Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.
Trop Med Int Health. 2011 Sep;16(9):1087-98. doi: 10.1111/j.1365-3156.2011.02821.x. Epub 2011 Jun 27.
To determine the differences in the quality of treatment for presumptive malaria received by different socio-economic status (SES) groups in Nigeria.
The study was conducted in southeast Nigeria. A household survey was used to collect data on patterns of use of different providers for treatment of adult and childhood malaria. The quality of services provided by different provider types was assessed using treatment vignettes. Quality scores for the different providers were computed based on their responses to the different points raised in the vignettes. Patterns of household treatment seeking for fever were disaggregated by SES, and then weighted by quality score to indicate the overall quality-weighted utilization by SES and the average quality of a visit by a member of each SES group. Equity ratios (poorest/least poor) provided the measure of inequity in quality-weighted utilization of different providers.
In treatment of adult malaria, higher SES groups used more of public and private hospitals, while lower SES groups used more of traditional healers. In case of children, higher SES used more of healthcare centres and private hospitals and lower SES groups used more of pharmacy shops. The lowest quality of services was measured among laboratories, patent medicine dealers (PMDs), mixed goods shops and pharmacies, all of which are private. The highest scores were observed among the two types of public providers (public hospital and healthcare centres). The quality of treatment services utilised by consumers decreased as SES decreased. However, when the quantity normalized index was used this SES disparity almost disappeared. The resulting equity ratio was 0.96 for adults and 0.94 for children.
Everybody used poor quality malaria treatment services but the poor people used providers with poor quality malaria treatment services more than others. The major driver of disparities in use of different providers by different SES was the greater number of visits of the higher SES groups, rather than the higher quality of the providers they used. Interventions should be developed to improve quality of treatment seeking behaviour and provision practices.
确定在尼日利亚，不同社会经济地位（SES）群体接受疑似疟疾治疗的质量差异。
本研究在尼日利亚东南部进行。采用家庭调查收集数据，了解不同提供者治疗成人和儿童疟疾的模式。使用治疗情节评估不同提供者提供的服务质量。根据不同提供者对情节中提出的不同要点的回答，计算不同提供者的质量得分。根据 SES 进行家庭发热治疗寻求模式的细分，然后根据质量得分加权，以表示 SES 的整体质量加权利用率以及每个 SES 组的成员每次就诊的平均质量。公平比率（最贫困/最不贫困）提供了衡量不同提供者的质量加权利用不公平的指标。
在治疗成人疟疾方面，SES 较高的群体更多地使用了公立医院和私立医院，而 SES 较低的群体更多地使用了传统治疗师。对于儿童，SES 较高的群体更多地使用了医疗中心和私立医院，而 SES 较低的群体更多地使用了药店。实验室、专利药品经销商（PMD）、混合商品店和药店的服务质量最低，这些都是私人的。公立医院和医疗中心的两种公共提供者得分最高。消费者利用的治疗服务质量随着 SES 的降低而降低。然而，当使用数量归一化指数时，这种 SES 差异几乎消失。结果显示，成人的公平比率为 0.96，儿童为 0.94。
每个人都使用了质量较差的疟疾治疗服务，但穷人比其他人更频繁地使用质量较差的疟疾治疗提供者。不同 SES 群体使用不同提供者的差异主要是由于较高 SES 群体的就诊次数较多，而不是他们使用的提供者的质量较高。应制定干预措施，以改善寻求治疗和提供服务的质量。
