Abstract

Background
Global research on health-seeking behaviours for malaria treatment suggests that exploring community perceptions and attitudes to health-seeking is essential in formulating responsive treatment policies and comprehensive strategies that promote appropriate health-seeking behaviours and overall well-being for different populations. Existing evidence conducted in Nigeria has highlighted some of the barriers that contribute to delay in treatment-seeking for malaria. However, this evidence is predominantly quantitative and is carried out in different regions of Nigeria, with essentially limited evidence in Makurdi, located in the North-Central region. Furthermore, there is very little evidence in the North-Central region of Nigeria that has explored perceptions and attitudes to health-seeking delay for malaria treatment. Therefore, this study aimed to take a qualitative approach to explore the perceptions and attitudes contributing to delay in health-seeking behaviour for malaria treatment in Makurdi, Nigeria.
The Health Belief Model (HBM) was adopted as the model used to conceptually frame this research which assists with understanding the perceptions and attitudes contributing to the delay in health-seeking behaviour for malaria treatment in Makurdi, Nigeria. The HBM provided a structure to compare the findings with previous studies that have used the HBM in the field.

Method
A qualitative research design with an interpretive philosophical stance was adopted to answer the research question and meet the objectives of the study. A total of 39 semi-structured interviews were conducted among adult Nigerians (n=18), traditional healers (n=7), healthcare professionals (n=10), and Ministry of Health policymakers (n=4) to ascertain their views using a semi-structured interview guide. Data were analysed using the framework analysis approach.

Findings
The review of literature on the care pathways for malaria treatment reported a dearth of literature available in the public domain. However, based on the available evidence the following pathways for malaria treatment in Nigeria were identified: consultations with traditional healing services, purchase of herbal concoctions (locally called ‘Agbo’) from hawkers of herbal drugs, visiting spiritualists for cleansing and ritual sacrifices, faith-based healing, consultations with drug vendors for remedies, home management with traditional medicines/self-medication and hospital/health centre visitation.
The semi-structured interviews with respondents revealed some key findings. These are presented in relation to the key construct of the Health Belief Model. Such as, perceived efficacy included: effectiveness and safety, lack of trust and confidence in medical treatment, fear of drug resistance and potential side effects, family views and treatment pattern, and preservation of cultural values/heritages. Perceived severity included: commonalization of malaria, easy-to-treat, and comparison of malaria with other diseases. Perceived susceptibility included: susceptibility associated with exposure to hot sunlight and susceptibility related to evil spirits and stress. Perceived benefit included: no unique benefit in medical treatment when compared to traditional medicines. Perceived barriers included: perceived high cost of biomedical treatment from health facilities, fear of being diagnosed with a different ailment, and health workers’ behaviour towards patients.

Conclusion and Recommendation
The findings from this research suggest the need for extensive health education, involving communities and families, aimed at promoting prompt and effective treatment-seeking for malaria, and making it a top priority of the Ministry of Health through the combined efforts of the electronic media system and introduction of person-to-person centred campaign approach. Also, the need to expand the coverage of the national health insurance scheme is key to accommodate other categories of the general population without occupational and socio-economic restrictions as it presently is, this will reduce the economic burden of accessing healthcare facilities for malaria treatment, thus, encourage effective and prompt health-seeking behaviours in Nigeria.