Barriers to prompt and effective treatment of malaria in northern Sri Lanka
Article first published online: 10 SEP 2002
Tropical Medicine & International Health
Volume 7, Issue 9, pages 744–749, September 2002
How to Cite
Reilley, B. , Abeyasinghe, R. and Pakianathar, M. V. (2002), Barriers to prompt and effective treatment of malaria in northern Sri Lanka. Tropical Medicine & International Health, 7: 744–749. doi: 10.1046/j.1365-3156.2002.00919.x
- Issue published online: 10 SEP 2002
- Article first published online: 10 SEP 2002
- treatment-seeking behaviour;
- treatment access;
BACKGROUND For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment.
METHODS Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups.
RESULTS A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23–10.24, P=0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods.
CONCLUSIONS A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.