title: Barriers to prompt and effective treatment of malaria in northern Sri Lanka.
abstract: BACKGROUND
  For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment.
  
  
  METHODS
  Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups.
  
  
  RESULTS
  A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P=0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods.
  
  
  CONCLUSIONS
  A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.
authors.affiliation: Medecins sans Frontieres, Colombo, Sri Lanka.
authors.forename: B
authors.initials: B
authors.lastname: Reilley
authors.forename: R
authors.initials: R
authors.lastname: Abeyasinghe
authors.forename: M Vincent
authors.initials: MV
authors.lastname: Pakianathar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008288:Malaria / Q000097:blood / Q000517:prevention & control*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013188:Sri Lanka / Q000453:epidemiology; D014857:Warfare