title: Patient Knowledge on Malaria Symptoms Is a Key to Promoting Universal Access of Patients to Effective Malaria Treatment in Palawan, the Philippines.
abstract: BACKGROUND
  Palawan, where health care facilities are still limited, is one of the most malaria endemic provinces in the Philippines. Since 1999, microscopists (community health workers) have been trained in malaria diagnosis and feasibility of early diagnosis and treatments have been enhanced throughout the province. To accelerate the universal access of malaria patients to diagnostic testing in Palawan, positive health seeking behavior should be encouraged when malaria infection is suspected.
  
  
  METHODS
  In this cross-sectional study, structured interviews were carried out with residents (N = 218) of 20 remote malaria-endemic villages throughout Palawan with a history of suspected malaria from January to February in 2012. Structural equation modeling (SEM) was conducted to determine factors associated with appropriate treatment, which included: (1) socio-demographic characteristics; (2) proximity to a health facility; (3) health seeking behavior; (4) knowledge on malaria; (5) participation in community awareness-raising activities.
  
  
  RESULTS
  Three factors independently associated with appropriate treatment were identified by SEM (CMIN = 10.5, df = 11, CFI = 1.000, RMSEA = .000): "living near microscopist" (p < 0.001), "not living near private pharmacy" (p < 0.01), and "having severe symptoms" (p < 0.01). "Severe symptoms" were positively correlated with more "knowledge on malaria symptoms" (p < 0.001). This knowledge was significantly increased by attending "community awareness-raising activities by microscopists" (p < 0.001).
  
  
  CONCLUSIONS
  In the resource-limited settings, microscopists played a significant role in providing appropriate treatment to all participants with severe malaria symptoms. However, it was considered that knowledge on malaria symptoms made participants more aware of their symptoms, and further progressed self-triage. Strengthening this recognition sensitivity and making residents aware of nearby microscopists may be the keys to accelerating universal access to effective malaria treatment in Palawan.
authors.affiliation: Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Emilie Louise Akiko
authors.initials: EL
authors.lastname: Matsumoto-Takahashi
authors.affiliation: Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila, the Philippines.
authors.forename: Pilarita
authors.initials: P
authors.lastname: Tongol-Rivera
authors.affiliation: Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila, the Philippines.
authors.forename: Elena A
authors.initials: EA
authors.lastname: Villacorte
authors.affiliation: Kilusan Ligtas Malaria/Pilipinas Shell Foundation, Inc., SPS Government Center, Palawan City, the Philippines.
authors.forename: Ray U
authors.initials: RU
authors.lastname: Angluben
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
authors.affiliation: Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kano
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D008297:Male; D010679:Philippines / Q000453:epidemiology; D012959:Socioeconomic Factors