title: Presumptive treatment of malaria from formal and informal drug vendors in Nigeria.
abstract: BACKGROUND
  Despite policies that recommend parasitological testing before treatment for malaria, presumptive treatment remains widespread in Nigeria. The majority of Nigerians obtain antimalarial drugs from two types of for-profit drug vendors-formal and informal medicine shops-but little is known about the quality of malaria care services provided at these shops.
  
  
  OBJECTIVE
  This study seeks to (1) describe the profile of patients who seek treatment at different types of drug outlets, (2) document the types of drugs purchased for treating malaria, (3) assess which patients are purchasing recommended drugs, and (4) estimate the extent of malaria over-treatment.
  
  
  METHODS
  In urban, peri-urban, and rural areas in Oyo State, customers exiting proprietary and patent medicine vendor (PPMV) shops or pharmacies having purchased anti-malarial drugs were surveyed and tested with malaria rapid diagnostic test. A follow-up phone survey was conducted four days after to assess self-reported drug administration. Bivariate and multivariate regression analysis was conducted to determine the correlates of patronizing a PPMV versus pharmacy, and the likelihood of purchasing an artemisinin-combination therapy (ACT) drug.
  
  
  RESULTS
  Of the 457 participants who sought malaria treatment in 49 enrolled outlets, nearly 92% had diagnosed their condition by themselves, a family member, or a friend. Nearly 60% pharmacy customers purchased an ACT compared to only 29% of PPMV customers, and pharmacy customers paid significantly more on average. Multivariate regression results show that patrons of PPMVs were younger, less wealthy, waited fewer days before seeking care, and were less likely to be diagnosed at a hospital, clinic, or laboratory. Only 3.9% of participants tested positive with a malaria rapid diagnostic test.
  
  
  CONCLUSIONS
  Poorer individuals seeking care at PPMVs are more likely to receive inappropriate malaria treatment when compared to those who go to pharmacies. Increasing accessibility to reliable diagnosis should be explored to reduce malaria over-treatment.
authors.affiliation: Research and Evaluation Division, Society for Family Health, Abuja, Nigeria.
authors.forename: Chinwoke
authors.initials: C
authors.lastname: Isiguzo
authors.affiliation: Technical Services Division, Society for Family Health, Abuja, Nigeria.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anyanti
authors.affiliation: Research and Evaluation Division, Society for Family Health, Abuja, Nigeria.
authors.forename: Chinazo
authors.initials: C
authors.lastname: Ujuju
authors.affiliation: Global Fund Malaria Division, Society for Family Health, Abuja, Nigeria.
authors.forename: Ernest
authors.initials: E
authors.lastname: Nwokolo
authors.affiliation: The Global Health Group, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: De La Cruz
authors.affiliation: The Global Health Group, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Eric
authors.initials: E
authors.lastname: Schatzkin
authors.affiliation: General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California, United States of America.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Modrek
authors.affiliation: Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Dominic
authors.initials: D
authors.lastname: Montagu
authors.affiliation: The Global Health Group, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Jenny
authors.initials: J
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D044383:Black People; D003132:Commerce / Q000331:legislation & jurisprudence; D004359:Drug Therapy, Combination; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D004366:Nonprescription Drugs / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004366:Nonprescription Drugs; C031327:artemisinin