Household responses to malaria and their costs: a study from rural Sri Lanka.

ABSTRACT

PIP: Knowledge of community perceptions of malaria, treatment-seeking behaviors, and the household costs of illness is essential to the planning of sustainable malaria control interventions. These factors were investigated in household surveys conducted in 5 villages in Sri Lanka's dry zone in February 1995. 95% of the 216 families interviewed regarded malaria as their main health problem, followed by diarrhea and eye diseases. Malaria was ranked as the third most important community concern, following lack of water for cultivation and poverty. Overall knowledge of malaria's causes, symptoms, and treatment was high, although the side effects of antimalarial drugs were often confused with symptoms of the disease. Reported for the 3-month period preceding the survey were 178 episodes of malaria involving 160 families. Home treatment with paracetamol was the first step taken in 85% of cases; however, all families sought prompt treatment from Western-type facilities, especially government hospitals (48%) and mobile clinics (30%). No families consulted indigenous or ayurvedic physicians, despite their availability in the area. This utilization of prompt, effective treatment is presumed to reflect high knowledge about malaria, the perceived seriousness of the disease, and good transport facilities in the area. The total direct expenditure on a single episode of malaria averaged US $3; the median net annual income was $258. Special foods for malaria patients aimed at neutralizing the perceived heating effect of malaria and antimalarial drugs (e.g., sodas, oranges) were the most costly item. Adults lost an average of 7.8 days of work per episode and those accompanying them to health facilities lost 2.9 days. Preventive measures used by families included bed nets (23%), mosquito coils (54%), and insecticides (93%).