Dying along the Ladder of Stratification: A View of Rural - Urban Dichotomy in Malaria Treatment among Pregnant Women in Ondo State

Article excerpt


Studies on malaria related maternal mortality in Nigeria have focused largely on preventive behaviours and healthcare providers' knowledge of treatment regimen. However, negligible attention has been paid to rural - urban differentials and treatment patterns adopted by care seekers in relevant contexts. This study, therefore, investigated the factors that influenced pregnant women's disposition to malaria treatment in rural and urban areas of Ondo state.

The Health Belief Model, Theory of Planned Behaviour and Health Utilization Model were used as the theoretical framework. The study employed descriptive survey research design using both quantitative and qualitative data collection techniques. Quantitative data were collected from 927 respondents selected through a multistage sampling technique in 10 Local Government Areas of the state. Qualitative data were elicited from six Key Informant Interviews (KIIs) conducted with Modern and Traditional health providers selected from the list of care providers in each LGA. The quantitative data were analysed employing descriptive statistics, chi-square, T- test and Ordinal Regression, while content analysis was used for the qualitative data.

Mild malaria were treated at home while severe cases were referred to formal health care, however moderate difference existed in rural (X= 1.52, SD=0.49) and urban (X= 1.29, SD=0.45) respondents' choice of treatment options. More urban men than their rural counterparts provided respondents first treatment for malaria. Rural respondents (20.9%) than their urban counterparts (19.7%) reported drug failure in their first treatment regimen.

Malaria treatment was influenced by socioeconomic and demographic factors both at rural and urban areas of the state. Policy and national programmes aimed at reduction in maternal mortality should recognise the cultural milieu given its linkage with the aetiology of disease. Without a deliberate intervention, malaria induced maternal morbidity and mortality will remain high not only in Ondo State but Nigeria in general.

Keywords: Rural-urban Dichotomy, malaria treatment, maternal mortality, Ondo State.


Improvement in maternal health, reducing child mortality and combating malaria related morbidity and mortality (MMM) are fundamental in Millennium Development Goals (MDGs). These areas are still major concern in sub-Saharan Africa. Maternal Mortality Rate (MMR) in Africa is the highest among other continents of the world; this is estimated at about 1000 deaths per 100,000 live births (New Partnership for African Development, 2008). By implication, 1 in 20 African women dies of pregnancy related conditions compared with 1 in 4000 women in Europe (NEPAD, 2008). Malaria contributes substantively to the increasing deaths of women, that is why the disease is regarded as a public health problem in the continent. (WHO, 2010) Factors associated with increasing MMM include poverty, social exclusion, marginalisation, inadequate or lack of sanitation and lack of standard health care system among others. Malaria in Nigeria is responsible for over50% out-patent attendances and 40% of hospital admissions, it is a major cause of infant and maternal mortality, at least 50% of the population suffer from at least one episode of malaria each year (Jimoh:2009).

The consequent effects of these maternal health challenges in Africa have undermined social and economic development in relevant communities, more so, that health of expectant mothers and their unborn babies are crucial both as reflection of health status of a large segment of the population and as predictors of health of the next generation (Mba:2006, Asante & AsensoOkyere:2008). Nigeria Demographic and Health Survey -NDHS(2008) estimates suggested that women in reproductive age 1 5-49 comprise 44.7% of the population while their male counterparts were 42.1%. Protecting the health of this large population in the views of Mba, 2006 is an investment in the labour force which is synonymous with wealth of the future. …