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User fee exemption and malaria treatment-seeking for children under five in a Cameroonian health district: a
Rolf Nyah Tuku Nzalie1, John Ngunde Palle2, Dickson Shey Nsagha3
1Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon. nzalierolf@yahoo.com.
Insights
Despite user fee exemptions, guardian income and education significantly impact malaria treatment-seeking time for children under five in Cameroon. Addressing these socioeconomic factors is crucial for improving healthcare access and timely malaria interventions.
Area of Science:
- Public Health
- Pediatrics
- Health Economics
Background:
- Malaria significantly impacts child morbidity and mortality in Cameroon.
- User fee exemptions for malaria treatment were implemented to improve healthcare access.
- Despite exemptions, many children present with severe malaria late, indicating delayed treatment-seeking.
Purpose of the Study:
- To identify factors influencing guardians' treatment-seeking time for children under five with malaria.
- To understand delays in seeking hospital care within the context of user fee exemptions.
Main Methods:
- Cross-sectional study in three randomly selected health facilities in Buea Health District.
- Data collected via pre-tested questionnaire on guardian treatment-seeking behavior and time.
- Multivariate regression analysis used to identify predictors of delayed treatment (seeking care >24 hours after symptom onset).
Main Results:
- Nearly half (49.5%) of guardians delayed seeking hospital treatment.
- Common reasons for delay included financial constraints and watchful waiting at home.
- Low/middle household income (AOR 3.794) and guardian occupation were significant predictors of delay, while tertiary education was associated with less delay (AOR 0.315).
Conclusions:
- Socioeconomic factors, including guardian education and income, significantly influence malaria treatment-seeking delays in children under five, even with user fee exemptions.
- Policies aimed at improving access to health facilities must consider these socioeconomic determinants.
- Further interventions should address financial barriers and promote timely care-seeking behavior among guardians.
Background:
In Cameroon, malaria contributes significantly to the morbidity and mortality of children under 5 years old. In order to encourage adequate treatment-seeking in health facilities, user fee exemptions for malaria treatment have been instituted. However, many children are still brought to health facilities in the late stage of severe malaria. This study sought to determine the factors affecting the hospital treatment-seeking time of guardians of children under 5 years within the context of this user fee exemption.
Methods:
This was a cross-sectional study conducted at three randomly selected health facilities of the Buea Health District. A pre-tested questionnaire was used to collect data on the treatment-seeking behaviour and time of guardians, as well as potential predictors of this time. Hospital treatment sought after 24 h of noticing symptoms was denoted as delayed. Continuous variables were described using medians while categorical variables were described using percentages. A multivariate regression analysis was used to determine the factors affecting malaria treatment-seeking time of guardians. All statistical tests were done at a 95% confidence interval.
Results:
Most of the guardians made use of pre-hospital treatments, with self-medication being practiced by 39.7% (95% CI 35.1-44.3%) of them. A total of 193 (49.5%) guardians delayed seeking treatment at health facilities. Reasons for delay included financial constraints and watchful waiting at home, during which guardians waited and hoped their child could get better without requiring medicines. Guardians with estimated monthly household incomes denoted as low/middle were significantly more likely (AOR 3.794; 95% CI 2.125-6.774) to delay seeking hospital treatment. The occupation of guardians was another significant determinant of treatment-seeking time (AOR 0.042; 95% CI 0.003-0.607). Also, guardians with tertiary education were less likely (AOR 0.315; 95% CI 0.107-0.927) to delay seeking hospital treatment.
Conclusions:
This study suggests that despite user fee exemption, other factors such as educational and income levels of guardians affect malaria treatment-seeking time for children aged under five. Therefore, these factors should be considered when enacting policies aimed at increasing access of children to health facilities.
