title: Care-seeking at patent and proprietary medicine vendors in Nigeria.
abstract: BACKGROUND
  To achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms.
  
  
  METHODS
  In Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop.
  
  
  RESULTS
  Most customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs.
  
  
  CONCLUSIONS
  Because care-seeking behaviors vary by symptoms and the sick person's age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving primary care need to target the places where most people access care, and equip PPMV workers with knowledge and tools to provide basic services.
authors.affiliation: Global Health Sciences, University of California, San Francisco, 550 16th Street, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94158, USA. Lisa.Prach@ucsf.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Prach
authors.affiliation: Global Health Sciences, University of California, San Francisco, 550 16th Street, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94158, USA. Emily.Treleaven@ucsf.edu.|Department of Social and Behavioral Sciences, University of California, 3333 California St., Suite 455, San Francisco, CA, 94143, USA. Emily.Treleaven@ucsf.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Treleaven
authors.affiliation: Society for Family Health, No 8 Port Harcourt Cresent, Area 11 Garki, Abuja, Nigeria. cIsiguzo@sfhnigeria.org.
authors.forename: Chinwoke
authors.initials: C
authors.lastname: Isiguzo
authors.affiliation: Global Health Sciences, University of California, San Francisco, 550 16th Street, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94158, USA. Jenny.Liu2@ucsf.edu.
authors.forename: Jenny
authors.initials: J
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003132:Commerce / Q000706:statistics & numerical data*; D005260:Female; D006269:Health Facilities, Proprietary / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations