Care-seeking behaviour of caregivers for suspected malaria in under-five children in a Southwestern State of Nigeria.

BACKGROUND: Effective malaria control in under-five children depends on caregivers seeking timely medical care. However, despite available healthcare services, many caregivers do not utilize health facilities, undermining malaria control efforts. This study assessed care-seeking behaviour of caregivers for suspected malaria in under-five children and associated factors in a southwest state of Nigeria. METHODS: A cross-sectional analytical study was conducted in Ondo State, Southwestern Nigeria. The study areas were Ifedore, Ondo East, and Idanre Local Government Areas (LGAs) randomly selected from the eighteen LGAs in Ondo state. A multistage sampling technique was used to select participants and data was collected using a structured questionnaire. Descriptive and inferential statistics were applied to analyse the data, with logistic regression identifying significant predictors of care-seeking behaviour of caregivers of under-five children at p-value < 0.05. RESULTS: The study included 301 caregivers of under-five children, predominantly aged 26-45 years (69.4%), males were 50.8% compared to females (49.2%) and 66.1% residing in rural areas. While 84.4% of caregivers identified infected mosquito bites as the cause of malaria, and 98.3% recognized fever as a main symptom, only 51.2% demonstrated good overall knowledge of malaria and symptoms in under-five children. Although 94.0% of caregivers suspected malaria in their under-five children within 12 months prior to the study, however, only 9.3% visited a health facility for treatment of their under-five children. In contrast, 37.4% purchased drugs from patent medicine vendors and pharmacies, while 25.2% used herbs for home management. Bivariate analysis showed significant associations between health facility visits and being a female caregiver (p = 0.009), urban residence (p = 0.002), residing within 5 km of a facility (p = 0.021), and good malaria knowledge (p = 0.033). Multivariate logistic regression indicated that female caregivers (aOR = 3.32, 95% CI 1.29-8.54), urban residents (aOR = 4.25, 95% CI 1.72-10.48), residing within 5 km of a health facility (aOR = 3.38, 95% CI 1.03-11.07), and those with good malaria knowledge (aOR = 4.16, 95% CI 1.61-10.77) were significant predictors of visiting a health facility for malaria care for under-five children with suspected malaria by caregivers. CONCLUSION: The study revealed low utilization of health facilities by caregivers seeking malaria treatment for under-five children with suspected malaria. Therefore, targeted community awareness campaigns are recommended to encourage caregivers to seek prompt, facility-based malaria care for under five children. Furthermore, in hard-to-reach or underserved rural areas with limited access to healthcare services, training and sensitization programmes for caregivers on appropriate home-based management of malaria including the use of pre-packaged artemisinin-based combination therapies are recommended.