Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District, Equatorial Guinea.
BACKGROUND
Malaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District.


METHODS
A cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively.


RESULTS
Differences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata.


CONCLUSIONS
The delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors.
Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
Maria
M
Romay-Barja
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
Inma
I
Jarrin
Centro de Referencia de Control de Endemias, Malabo, Equatorial Guinea.
Policarpo
P
Ncogo
Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea.
Gloria
G
Nseng
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
Maria Jose
MJ
Sagrado
Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain.
Maria A
MA
Santana-Morales
Pilar
P
Aparicio
Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
Pilar
P
Aparcio
Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain.
Basilio
B
Valladares
Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea.
Matilde
M
Riloha
Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
Agustin
A
Benito
D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D016703:Equatorial Guinea; D005260:Female; D006798:Housing; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
D000962:Antimalarials