Determinants of provider choice for malaria treatment: experiences from The Gambia.

Malaria is responsible for an estimated one million deaths per year, the vast majority in sub-Saharan Africa. Many of these deaths are attributed to delays in seeking treatment and poor adherence to drug regimes. While there are a growing number of studies describing the factors influencing treatment seeking for malaria, far less is known about the relative weight given to these factors in different settings. This study estimates two models of demand for malaria treatment in the Farafenni region of The Gambia. The first examines the determinants of seeking malaria treatment outside the home versus no treatment or self-care while the second identifies the determinants of provider choice conditional on having decided to seek malaria treatment outside the home. Providers included hospital; health centre; and 'other' which included pharmacies, kiosks; petty traders; neighbours; and traditional healers. Results show that older people were more likely to opt for self-care, or no treatment. The longer the time spent ill or the more severe the fever, the more likely a treatment was sought outside the home. Time of the year and availability of community infrastructure played a key role in both models. Poorer households and those from the Fula ethnic group were much more likely to visit an 'other' provider than a hospital. The policy and methodological implications of these findings are discussed.