Patient Knowledge on Malaria Symptoms Is a Key to Promoting Universal Access of Patients to Effective Malaria Treatment in Palawan, the Philippines

PLoS One. 2015 Jun 16;10(6):e0127858. doi: 10.1371/journal.pone.0127858. eCollection 2015.

Abstract

Introduction: Palawan, where health care facilities are still limited, is one of the most malaria endemic provinces in the Philippines. Since 1999, microscopists (community health workers) have been trained in malaria diagnosis and feasibility of early diagnosis and treatments have been enhanced throughout the province. To accelerate the universal access of malaria patients to diagnostic testing in Palawan, positive health seeking behavior should be encouraged when malaria infection is suspected.

Methods: In this cross-sectional study, structured interviews were carried out with residents (N = 218) of 20 remote malaria-endemic villages throughout Palawan with a history of suspected malaria from January to February in 2012. Structural equation modeling (SEM) was conducted to determine factors associated with appropriate treatment, which included: (1) socio-demographic characteristics; (2) proximity to a health facility; (3) health seeking behavior; (4) knowledge on malaria; (5) participation in community awareness-raising activities.

Results: Three factors independently associated with appropriate treatment were identified by SEM (CMIN = 10.5, df = 11, CFI = 1.000, RMSEA = .000): "living near microscopist" (p < 0.001), "not living near private pharmacy" (p < 0.01), and "having severe symptoms" (p < 0.01). "Severe symptoms" were positively correlated with more "knowledge on malaria symptoms" (p < 0.001). This knowledge was significantly increased by attending "community awareness-raising activities by microscopists" (p < 0.001).

Conclusions: In the resource-limited settings, microscopists played a significant role in providing appropriate treatment to all participants with severe malaria symptoms. However, it was considered that knowledge on malaria symptoms made participants more aware of their symptoms, and further progressed self-triage. Strengthening this recognition sensitivity and making residents aware of nearby microscopists may be the keys to accelerating universal access to effective malaria treatment in Palawan.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Community Health Workers
  • Cross-Sectional Studies
  • Female
  • Health Education
  • Health Knowledge, Attitudes, Practice
  • Health Literacy*
  • Health Services Accessibility
  • Humans
  • Malaria / diagnosis*
  • Malaria / drug therapy
  • Malaria / epidemiology
  • Malaria / pathology
  • Male
  • Philippines / epidemiology
  • Socioeconomic Factors

Grants and funding

The present study was supported by a grant from the Japanese Ministry of Health, Labour and Welfare (http://www.mhlw.go.jp) (grant number: H21-Chikyukibo-Ippan-006) and by a Grant from the National Center for Global Health and Medicine (http://www.ncgm.go.jp/) (grant number: 25A-2). SK received both funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this manuscript.