title: Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria.
abstract: BACKGROUND
  The African Heads of State meeting in Abuja, Nigeria on Roll Back Malaria adopted effective treatment of malaria nearer the home as one of the strategies for malaria control in Africa. A potentially effective strategy for bringing early, appropriate and low cost treatment of malaria closer to the home is through the use of community health workers (CHWs). There is paucity of information about people's actual preferences for CHWs and how stated preferences relates to revealed preferences for both the CHW strategy and other strategies for improving the timeliness of malaria treatment in not only Nigeria but in many malaria endemic countries.
  
  
  OBJECTIVE
  To determine peoples' stated and actual preferences for different strategies for improving the timeliness and appropriateness of treatment of malaria before and after the implementation of a community health workers (CHW) strategy in their community.
  
  
  METHODS
  A prospective study was undertaken in a rural malaria holo-endemic Nigerian community. A questionnaire was used to collect information on health-seeking from householders before (first survey) and after (second survey) implementation of a CHW malaria treatment strategy.
  
  
  RESULTS
  The consumers mostly preferred the CHW strategy over self-treatment in the homes and other strategies of treatment. The use of community health workers (CHWs) increased from 0% to 26.1% (p < 0.05), while self-treatment in the homes decreased from 9.4% to 0% (p < 0.05) after the implementation of the CHW strategy. Use of patent medicine dealers also decreased from 44.8% to 17.9% (p < 0.05) after CHW strategy was implemented.
  
  
  CONCLUSIONS
  Community health workers can be used to improve and ensure timely and appropriate treatment of malaria. The CHW strategy could also be sustained since it was preferred and used by consumers over self-treatment in the homes as well as other strategies for improving treatment. Hence, the CHW strategy is a feasible and promising method of improving home-management of uncomplicated malaria.
authors.affiliation: Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria. onwujekwe@yahoo.co.uk
authors.forename: Obinna
authors.initials: O
authors.lastname: Onwujekwe
authors.forename: Nkem
authors.initials: N
authors.lastname: Dike
authors.forename: Juliana
authors.initials: J
authors.lastname: Ojukwu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Uzochukwu
authors.forename: Nkoli
authors.initials: N
authors.lastname: Ezumah
authors.forename: Elvis
authors.initials: E
authors.lastname: Shu
authors.forename: Paul
authors.initials: P
authors.lastname: Okonkwo
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002738:Chloroquine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003153:Community Health Services / Q000379:methods*; D003150:Community Health Workers; D003258:Consumer Behavior; D004338:Drug Combinations; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D017060:Patient Satisfaction; D010963:Plasmodium falciparum / Q000187:drug effects; D011739:Pyrimethamine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012424:Rural Population; D013413:Sulfadoxine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine