Gloria Oramasionwu just completed her MPH at the Johns Hopkins Bloomberg School of Public Health and did her Capstone Project by analyzing the 2003 Nigeria Demographic and Health Survey in greater depth concerning correct treatment of childhood malaria. Among 1603 children under five years of age who had a febrile illness in the two weeks prior to the survey (a proxy measure for malaria) 26.9% received the appropriate malaria drug (as of 2003) by the second day of onset.
An important finding, seen in the chart below was that correctness was related to source of care. Those who got care from a public sector health facility were the most likely (41.7%) to have received correct treatment. Unfortunately only 24.5% of children got their treatment from a public facility. In contrast 42.1% got treatment from drug vendors, but only 27.8% of this treatment was correct. This has important implications for planning national malaria treatment programs.
Two key concerns arise – training of providers in the non-public sectors to give correct treatment and the cost and availability of new first line ACT drugs. With training, we have found that among staff of orthodox health facilities, those in the public sector are more likely to be included in in-service training programs compared to their counterparts in private facilities. Additionally few programs exist to train drug vendors even though they provide the bulk of malaria medicines in some countries. These training gaps need to be closed in order to increase the likelihood that children will receive correct and timely malaria treatment.
The ACT issue poses different challenges. ACTs may cost up to 10 times that of the chloroquine or sulfadoxine-pyrimethamine that children were given in 2003. This may influence access to correct treatment unless ACTs are free or highly subsidized. Usually ACTs are free in the public sector because of programs like GFATM, PMI and the World Bank Booster Program. These programs may not cover 100% of need, and so cash strapped local health services may buy inappropriate but cheaper alternatives. Additionally, these donor programs have not so far extended into the private sector. There are exploratory efforts to make ACTs available at subsidized rates for the private sector, and those need to be expanded because it is the private sector that meets to bulk of need, for example, nearly 50% of parents get their antimalarial drugs from drug vendors and medicine shops in rural Nigeria.
In conclusion, a proper national malaria treatment plan or strategy requires coordination and planning among all sectors so that whenever a parent of a child with malaria seeks care he/she will be guaranteed to get correct treatment at whatever type of source or facility that is convenient and acceptable.