Between traditional remedies and pharmaceutical drugs: prevention and treatment of "Palu" in households in Benin, West Africa.

BACKGROUND: In Benin, malaria clinical cases, including the larger popular entity called "Palu" are evoked when people get fever. "Palu" is often self-diagnosed and self-medicated at home. This study aimed to describe the use of herbal medicine, and/or pharmaceutical medicines for prevention and treatment of malaria at home and the factors associated with this usage. METHODS: A cross-sectional survey was conducted in Benin in an urban and in a rural area in 2016. Around 600 households in each place were selected by using a random sampling of houses GPS coordinates of the families. The association between socio demographic characteristics and the use of herbal medicine was tested by using logistic regression models. RESULTS: In Cotonou (urban), 43.64% of households reported using herbal or pharmaceutical medicine to prevent "Palu", while they were 53.1% in Lobogo (rural). To treat "Palu" in Cotonou, 5.34% of households reported using herbal medicine exclusively, 33.70% pharmaceutical medicine exclusively and 60.96% reported using both. In Lobogo, 4% reported using herbal medicine exclusively, 6.78% pharmaceutical medicine exclusively and 89.22% reported using both. In Cotonou, the factors "age of respondent", "participation to a traditional form of savings" and "low socioeconomic level of the household" were associated with the use of herbal medicine. CONCLUSIONS: This study shows the strong use of herbal medicine to prevent "Palu" or even treat it, and in this case it is mostly associated with the use of pharmaceutical medicine. It also highlights the fact that malaria control and care seeking behaviour with herbal medicine remain closely linked to household low-income status but also to cultural behaviour. The interest of this study is mostly educational, with regards to community practices concerning "Palu", and to the design of adapted behaviour change communication strategies. Finally, there is a need to take into account the traditional habits of populations in malaria control and define a rational and risk-free use of herbal medicine as WHO-recommended.

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin.

BACKGROUND: Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied. METHODS: A cross-sectional study was carried out among 340 children's caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD. RESULTS: Beyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169-0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest quintile. The caregivers age group 30-39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD. CONCLUSION: This study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.