title: Equity and seeking treatment for young children with fever in Nigeria: a cross-sectional study in Cross River and Bauchi States.
abstract: BACKGROUND
  Poor children have a higher risk of contracting malaria and may be less likely to receive effective treatment. Malaria is an important cause of morbidity and mortality in Nigerian children and many cases of childhood fever are due to malaria. This study examined socioeconomic factors related to taking children with fever for treatment in formal health facilities.
  
  
  METHODS
  A household survey conducted in Bauchi and Cross River states of Nigeria asked parents where they sought treatment for their children aged 0-47 months with severe fever in the last month and collected information about household socio-economic status. Fieldworkers also recorded whether there was a health facility in the community. We used treatment of severe fever in a health facility to indicate likely effective treatment for malaria. Multivariate analysis in each state examined associations with treatment of childhood fever in a health facility.
  
  
  RESULTS
  43% weighted (%wt) of 10,862 children had severe fever in the last month in Cross River, and 45%wt of 11,053 children in Bauchi. Of these, less than half (31%wt Cross River, 44%wt Bauchi) were taken to a formal health facility for treatment. Children were more likely to be taken to a health facility if there was one in the community (OR 2.31 [95% CI 1.57-3.39] in Cross River, OR 1.33 [95% CI 1.0-1.7] in Bauchi). Children with fever lasting less than five days were less likely to be taken for treatment than those with more prolonged fever, regardless of whether there was such a facility in their community. Educated mothers were more likely to take children with fever to a formal health facility. In communities with a health facility in Cross River, children from less-poor households were more likely to go to the facility (OR 1.30; 95% CI 1.07-1.58).
  
  
  CONCLUSIONS
  There is inequity of access to effective malaria treatment for children with fever in the two states, even when there is a formal health facility in the community. Understanding the details of inequity of access in the two states could help the state governments to plan interventions to increase access equitably. Increasing geographic access to health facilities is needed but will not be enough.
authors: CIET Trust, 71 Oxford Road, Saxonwold, Johannesburg, 2196 South Africa.
authors: Bikom Patrick
authors: BP
authors: Odu
authors: CIET/PRAM, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC H3Z 1Z1 Canada.
authors: Steven
authors: S
authors: Mitchell
authors: CIET Trust, 71 Oxford Road, Saxonwold, Johannesburg, 2196 South Africa.
authors: Hajara
authors: H
authors: Isa
authors: Community Health Department and Roll Back Malaria Program, Calabar, Cross River State Nigeria.
authors: Iyam
authors: I
authors: Ugot
authors: State Ministry of Health, Bauchi, Bauchi State Nigeria.
authors: Robbinson
authors: R
authors: Yusuf
authors: CIET Trust Botswana, PO Box 1240, Gaborone, Botswana.
authors: Anne
authors: A
authors: Cockcroft
authors: CIET/PRAM, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC H3Z 1Z1 Canada.
authors: Neil
authors: N
authors: Andersson
keywords: Access to care; Equity; Malaria; Nigeria; Severe fever