Project – Factors Influencing Treatment-Seeking Behaviour among Caregivers of Under-Five Children with Malaria: A Study of Selected Communities in Ijebu North LGA, Ogun State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria remains one of the most important communicable diseases affecting children in sub-Saharan Africa, with children under five years of age bearing a particularly high risk of severe illness and death. The disease is caused by Plasmodium parasites and transmitted mainly through the bites of infected female Anopheles mosquitoes. Young children are especially vulnerable because they have not developed sufficient immunity to malaria and can progress rapidly from uncomplicated illness to severe disease. The World Health Organization (WHO) reported that in 2024 children under five accounted for approximately 75% of malaria deaths in the WHO African Region, emphasizing the importance of early recognition, diagnosis and effective treatment of malaria in this age group (World Health Organization [WHO], 2025).

The effectiveness of malaria control among under-five children depends not only on the availability of effective antimalarial medicines but also on the actions of caregivers when a child develops fever or other suspected symptoms. Because young children depend almost entirely on adults for decisions concerning healthcare, caregivers play a central role in determining whether treatment is sought, where treatment is obtained, how quickly it is obtained and whether the recommended treatment is completed. WHO emphasizes early diagnosis and prompt, effective treatment as important components of malaria case management, particularly because Plasmodium falciparum malaria can progress rapidly to severe disease and death if treatment is delayed (WHO, 2026).

Treatment-seeking behaviour refers to the actions taken by individuals or caregivers when illness is recognized, including the decision to seek professional healthcare, the choice of healthcare provider, timing of care-seeking and the type of treatment obtained. In childhood malaria, this behaviour can involve taking the child to a government health facility, private hospital, pharmacy, patent and proprietary medicine vendor (PPMV), community health worker or traditional practitioner, or administering medicines or herbal preparations at home. Evidence from the 2021 Nigeria Malaria Indicator Survey showed that 37% of Nigerian children under five had fever during the two weeks preceding the survey, but treatment or advice was sought for only 63% of these children when traditional practitioners were excluded. Chemist shops/PPMVs, pharmacies, private facilities and government health facilities were among the major sources of treatment or advice (National Malaria Elimination Programme [NMEP] & National Population Commission [NPC], 2022).

Several factors can influence whether caregivers seek timely and appropriate treatment for children with suspected malaria. These factors include caregivers’ knowledge of malaria, recognition of symptoms, perceived severity of the illness, previous experience with malaria, educational attainment, household income, cost of treatment, distance to health facilities, transportation, availability of medicines, quality of healthcare services and cultural beliefs. A study in southeastern Nigeria found that only about 22% of respondents sought treatment for children with malaria within 24 hours, while watching the child for some days and financial difficulties were important reasons for delayed treatment. The study further found significant relationships between treatment delay and factors such as maternal education, socioeconomic status, marital status and other demographic characteristics (Uzochukwu et al., 2014).

Cultural beliefs and perceptions about malaria can also shape the pathway through which caregivers respond to childhood fever. In southwestern Nigeria, Falade et al. (2007) found that caregivers sometimes attributed malaria to causes other than mosquito infection and that perceptions of malaria severity influenced treatment choices. More than half of the children with malaria in that study were treated at home, while treatment choices were influenced by previous experience and advice from members of the community. Similarly, an earlier study conducted in a rural community in Ogun State found that a substantial proportion of mothers did not correctly identify the cause of malaria and that herbal concoction was the first treatment action for many respondents (Falade et al., 2007; Adebayo et al., 2005). These findings demonstrate that treatment-seeking behaviour is not determined solely by the availability of health facilities but is also embedded in caregivers’ beliefs, experiences and social environment.

Geographical accessibility and socioeconomic circumstances are particularly important in rural communities, where caregivers may experience difficulties reaching appropriate healthcare services. A Nigerian study comparing rural and urban treatment-seeking behaviour found significant differences between the two groups: while a majority of urban caregivers patronized private or government health facilities, many rural caregivers resorted to self-treatment with drugs obtained over the counter or from patent medicine vendors. Rural caregivers were also more likely to visit hospitals only when the child’s condition persisted or became worse, thereby increasing the possibility of delayed treatment (Onwujekwe et al., 2009). More recent WHO evidence similarly identifies financial barriers, transportation costs, distance to healthcare facilities, perceived disease severity and the quality of available services as important influences on care-seeking decisions for sick children (WHO, 2024).

The problem is particularly relevant to Ijebu North Local Government Area of Ogun State because empirical research has already demonstrated the importance of caregiver practices in malaria management within the area. A quasi-experimental study conducted among caregivers of under-five children in Ijebu North LGA found that health education could improve caregivers’ knowledge of malaria and recognition of signs and symptoms requiring referral. Before the intervention, many caregivers reported using artemisinin-based combination therapy as home treatment, while the intervention improved knowledge of referral signs and symptoms. The study demonstrates that caregiver knowledge and behaviour are modifiable and that community-level interventions can influence malaria-management practices (Oladimeji et al., 2012).

More recent evidence from southwestern Nigeria further strengthens the need for a localized assessment of caregiver treatment-seeking behaviour. A 2025 study reported that although 94% of caregivers had suspected malaria in their under-five children within the previous year, only 9.3% had visited a health facility for treatment, while others obtained medicines from patent medicine vendors or pharmacies or used herbs. The study found that caregiver sex, urban residence, proximity to a health facility and malaria knowledge were significant predictors of visiting a health facility. These findings demonstrate that treatment-seeking behaviour is influenced by a combination of individual, socioeconomic, geographical and health-system factors (Akinrinade et al., 2025).

Therefore, understanding the factors influencing treatment-seeking behaviour among caregivers of under-five children with malaria is essential for improving childhood malaria outcomes. Although studies have examined treatment-seeking behaviour in different parts of Nigeria, findings from one community cannot automatically be generalized to another because cultural practices, socioeconomic conditions, accessibility of healthcare facilities and patterns of healthcare utilization differ across communities. A study focusing on selected communities in Ijebu North LGA is consequently important for identifying the specific factors that encourage or discourage caregivers from seeking timely and appropriate malaria treatment for their under-five children. The findings may provide evidence for strengthening community health education, improving referral practices, reducing treatment delays and promoting appropriate utilization of primary healthcare services in the study area (WHO, 2025; NMEP & NPC, 2022).

1.2 Statement of the Problem

Malaria continues to constitute a major threat to child health in Nigeria, particularly among children below five years of age. Despite the availability of effective diagnostic and antimalarial treatment, children continue to experience malaria-related morbidity and mortality. The vulnerability of young children means that delays in recognizing symptoms and obtaining appropriate treatment can allow uncomplicated malaria to progress to severe disease. WHO identifies children under five as a major high-risk group and emphasizes prompt diagnosis and effective treatment as critical components of malaria case management (WHO, 2025, 2026).

A major concern is that caregivers do not always seek appropriate treatment promptly when their children develop fever or suspected malaria. National evidence indicates that although fever is common among Nigerian children, treatment or advice is not sought for all affected children. Among children under five with fever in the 2021 Nigeria Malaria Indicator Survey, treatment or advice was sought for 63%, while a substantial proportion did not receive such care. Furthermore, PPMVs, pharmacies and private-sector providers constituted important sources of treatment, demonstrating that caregivers frequently use alternatives to government health facilities (NMEP & NPC, 2022).

Another concern is the persistence of inappropriate or delayed treatment practices. Nigerian studies have shown that caregivers may initially observe a sick child at home, administer medicines without professional diagnosis, purchase drugs from patent medicine vendors or use traditional remedies before seeking care from a formal health facility. In southeastern Nigeria, financial difficulties and the decision to wait and observe the child were important causes of delayed treatment, while previous research in southwestern Nigeria found that cultural perceptions and beliefs about the causes and severity of malaria influenced treatment choices (Uzochukwu et al., 2014; Falade et al., 2007). Such practices can delay effective treatment and increase the risk of severe malaria and other complications.

The situation warrants specific investigation in selected communities in Ijebu North LGA, Ogun State. Although a previous intervention study in Ijebu North demonstrated that health education could improve caregivers’ knowledge of malaria and recognition of danger signs, there remains a need to examine the broader factors currently influencing caregivers’ decisions about where, when and how to seek treatment for under-five children with malaria. Recent evidence from southwestern Nigeria suggests that knowledge, distance from health facilities, residence and other socioeconomic characteristics can significantly influence health-facility utilization. However, such evidence cannot fully explain the specific realities of caregivers in selected Ijebu North communities. Therefore, this study seeks to identify the factors influencing treatment-seeking behaviour among caregivers of under-five children with malaria in selected communities in Ijebu North LGA, with the aim of generating evidence that can guide appropriate community-based malaria interventions (Oladimeji et al., 2012; Akinrinade et al., 2025).

1.3 Purpose of the Study

The main purpose of this study is to assess the factors influencing treatment-seeking behaviour among caregivers of under-five children with malaria in selected communities in Ijebu North Local Government Area, Ogun State.

Specifically, the study seeks to:

1. assess the treatment-seeking behaviour of caregivers of under-five children with malaria in selected communities in Ijebu North LGA;
2. determine the level of knowledge of malaria among caregivers of under-five children;
3. examine the influence of caregivers’ socioeconomic characteristics on their treatment-seeking behaviour;
4. determine the influence of cultural beliefs and perceptions about malaria on caregivers’ treatment-seeking behaviour

1.4 Research Questions

The following research questions will guide the study:

1. What is the treatment-seeking behaviour of caregivers of under-five children with malaria in selected communities in Ijebu North LGA?
2. What is the level of malaria-related knowledge among caregivers of under-five children in the selected communities?
3. To what extent do caregivers’ socioeconomic characteristics influence their treatment-seeking behaviour?
4. What influence do cultural beliefs and perceptions about malaria have on caregivers’ treatment-seeking behaviour?

1.5 Research Hypothesis

The following null hypothesis will be tested at 0.05 level of significance:

H₀: There is no significant relationship between caregivers’ knowledge of malaria and their treatment-seeking behaviour for under-five children with malaria in selected communities in Ijebu North LGA, Ogun State.

1.6 Significance of the Study

The study will be significant to caregivers of under-five children because it will provide information about the importance of early recognition of malaria symptoms and prompt utilization of appropriate healthcare services. The findings may help caregivers understand the dangers associated with delayed treatment, self-medication and inappropriate home management of malaria.

The study will be beneficial to healthcare workers, particularly community health officers, nurses, doctors and other primary healthcare personnel. Findings may enable healthcare workers to identify common misconceptions and barriers affecting caregivers and develop more targeted health education during community outreach, immunization sessions and child welfare clinics.

The study will also be useful to Ogun State Ministry of Health and local health authorities. The findings may provide evidence for designing malaria-control programmes that address the specific social, economic, cultural and geographical factors influencing healthcare utilization among caregivers in Ijebu North LGA.

The study may benefit community leaders and community-based organizations by identifying cultural practices and community-level barriers associated with delayed treatment. Such information may support community mobilization and health promotion activities aimed at encouraging caregivers to seek appropriate treatment promptly.

The study will further contribute to public health practice and research by providing empirical evidence on childhood malaria treatment-seeking behaviour within a specific local government area. It may serve as a reference for subsequent researchers investigating malaria, childhood illness, healthcare utilization and caregiver behaviour in Ogun State and other parts of Nigeria.

1.7 Scope of the Study

The study will focus on factors influencing treatment-seeking behaviour among caregivers of under-five children with malaria in selected communities in Ijebu North Local Government Area, Ogun State.

The study will examine treatment-seeking behaviour in terms of the timing of care-seeking, first source of treatment, use of health facilities, use of patent medicine vendors/pharmacies, home treatment and the use of traditional remedies.

The major factors to be examined will include caregivers’ knowledge of malaria, socioeconomic characteristics, cultural beliefs and perceptions, accessibility of healthcare facilities, distance to healthcare facilities, cost of treatment, availability of medicines and perceived quality of healthcare services.

The study population will comprise caregivers of children below five years of age who have experienced malaria or suspected malaria in the selected communities.

Geographically, the study will be restricted to selected communities within Ijebu North Local Government Area of Ogun State. The findings will therefore be interpreted within the context of the selected communities and should not automatically be generalized to all caregivers in Ogun State or Nigeria.

1.8 Operational Definition of Terms

Caregiver: An adult who is primarily responsible for the care and healthcare decisions of an under-five child. The caregiver may be the child’s parent, grandparent, guardian or another adult responsible for the child.

Child: For the purpose of this study, a child refers to a person below five years of age.

Malaria: A parasitic disease caused by Plasmodium species and transmitted primarily through the bite of infected female Anopheles mosquitoes.

Under-Five Child: A child who is below five completed years of age.

Treatment-Seeking Behaviour: The actions and decisions taken by a caregiver when an under-five child develops suspected or confirmed malaria, including when care is sought, where care is sought and the type of treatment obtained.

Prompt Treatment-Seeking: Seeking appropriate healthcare for a child with suspected malaria as soon as possible after recognition of symptoms, particularly within the period recommended for early malaria case management.

Delayed Treatment-Seeking: Failure to obtain appropriate healthcare promptly after the onset or recognition of malaria symptoms in an under-five child.

Healthcare Facility: A recognized health establishment, such as a primary health centre, hospital or clinic, where qualified healthcare services are provided.

Patent and Proprietary Medicine Vendor (PPMV): A licensed medicine retailer authorized to sell specified categories of medicines and provide permitted basic health-related services within Nigeria.

Self-Medication: The administration of medicines to an under-five child by a caregiver without appropriate consultation, diagnosis or prescription from a qualified healthcare professional.

Cultural Beliefs: Shared beliefs, perceptions, customs and traditional understandings within a community that may influence how caregivers interpret malaria and respond to childhood illness.

Malaria Knowledge: The caregiver’s understanding of malaria, including its causes, mode of transmission, symptoms, severity, prevention and appropriate treatment.

Treatment-Seeking Barrier: Any social, economic, cultural, geographical or health-system factor that prevents or discourages a caregiver from obtaining timely and appropriate treatment for an under-five child with malaria.

Project – Factors Influencing Treatment-Seeking Behaviour among Caregivers of Under-Five Children with Malaria: A Study of Selected Communities in Ijebu North LGA, Ogun State.