Factors Affecting the Uptake of Anti-Malarial Drugs by Children in Public Primary Health Facilities in Cross River State, Nigeria

Background: Despite the supply of artemisinin-based combination therapy (ACT) drugs to public health facilities in Nigeria, the uptake of these drugs appear to have remained suboptimal with low improvement in childhood morbidity and mortality. Aim: To use a controlled study to estimate the factors affecting the uptake of ACT in public health facilities in Cross River State (CRS), Nigeria. Methods: The design of this study was cross sectional analytical. The study was carried out in two sites, Akpabuyo (experimental) and Obudu (control) Local Government Areas (LGA) in the south and northern parts of CRS, Nigeria, respectively. Multidisciplinary research team consists of health professionals, biomedical and social scientists who worked with staff of the target facilities. Validated semi-structured questionnaires were administered by trained interviewers on respondents of consecutive households selected by multi-stage sampling procedure. Results: A total of 1250 households (588 in Akpabuyo and 662 in Obudu LGAs) were assessed. More informants in Obudu had formal education than in Akpabuyo (p<0.0001). Mortality of U5 children was higher in Akpabuyo. Stepwise regression analysis showed that farmers (p = 0.009) and people without formal education (p = <0.0001) were less likely than older age group (p = <0.0001) to access anti-malaria drugs in Akpabuyo. Religious beliefs (p=0.003) also predicted uptake of ACTs in Obudu. Conclusion: Informants’ occupation, age, education and religious beliefs were key determinants of uptake of ACTs in public health facilities in Nigeria. We recommend targeted malaria education programmes to explore the belief systems in treating fevers in children in this population.