Skip to main content
Top
Published in: Malaria Journal 1/2008

Open Access 01-12-2008 | Research

Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria

Authors: Obinna Onwujekwe, Benjamin Uzochukwu, Soludo Eze, Eric Obikeze, Chijioke Okoli, Ogbonnia Ochonma

Published in: Malaria Journal | Issue 1/2008

Login to get access

Abstract

Background

Equitable improvement of treatment-seeking for malaria will depend partly on how different socio-economic groups perceive the ease of accessing and utilizing malaria treatment services from different healthcare providers. Hence, it was important to investigate the link between socioeconomic status (SES) with differences in perceptions of ease of accessing and receiving treatment as well as with actual health seeking for treatment of malaria from different providers.

Methods

Structured questionnaires were used to collect data from 1,351 health providers in four malaria-endemic communities in Enugu state, southeast Nigeria. Data was collected on the peoples' perceptions of ease of accessibility and utilization of different providers of malaria treatment using a pre-tested questionnaire. A SES index was used to examine inequities in perceptions and health seeking.

Results

Patent medicine dealers (vendors) were the most perceived easily accessible providers, followed by private hospitals/clinics in two communities with full complement of healthcare providers: public hospital in the community with such a health provider and traditional healers in a community that is devoid of public healthcare facilities. There were inequities in perception of accessibility and use of different providers. There were also inequity in treatment-seeking for malaria and the poor spend proportionally more to treat the disease.

Conclusion

Inequities exist in how different SES groups perceive the levels of ease of accessibility and utilization of different providers for malaria treatment. The differentials in perceptions of ease of access and use as well as health seeking for different malaria treatment providers among SES groups could be decreased by reducing barriers such as the cost of treatment by making health services accessible, available and at reduced cost for all groups.
Literature
1.
go back to reference Uzochukwu B, Onwujekwe O, Erikson B: Inequity in Bamako initiative: Implications for malaria control in southeast Nigeria. Int J Health Plan Manag. 2004, 19 (Suppl 1): S107-16. 10.1002/hpm.779.CrossRef Uzochukwu B, Onwujekwe O, Erikson B: Inequity in Bamako initiative: Implications for malaria control in southeast Nigeria. Int J Health Plan Manag. 2004, 19 (Suppl 1): S107-16. 10.1002/hpm.779.CrossRef
2.
go back to reference Worrall E, Basu S, Hanson K: Paper prepared for meeting on "Ensuring the malaria control interventions reach the poor". 2002, London: London School of Hygiene and Tropical Medicine Worrall E, Basu S, Hanson K: Paper prepared for meeting on "Ensuring the malaria control interventions reach the poor". 2002, London: London School of Hygiene and Tropical Medicine
3.
go back to reference Onwujekwe O, Dike N, Uzochukwu B: Issues in measuring and improving the treatment of malaria in sub-Saharan Africa. Trop Doct. 2005, 35: 224-5. 10.1258/004947505774938792.CrossRef Onwujekwe O, Dike N, Uzochukwu B: Issues in measuring and improving the treatment of malaria in sub-Saharan Africa. Trop Doct. 2005, 35: 224-5. 10.1258/004947505774938792.CrossRef
4.
go back to reference Hanson K, Goodman C, Lines J, Meek S, Bradley D, Mills A: The economics of malaria control interventions. 2004, Geneva: Global Forum for Health Research Hanson K, Goodman C, Lines J, Meek S, Bradley D, Mills A: The economics of malaria control interventions. 2004, Geneva: Global Forum for Health Research
5.
go back to reference Schellenberg AJ, Victora CG, Mushi A: Inequities among the very poor: healthcare for children in rural Tanzania. Lancet. 2003, 361: 561-566. 10.1016/S0140-6736(03)12515-9.CrossRef Schellenberg AJ, Victora CG, Mushi A: Inequities among the very poor: healthcare for children in rural Tanzania. Lancet. 2003, 361: 561-566. 10.1016/S0140-6736(03)12515-9.CrossRef
6.
go back to reference Gwatkin DR, Rustein S, Johnson K, Pande RP, Wagstaff A: Socio-economic difference in health, nutrition, and population:Madagascar. 2000, Washington DC: World Bank HNP/Poverty Thematic Group Gwatkin DR, Rustein S, Johnson K, Pande RP, Wagstaff A: Socio-economic difference in health, nutrition, and population:Madagascar. 2000, Washington DC: World Bank HNP/Poverty Thematic Group
7.
go back to reference Valdivia M: Public health infrastructure and equity in the utilization of outpatient healthcare services in Peru. Health Policy Plan. 2002, 17 (Suppl): 12-9. 10.1093/heapol/17.suppl_1.12.CrossRefPubMed Valdivia M: Public health infrastructure and equity in the utilization of outpatient healthcare services in Peru. Health Policy Plan. 2002, 17 (Suppl): 12-9. 10.1093/heapol/17.suppl_1.12.CrossRefPubMed
8.
go back to reference Biritwum RB, Welbeck J, Barnish G: Incidence and management of malaria in two communities of different socioeconomic level in Accra, Ghana. Ann Trop Med Parasitol. 2000, 94: 771-778. 10.1080/00034980020013037.CrossRefPubMed Biritwum RB, Welbeck J, Barnish G: Incidence and management of malaria in two communities of different socioeconomic level in Accra, Ghana. Ann Trop Med Parasitol. 2000, 94: 771-778. 10.1080/00034980020013037.CrossRefPubMed
9.
go back to reference Bondi FS: Childhood coma in Ibadan: Relationship to socioeconomic factors. Trop Geogr Med. 1991, 43: 288-292. Bondi FS: Childhood coma in Ibadan: Relationship to socioeconomic factors. Trop Geogr Med. 1991, 43: 288-292.
10.
go back to reference Ityavyar D: Health Inequalities in Nigeria. 1998, Lagos:Pergamon Press Plc Ityavyar D: Health Inequalities in Nigeria. 1998, Lagos:Pergamon Press Plc
11.
go back to reference Egunjiobi I: Factors influencing the utilization of hospitals: a case study of northern part of Oyo State of Nigeria. Soc Sci Med. 1983, 17: 209-225. Egunjiobi I: Factors influencing the utilization of hospitals: a case study of northern part of Oyo State of Nigeria. Soc Sci Med. 1983, 17: 209-225.
12.
go back to reference Ryan GW: What do sequential behaviour patterns suggest about the medical decision-making process? Modelling home case management of acute illness in a rural Cameroonian village. Soc Sci Med. 1998, 46: 209-225. 10.1016/S0277-9536(97)00151-2.CrossRefPubMed Ryan GW: What do sequential behaviour patterns suggest about the medical decision-making process? Modelling home case management of acute illness in a rural Cameroonian village. Soc Sci Med. 1998, 46: 209-225. 10.1016/S0277-9536(97)00151-2.CrossRefPubMed
13.
go back to reference Sambo MN, Ejembi CL, Adamu YM, Aliyu AA: Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria. J Comm Med Primary Health Care. 2004, 16: 29-32. Sambo MN, Ejembi CL, Adamu YM, Aliyu AA: Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria. J Comm Med Primary Health Care. 2004, 16: 29-32.
14.
go back to reference Onwujekwe O, Uzochukwu B: Socio-economic and geographic differentials in costs and payment strategies for primary health care services in Southeast Nigeria. Health Policy. 2005, 71: 383-397. 10.1016/j.healthpol.2004.06.006.CrossRefPubMed Onwujekwe O, Uzochukwu B: Socio-economic and geographic differentials in costs and payment strategies for primary health care services in Southeast Nigeria. Health Policy. 2005, 71: 383-397. 10.1016/j.healthpol.2004.06.006.CrossRefPubMed
15.
go back to reference de Bartolome CA, Vosti SA: Choosing between public and private health-care: a case of study of malaria treatment in Brazil. J Health Econs. 1995, 14: 191-205. 10.1016/0167-6296(94)00045-6.CrossRef de Bartolome CA, Vosti SA: Choosing between public and private health-care: a case of study of malaria treatment in Brazil. J Health Econs. 1995, 14: 191-205. 10.1016/0167-6296(94)00045-6.CrossRef
16.
go back to reference Mills A: Health policy reforms and their impact on the practice of tropical medicine. Br Med Bull. 1998, 54: 503-513.CrossRefPubMed Mills A: Health policy reforms and their impact on the practice of tropical medicine. Br Med Bull. 1998, 54: 503-513.CrossRefPubMed
17.
go back to reference Ke X, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ: Household catastrophic health expenditure: a multi-country analysis. Lancet. 2003, 362: 111-117. 10.1016/S0140-6736(03)13861-5.CrossRef Ke X, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ: Household catastrophic health expenditure: a multi-country analysis. Lancet. 2003, 362: 111-117. 10.1016/S0140-6736(03)13861-5.CrossRef
18.
go back to reference Malaria and Vectors Control Unit (MVCU): Prevalence of malaria morbidity and mortality in Enugu state: 2000–2005. 2005, Enugu: Malaria and Vectors Control Unit, Ministry of Health Enugu, Nigeria Malaria and Vectors Control Unit (MVCU): Prevalence of malaria morbidity and mortality in Enugu state: 2000–2005. 2005, Enugu: Malaria and Vectors Control Unit, Ministry of Health Enugu, Nigeria
19.
go back to reference Filmer D, Pritchett LH: Estimating wealth effects without expenditure data- or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed Filmer D, Pritchett LH: Estimating wealth effects without expenditure data- or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed
20.
go back to reference Wagstaff A, Van Doorslaer E, Paci P: Equity in the finance and delivery of health care: some tentative cross-country comparisons. Oxford Rev Econs. 1989, 5: 89-112. 10.1093/oxrep/5.1.89.CrossRef Wagstaff A, Van Doorslaer E, Paci P: Equity in the finance and delivery of health care: some tentative cross-country comparisons. Oxford Rev Econs. 1989, 5: 89-112. 10.1093/oxrep/5.1.89.CrossRef
21.
go back to reference Wagstaff A, Van Doorslaer E, Paci P: On the measurement of inequalities in health. Soc Sci Med. 1991, 33: 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed Wagstaff A, Van Doorslaer E, Paci P: On the measurement of inequalities in health. Soc Sci Med. 1991, 33: 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed
22.
go back to reference Onwujekwe O, Dike N, Ojukwu J, Uzochukwu B, Ezumah N, Shu E, Okonkwo P: Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria. Malar J. 2006, 5: 117-10.1186/1475-2875-5-117.PubMedCentralCrossRefPubMed Onwujekwe O, Dike N, Ojukwu J, Uzochukwu B, Ezumah N, Shu E, Okonkwo P: Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria. Malar J. 2006, 5: 117-10.1186/1475-2875-5-117.PubMedCentralCrossRefPubMed
23.
go back to reference Kamat VR, Nichter M: Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med. 1998, 47: 779-794. 10.1016/S0277-9536(98)00134-8.CrossRefPubMed Kamat VR, Nichter M: Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med. 1998, 47: 779-794. 10.1016/S0277-9536(98)00134-8.CrossRefPubMed
Metadata
Title
Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria
Authors
Obinna Onwujekwe
Benjamin Uzochukwu
Soludo Eze
Eric Obikeze
Chijioke Okoli
Ogbonnia Ochonma
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2008
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/1475-2875-7-5

Other articles of this Issue 1/2008

Malaria Journal 1/2008 Go to the issue