaria illness within 3 days of illness, while none of the alternatives source of health care enhanced promptness of seeking treatment. The sources of health care were distributed across the available options. The government was found to be the major provider for treatment of malaria with 58.2% of the households using government health facilities, followed by use of self medication purchased from the retail shops (29.4%), 22.5 % using private health facilities while only 4.0 % using mission health facilities. The study findings reported that tremendous amount of treatment takes place at home. Home care takes place before, during and after treatment from a formal health facility, in few cases, it is the only treatment 0ffered. In response to malarial illness, the community also reported the use of indigenous traditional health systems. This finding predominated in the qualitative phase of data

collection but was only reported III 3.5% of the households that reported utilization III the quantitative phase. Various treatment sequences were used during a malarial illness. Government health care option was commonly utilized as a single source of treatment (37.8%) followed by private facilities. The commonest combination of sources of treatment was the use of a retail shop and a health facility for a single malaria episode (18.4 %). Lack of recovery following single treatment was associated with multiple treatments. In order to determine factors that influence the choice and utilization of treatment options, chi squared tests were performed. Three households characteristics were considered and related to the choices made as a single source of treatment. These included size of the household, socio economic status and the per capita monthly incomes of the households. The socio-economic status was reported to have a statistically significant relationship to choice and utilization of the treatment options. The socio-demographic characteristics of the head of households and individuals reporting illness that included sex, age, education levels, religion, occupation and marital status were related to utilization of the treatment options namely self-medication, government and private health providers. The quantitative findings reported a statistically significant relationship between the occupation of both the head of household and the individuals reporting malaria illness to choice and utilization of treatment options (p-value=;O. 048;0. 013 respectively). In 56.2% of the households studied, the head of the household purely depended on farming as the main source of livelihood. Retired or unemployed heads of households headed 26.0% of the households. Accessibility variables were also studied and related to utilization of the health providers. These included distance to the health care provider, quality of care as perceived by the consumers and the cost of services for malaria illness. There was a statistically significant relationship between the cost and perceived quality to the choice and utilization of the treatment options.

Among the individuals utilizing government health facility during the health facility based exit interviews, 39.7% and 45.2% cited the cost of service and perceived quality respectively as the factors considered when choosing the facility. The location of the treatment facility in either the irrigated or non-irrigated regions was also reported to relate statistically significant to its utilization (p-value=O.OOOD). istance to the treatment options was statistically significantly related also to its utilization (P-value=OOO). The fourth phase of the study was interested in observing actual episodes as they occurred in the formal health care options for validation purposes. Ninety-eight individuals were found utilizing either the government, private and mission facilities in the study areas. It was noted that, 27 (27.6%) of them had already used self-medication. Self-medication was therefore a common practice in this community that calls for policy address. The health facility based data reported that 34 (34.7%)of the patient were utilizing the facility as a second choice of care while the household data reported that of the 180 cases reported to have utilized formal health facility in either of the choices, 55(30.6%) utilized the facility as a second source of care. This emphasized use of multiple treatment as an important finding for this study. This study recommends the development of home care management guidelines and integration of retail shops and pharmacy as part of the peripheral health care systems; An urgent need to improve patient -provider interaction, and perceived quality of care to positively influence the decision making dynamics; Initiation of sustainable income generating activities to support the communities and-formulation of a national health insurance scheme in order to improve the accessibility of health services,

Further research to establish adequacy of treatment and compliance is recommended together with operational research in the area of health seeking behaviour that will address in wholistic manner issues that lead to increasing morbidity and mortality due to Malaria in Sub-Sahara Africa. The use of qualitative methods of PRA in collection of primary data once used very early in research projects has been found useful and is recommended in further research.