title: Choice of treatment for fever at household level in Malawi: examining spatial patterns.
abstract: BACKGROUND
  Although malaria imposes an enormous burden on Malawi, it remains a controllable disease. The key strategies for control are based on early diagnosis and prompt treatment with effective antimalarials. Its success, however, depends on understanding the factors influencing health care decision making at household level, which has implications for implementing policies aimed at promoting health care practices and utilization.
  
  
  METHODS
  An analysis of patterns of treatment-seeking behaviour among care-givers of children of malarial fever in Malawi, based on the 2000 Malawi demographic and health survey, is presented. The choice of treatment provider (home, shop, or formal hospital care, others) was considered as a multi-categorical response, and a multinomial logistic regression model was used to investigate determinants of choosing any particular provider. The model incorporated random effects, at subdistrict level, to measure the influence of geographical location on the choice of any treatment provider. Inference was Bayesian and based on Markov chain Monte Carlo techniques.
  
  
  CONCLUSIONS
  Spatial variation was found in the choice of a provider and determinants of choice of any provider differed. Important risk factors included place of residence, access to media, care-giver's age and care factors including unavailability and inaccessibility of care. A greater effort is needed to improve the quality of malaria home treatment or expand health facility utilization, at all levels of administration if reducing malaria is to be realised in Malawi. Health promotion and education interventions should stress promptness of health facility visits, improved access to appropriate drugs, and accurate dosing for home-based treatments.
authors.affiliation: Applied Statistics and Epidemiology Research Unit, Mathematical Sciences Department, Chancellor College, University of Malawi, Zomba, Malawi. lkazembe@yahoo.com
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Kazembe
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Appleton
authors.forename: Immo
authors.initials: I
authors.lastname: Kleinschmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D017028:Caregivers; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000191:economics; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000191:economics; D008295:Malawi; D008875:Middle Aged; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care; D010961:Plasmodium; D012648:Self Care; D012959:Socioeconomic Factors