title: Public and private sector treatment of malaria in Lao PDR.
abstract: This study aimed to examine the care-seeking choices for treatment of a febrile illness compatible with malaria in the public and private sectors in Lao PDR. We conducted interviews with 745 heads of household in 14 villages in the Sekong province, using a structured-questionnaire. We asked each about who the care-providers were for febrile illness episodes affecting their household members during the past year. If patients used more than one care-provider for a single episode over a period of time, we identified patterns of the care-sequences for the initial and subsequent care choices. Then, we analyzed the relationship between the initial care choices and secondary care choices for care-providers by Chi-square test, categorizing care-providers into public (hospital, health centre, and village health volunteer) and private care-providers (private pharmacy, informal retailer, faith healing and herbs). As a result, we found that 624 patients sought care at least once, 255 (40.9%) twice, and 66 (10.6%) three times or more during a single episode. Of 138 patients who started with a public care-provider and then sought a secondary care, 71 (51.4%) switched to a private care-provider. In contrast, of 117 patients who started with a private care-provider and then sought a secondary care, 82 (70.1%) switched to a public care-provider (p<0.001). In conclusion, although most patients who failed being treated by a private care-provider switched to a public one, some exclusively relied on care within the private sector. An intervention is necessary to make the private sector an integral component of malaria treatment in Lao PDR.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nonaka
authors.forename: Kongshin
authors.initials: K
authors.lastname: Vongseththa
authors.forename: Jun
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Somboun
authors.initials: S
authors.lastname: Bounyadeth
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kano
authors.forename: Samlane
authors.initials: S
authors.lastname: Phompida
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007812:Laos; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult