title: Quality of care for the treatment for uncomplicated malaria in South-East Nigeria: how important is socioeconomic status?
abstract: BACKGROUND
  Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups.
  
  
  METHODS
  A total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey.
  
  
  RESULTS
  Among the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups.
  
  
  CONCLUSIONS
  The quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind.
authors: Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria. mypaskie@yahoo.co.uk.
authors: Ogochukwu P
authors: OP
authors: Ibe
authors: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Lindsay.Mangham-Jefferies@lshtm.ac.uk.
authors: Lindsay
authors: L
authors: Mangham-Jefferies
authors: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Bonnie.Cundill@lshtm.ac.uk.
authors: Bonnie
authors: B
authors: Cundill
authors: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Virginia.Wiseman@lshtm.ac.uk.
authors: Virginia
authors: V
authors: Wiseman
authors: Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria. bscuzochukwu@gmail.com.|Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria. bscuzochukwu@gmail.com.
authors: Benjamin S
authors: BS
authors: Uzochukwu
authors: Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria. obinna.onwujekwe@unn.edu.ng.|Department of Health Administration and Management, Faculty of Health Sciences, University of Nigeria, Enugu, Nigeria. obinna.onwujekwe@unn.edu.ng.
authors: Obinna E
authors: OE
authors: Onwujekwe
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000628:therapy*; D008297:Male; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D012923:Social Class; D011795:Surveys and Questionnaires
chemical_list: D000962:Antimalarials