Treatment Seeking Behavior and Associated Factors Among Malaria Suspected Patients in Bale Zone, Southeast Ethiopia: Institution-Based Cross-sectional Study

Research Article

J Fam Med. 2015;2(1): 5.

Treatment Seeking Behavior and Associated Factors Among Malaria Suspected Patients in Bale Zone, Southeast Ethiopia: Institution-Based Cross-sectional Study

Nagasa Dida1*, Birhanu Darega2 and Amene Abebe2

1Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia

2Department of Nursing, College of Medicine and Health Sciences, Madawalabu University, Ethiopia

*Corresponding author: Nagasa Dida, Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia

Received: December 16, 2014; Accepted: January 05, 2015; Published: January 06, 2015


Introduction: Seeking the treatment within twenty four hours from the first symptom and effective treatment are important for controlling the transmission of malaria. But there is no study done on treatment seeking behavior of malaria patients. Thus, this study aimed to assess treatment seeking behavior and associated factors among malaria suspected patients in Bale Zone, Southeast Ethiopia.

Materials and Methods: An institution-based cross-sectional study design was employed among three hundred eleven malaria suspected patients in malaria endemic public health institutions of Bale Zone, Southeast Ethiopia in March, 2014. Proportionally allocated sample size was collected consecutively until the required sample size fulfilled from eleven health institutions providing microscopic diagnostic test for malaria patients. The data were analyzed using SPSS. Descriptive statistics, binary and multiple logistic regressions were employed to identify those factors that determined treatment seeking behavior.

Result: From the total respondents (297) fully responded to the survey 87.8% (260) of them did not seek treatment within the recommended first 24 hours from onset of illness. 15.2% (45) of the patients sought treatment from non-medical center before coming to the health institution. Perceived susceptibility for malaria and having knowledge of mosquito nets as means of mosquito bite prevention were independently associated with treatment seeking behavior. Those respondents who had low perceived susceptibility of malaria diseases sought 0.24 times less likely when compared with those respondents who perceived malaria as a deadly disease (AOR= 0.24; CI 95%: 0.07-0.85)

Conclusion: Majority of the respondents did not seek treatment for the disease within the right time, which is from the first onset of symptoms. Perceived susceptibility for malaria disease was the best predictor for the respondents to sought treatment early. On the other hand delayed in seeking treatment behavior is alarming to health institution, district health office and health extension workers as this will enhance malaria transmission. Thus, malaria prevention and control program should focus these identified factors.

Keywords: Malaria; Treatment seeking behavior; Associated factors


Malaria is a preventable and treatable mosquito-borne disease, whose main victims are children under five years of age in Africa [1, 2]. The symptoms of malaria can be non-specific but fever is its cardinal symptom. The fever is often accompanied by headache, chills, rigors, myalgia, arthralgia, anorexia, nausea and vomiting. Malaria should be suspected in patients residing in endemic areas and presenting with above symptoms [3]. Malaria control requires an integrated approach, comprising prevention and treatment with effective anti malarial agents. The provision of prompt and effective treatment is the cornerstone of malaria case management and in reducing severe morbidity and mortality from the disease [4].

According to the latest World Health Organization (WHO) estimates, there were about 219 million cases of malaria in 2010 and an estimated 660 000 deaths. Africa is the most affected continent: about 90% of all malaria deaths occur there [2, 5].

Ethiopia is one of the most malaria epidemic-prone countries in Africa [6]. Despite the low malaria parasite prevalence compared to many African countries, malaria remains the leading communicable disease seen at health facilities in Ethiopia. About 75% of the geographic area of the country has significant malaria transmission risk (defined as areas <2,000 m), with about 68% (57.3 million) of the country’s total population living in these areas. Malaria is ranked as the leading communicable disease in Ethiopia, accounting for about 30% of the overall Disability Adjusted Life Years lost. According to the Ethiopia Federal Ministry of Health (FMOH), malaria was the leading cause of outpatient visits and health facility admissions in 2009/2010, accounting for 14% of reported outpatient visits and nearly 9% of admissions. Malaria was also among the ten leading causes of inpatient deaths among children less than five years of age [7].

Oromiya Regional State has about one-third of Ethiopia’s malaria burden, population and land area [7]. In the year 2011, from the total 441, 058 malaria suspected cases, 160,191of them were confirmed for all species of malaria resulting with 51 deaths [8].

Ensuring prompt and effective treatment will prevent most cases of uncomplicated malaria from progressing to severe and fatal illness. To avoid this progression, treatment must begin as soon as possible, generally within 24 hours after symptom onset. Communities should be aware of the importance of seeking early diagnosis and treatment and adhering to prescribed drug regimens for malaria [9].

Malaria is curable if effective treatment is started early. Delay in treatment may lead to serious consequences including death. Prompt and effective treatment is also important for controlling the transmission of malaria [3]. However, in Bale Zone there hasn’t been any study that addresses treatment seeking behavior of malaria patients that would play role in malaria prevention and control. Thus this study assessed treatment seeking behavior and its associated factors among malaria suspected patients in Bale Zone, Oromiya Regional State Southeast Ethiopia.

Materials and Methods

Study design and setting

An institutional-based cross-sectional study was conducted in malaria endemic area of public health institution in Bale Zone in May, 2014. Bale Zone is found in Oromiya Regional State at 430km away from Addis Ababa to the Southeast, Ethiopia. The total population of the zone is 1,708,910. 711523 (42%) of population live in malaria endemic area. It is the largest zone of Oromiya Regional State with surface area of 62,555 km2. The zone is composed of 14.92% highland, 21.53% midland and 63.55% lowland with an altitude of 300–4,377 km and annual rainfall of 900–1,400 mm. The zone has eighteen rural districts and three administrative towns. Fifteen of the districts and one administrative town of the Zone were malaria endemic area. These malarious districts had 28 health facilities providing blood film for malaria suspected patients [10].

Sampling and participation

All febrile patients sought treatment from health facility were the source population whereas suspected malaria patients who were sent for blood film to laboratory department during the study period were study population. Sample size included in the study was determined using single population proportion formula with the assumption of: level of confidence of the study 95%, margin of error 5% and proportion of malaria cases visiting laboratories within two days of onset of illness 25.5% [11]. Using last years’ malaria cases load identified in each health facility, the sample size was allocated proportionally for eleven health facilities that were selected randomly from the 28 facilities. The proportional samples allocated for each health facility were collected from all eligible patients consecutively until sample fulfilled during the study period.

Instruments and data collection methods

Structured questionnaire covering treatment seeking behavior and associated factors like socio-demographic variables, malaria related variables, perceived susceptibility for malaria, perceived severity of malaria and attitudes toward health institution services was adapted using health belief model as a guide by reviewing different literatures that were pertinent to the topic [2, 3, 11-14]. In addition to health belief model, for some variables other similar study variables were considered. There were seven questions each for perceived severity of malaria, perceived susceptibility of malaria and attitudes toward health facility that were assessed using Likert Scale Method. There were also eleven knowledge questions. The mean scores for both perception construct were computed and dichotomized into high and low. Respondent scores below the mean were labeled as having low perception of severity and susceptibility and those respondents who score mean and above categorized into high perceived severity and susceptibility of malaria disease. Similarly, respondents who score below and above the mean for attitude questions were classified into unfavorable and favorable attitude toward health facility respectively. Concerning the knowledge questions, those respondents who answered seven and above correctly were labeled as good knowledge and who answered incorrectly more than five questions were categorized into poor knowledge.

The questionnaire was translated to local language – Afan Oromo and retranslated to English language to check its consistency by language expertise. To check an internal consistency of the variables under perception, attitude and knowledge Cronbach’s alpha coefficients was used. A 0.7 was considered for its lower limit. The data collectors were trained on data collection process for two days. Data were collected through interviewer administered questionnaire. Pretest was conducted two weeks prior to the main study on 5% of the sample size among similar subject in two health facilities that were not selected for the actual study and amendments were made accordingly.

Operational definition

Treatment seeking behavior: recognition of signs and symptoms of malaria and self referral for treatment; Early treatment seeking behavior: early recognition of symptom(s) and self referral for malaria disease with in twenty four hours of the first symptom(s) (fever); Delayed treatment seeking behavior: seeking the treatment after twenty four hours of first symptom(s) recognition.

Data management and analysis

The data were entered into EpiData 3.1 after 10% double entry was made and exported to SPSS version 16.0 for analysis. Descriptive, binary and multiple logistic regressions were used to assess factors associated with delay or early treatment seeking behavior; a corresponding p-value of <0.05 was considered to be statistically significant.

Ethical consideration

Ethical issue was approved by Madawalabu University Ethical Review Committee. A supportive letter was obtained from the University Research Directorate to all health institutions. Explaining the purpose of the study, verbal consent was obtained from the participants whose age were fifteen and above respondents. For under fifteen years old patients ascent was sought from the parents for providing the information about them. In the case of patients whose age was 15-17 years old, permission was sought from their family and information for the survey was provided by the patients themselves. The respondents had the right to fill-up or refuse the questionnaire at all or partially. All the information given by the respondents has been used for research purposes only; and confidentiality was maintained by omitting the name of the respondents.



A total of two hundred ninety seven malaria suspected patients who participated in the study has a response rate of 95.5%. The median age of the respondents was 28 years with the standard deviation of ± 13.7. Majority of the respondents 87.2% (259) were Muslim religion followers followed by orthodox Christianity 29(9.8%). Regarding their educational status 132(44.4%) has attended primary school. The time elapsed to reach the health facility was >1 hour among 42.2% (116) of the respondents (Table 1).