Academic journal article Journal of Health Population and Nutrition

Is There a Role for Patent Medicine Vendors in Tuberculosis Control in Southern Nigeria?

Academic journal article Journal of Health Population and Nutrition

Is There a Role for Patent Medicine Vendors in Tuberculosis Control in Southern Nigeria?

Article excerpt

INTRODUCTION

There is a growing body of evidence demonstrating the increasing incidence of tuberculosis (TB) in Nigeria with well-developed directly-observed treatment short-course (DOTS) (1-3). Infected persons take a number of options, mainly private-sector operators, before identifying an appropriate DOTS clinic for treatment (4-5).

Persons with undiagnosed TB are reservoirs for high levels of its transmission. Jochem and Walley noted that the contagion parameter suggests that where TB is endemic, each infectious case will result in 20-28 secondary infections (6). Delay in the diagnosis and treatment contributes to worsening complications due to TB.

A recent study on healthcare-seeking behaviours of persons with TB in southern Nigeria revealed that chemists/patent medicine vendors (PMVs) and traditional healers respectively constituted the first port of call for 107 (48.4%) and 27 (12.2%) of the persons with TB in the states studied (2). The number relying on the traditional healers increases as they evaluate the effectiveness of the first options and seek alternative options. They begin to report to the DOTS clinics as the fourth or the last option. This practice is typical of the response pattern to health conditions in most Nigerian societies. For instance, several studies demonstrated that PMVs were the most common source of treatment for malaria in rural and urban communities in Nigeria (7-11).

Despite their prominence in healthcare provision, relatively little is known about PMVs and how they work. Although PMVs are known to belong to PMV associations, there are virtually no published studies on how PMV associations operate. The Pharmacy Law of Nigeria specifies that PMVs should sell only prepackaged patent medicines, which requires that the license be of at least 21 years and submits the names of two referees (12). Within their shops, PMVs have been observed to behave primarily as commercial salesmen, since around 75% simply sell what a customer requests for, and on other rare occasions, fills a prescription (9). In the remainder of the time, the PMV responds to customer requests for advice or a description of symptoms.

Given the massive and complex challenges of case-finding, prompt diagnosis, and providing appropriate and quality treatment for persons with TB in the Nigerian context, it is important to better understand how the informal sector (PMVs) involved in the treatment of TB actually works and identify the pathways of involving them in ensuring prompt diagnosis and appropriate treatment of TB cases.

MATERIALS AND METHODS

Study setting

The area is made up of people with very diverse cultural systems, beliefs, and healthcare-seeking practices that are associated with the people's myths about existence and differences in the levels of western education, urbanization, and access to modern health facilities and cultures.

With the promotion of the primary healthcare (PHC) system in Nigeria, communities in each state are linked to a PHC unit that provides services, including disease control and eradication. In these units, there are DOTS services for persons with TB. Along with these formal healthcare-provisioning facilities are a plethora of PMVs and traditional healing homes. The PMVs constitute the primary focus of this study.

Study area and population

The study focused on the 14 states in the German Leprosy and TB Relief Association-assisted DOTS programme in southern Nigeria. The states are Ekiti, Ondo, and Ogun states in Southwestern zone; Akwa Ibom, Bayelsa, Cross River, Delta, Edo, and Rivers states in South-south zone; and Abia, Anambra, Ebonyi, Enugu, and Imo in Southeast. The 2006 census put that the combined population of these states is over 64,978,686 million. The cross-sectional approach was adopted in collecting quantitative and qualitative data from community members and PMVs in six states in the three geopolitical zones of southern Nigeria. …

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