Differences in malaria care seeking and dispensing outcomes for adults and children attending drug vendors in Nasarawa, Nigeria

OBJECTIVES: To characterise the differences in care seeking behaviour and dispensing outcomes between adults and children purchasing drugs for malaria at retail shops in Nigeria. METHODS: In Nasarawa State, retail drug shops were enumerated and a subset of those stocking antimalarials were selected as study sites and surveyed. Customers exiting shops after purchasing antimalarial drugs were surveyed and tested with a malaria rapid diagnostic test. Sick adults and caregivers accompanying sick children were eligible, but individuals purchasing drugs for a sick person that was not present were excluded. Multivariate regression analysis was used to identify the correlates of care seeking and the quality of interaction at the shop. RESULTS: Of 737 participants, 80% were adults and 20% were children (under age 18). Caregivers of sick children were more likely to obtain a prescription prior to attending a drug retailer than adults seeking care for themselves and waited a shorter time before seeking care. Caregivers of sick children were also more likely than sick adults to have been asked about symptoms by the retailer, to have been given an examination, and to have purchased an ACT. Fewer than half of respondents had purchased an ACT. Only 14% of adults, but 27% of children were RDT-positive; RDT-positive children were more likely to have had an ACT purchased for them than RDT-positive adults. CONCLUSIONS: Children with suspected malaria tend to receive better care at drug retailers than adults. The degree of overtreatment and prevalence of dispensing non-recommended antimalarials emphasise the need for routine diagnosis before treatment to properly treat both malaria and non-malaria illnesses.