title: Mothers' perception of recovery and satisfaction with patent medicine dealers' treatment of childhood febrile conditions in rural communities.
abstract: Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine 'mothers' perception of recovery' and 'mothers' satisfaction' after PMD treatment of childhood febrile conditions, as likely drivers of mothers' health-seeking behaviour, which must be targeted to reverse the trend.
  
  
  
  Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15-45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21-47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05.
  
  
  
  Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs' treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers' satisfaction with PMDs' treatment is significantly (p < 0.05) associated with mothers' perception of recovery of their child (χ(2) = 192.94, df = 4; p < 0.0001; Cramer's V = 0.7079). However, predicting mothers' satisfaction with PMDs' treatment from a knowledge of mothers' perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers' perception of recovery based on knowledge of mothers' satisfaction with PMDs' treatment (lambda[A from B] = 0.4727).
  
  
  
  Mothers' satisfaction could be the key 'driver' of mothers' health-seeking behaviour and is less likely to be influenced by mothers' perception of recovery of their child. Therefore, mothers' negative perception of their child's recovery may not induce proportionate decline in mothers' health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers' satisfaction with the positive attributes of PMDs' personality/practice and sets an important agenda for PHC reforms.
authors.affiliation: Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Georgian Chiaka
authors.initials: GC
authors.lastname: Ibeneme
authors.affiliation: Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Ada Caroline
authors.initials: AC
authors.lastname: Nwaneri
authors.affiliation: Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria. sam.ibeneme@unn.edu.ng.|German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany. sam.ibeneme@unn.edu.ng.
authors.forename: Sam Chidi
authors.initials: SC
authors.lastname: Ibeneme
authors.affiliation: Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Nnewi, Anamabra State, Nigeria.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ezenduka
authors.affiliation: German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Strüver
authors.affiliation: German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany.
authors.forename: Gehard
authors.initials: G
authors.lastname: Fortwengel
authors.affiliation: Department of Radiation Medicine, Faculty of Medical sciences, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Ifeoma Joy
authors.initials: IJ
authors.lastname: Okoye
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009549:Nigeria; D004366:Nonprescription Drugs / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care; D010549:Personal Satisfaction; D010594:Pharmacies; D012424:Rural Population; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004366:Nonprescription Drugs
keywords: Childhood febrile conditions; Mothers’ perception of recovery; Mothers’ satisfaction; Patent medicine dealers; Rural community