Rural-urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria

• Published in: Malaria journal Vol. 19; no. 1; p. 294
• Main Authors: Babalola, Obafemi J, Ajumobi, Olufemi, Ajayi, IkeOluwapo O
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.08.2020; BioMed Central; BMC
• Subjects: Adolescent; Adult; Antimalarials - therapeutic use; Care and treatment; Child, Preschool; Children; Children & youth; Comparative analysis; Cross-Sectional Studies; Data collection; Demographic aspects; Diagnosis; Diagnostic Tests, Routine - statistics & numerical data; Disease transmission; Evaluation; Female; Fever; Fever - epidemiology; Fever - parasitology; Fever - psychology; Health behavior; Health care disparities; Health facilities; Health Knowledge, Attitudes, Practice; Health surveys; Households; Human diseases; Humans; Infant; Infant, Newborn; Knowledge; Malaria; Malaria - epidemiology; Malaria - parasitology; Malaria - prevention & control; Malaria - psychology; Male; Medical care utilization; Mothers; Mothers - statistics & numerical data; Nigeria - epidemiology; Patient Acceptance of Health Care - statistics & numerical data; Polls & surveys; Population; Prevalence; Profiles; Questionnaires; Rural areas; Rural health; Rural Population - statistics & numerical data; Sample size; Sampling techniques; Statistical analysis; Surveying; Testing; Treatment-seeking; Under-fives; Urban health; Urban Population - statistics & numerical data; Vector-borne diseases; Young Adult; Nigeria; Kaduna Nigeria; Treatment-seeking; Under-fives; Malaria; Nigeria; Knowledge; Mothers; Fever
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-020-03371-w

Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers' recognition is an entry point for fever treatment, including malaria. This study describes rural-urban disparity in fever prevalence in U5, mothers' malaria knowledge, care-seeking, testing for malaria before anti-malarial medication and the associated factors. A cross-sectional survey was conducted among 630 mother-child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before anti-malarial use, and delayed care-seeking defined as care sought for fever > 48 h of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥ 75th, 50th-74th, and < 50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05. The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI 1.8-4.2, p < 0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times more likely to receive anti-malarial medications without testing for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI 1.6-9.9, p < 0.000). Rural-urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than 'one-size-fits-all' approach.