Understanding Malaria Treatment Patronage from Informal Healthcare Providers in Nigerian Urban Settlements: Insights from community members and providers

Abstract

<title>Abstract</title> Informal Healthcare Providers (IHCPs), including Proprietary Patent Medicine Vendors (PPMVs), Drug Peddlers (DPs), Traditional Healers (THs), and Herbal Drug Sellers (HDSs) are often the first choice for malaria treatment, especially in urban slums. Unplanned urbanization significantly impacts malaria transmission by creating cities with inadequate safety nets and healthcare access, increasing reliance on IHCPs. While WHO recognizes IHCP’s crucial role and emphasizes integrating them into formal healthcare for improved malaria care, they lack requisite training in malaria management and operate outside official regulations, raising concerns about the quality of care. Understanding IHCPs' perceptions and practices is essential for their proper integration. This study explored the perceived malaria burden, IHCPs' competence in malaria treatment, and reasons for visiting IHCPs in various urban settlements from both community member and provider perspectives. This was a qualitative cross-sectional study in Ibadan and Kano metropolis. Eighteen (18) Focus Group Discussions (FGD) among 157 adult community members, and twelve (12) Key-Informant Interviews (KIIs) among PPMVs, DPs, THs, and HDSs were conducted in these cities. Participants were drawn purposively from settlements - designated as formal, informal and slum based on local definitions - in selected wards within the cities. Data were collected using pre-tested guides and analyzed thematically. Our study reveals that malaria remains a significant health problem in these Nigerian cities. Patronage of IHCPs is driven by affordable treatment, perceived mildness of illness and access to credit facilities while cultural belief was key to patronage of HDSs and THs, largely among informal and slum residents. Furthermore, while IHCPs had a strong perceived competence in managing malaria cases, inadequate diagnosis and treatment were common practices. Educating and equipping IHCPs with diagnostic tools, enhancing access to affordable healthcare, and raising public awareness are crucial for proper malaria management and promoting collaborations with formal health care providers.