title: Stated preferences for anti-malarial drug characteristics in Zomba, a malaria endemic area of Malawi.
abstract: BACKGROUND
  The evidence on determinants of individuals' choices for anti-malarial drug treatments is scarce. This study sought to measure the strength of preference for adult antimalarial drug treatment attributes of heads of urban, rural and peri-urban households in a resource-limited malaria-endemic area of sub-Saharan Africa.
  
  
  METHODS
  Discrete choice experiments were conducted with 508 heads of household interviewed face-to-face for a household population survey of health-seeking behavior in Zomba District, Malawi. The interviews were held in Chichewa and the choice experiment questions were presented with cartoon aids. The anti-malarial drug attributes included in the stated preference experiment were: speed of fever resolution, side effects (pruritus) risk, protection (duration of prophylactic effect), price, duration of treatment course and recommendation by a health professional. Sixteen treatment profiles from a fractional factorial design by orthogonal array were paired into choice scenarios, and scenarios were randomly assigned to participants so that each participant was presented with a series of eight pairwise choice scenarios. Respondents had the option to state indifference between the two profiles or decline to choose. Data were analysed in a mixed logit model, with normally distributed coefficients for all six attributes.
  
  
  RESULTS
  The sex ratio was balanced in urban areas, whereas 63% of participants in rural areas were male. The proportion of individuals with no education was considerably higher in the rural group (25%) than in the urban (5%) and peri-urban (6%) groups. All attributes investigated had the expected influence, and traded-off in most respondents' choices. There were heterogeneous effects of price, pruritus risk, treatment recommendation by a professional, and duration of prophylaxis across respondents, only partly explained by their differences in education, household per capita expenditure, sex and age. Individuals' demand elasticity (simulated median, inter-quartile range) was highest (most responsive) to speed of symptom resolution (0.88, 0.80-0.89) and pruritus risk (0.25, 0.08-0.62).
  
  
  CONCLUSIONS
  Most adult antimalarial users are willing to use treatments without recommendation from health professional, and may be influenced by price. Future studies should investigate the magnitude of differences in price and treatment attribute sensitivity between adult anti-malarial drug users in rural, peri-urban and urban areas in order to determine optimal price subsidies.
authors.forename: Antonieta
authors.initials: A
authors.lastname: Medina-Lara
authors.affiliation: Institute of Health Research, University of Exeter Medical School, University of Exeter, Vesey Building, Salmon Pool Lane, Exeter EX2 5GU, UK. R.E.Mujica-Mota@exeter.ac.uk.
authors.forename: Ruben E
authors.initials: RE
authors.lastname: Mujica-Mota
authors.forename: Esthery D
authors.initials: ED
authors.lastname: Kunkwenzu
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003906:Developing Countries; D019353:Endemic Diseases; D005260:Female; D017144:Focus Groups; D006306:Health Surveys; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008295:Malawi; D008297:Male; D008962:Models, Theoretical; D009042:Motivation; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011306:Prescription Fees; D011537:Pruritus / Q000139:chemically induced; D012424:Rural Population; D012494:Sampling Studies; D013383:Suburban Population; D011795:Surveys and Questionnaires; D013997:Time Factors; D014505:Urban Population
chemical_list: D000962:Antimalarials