Background: Despite the supply of artemisinin-based combination therapy (ACT) drugs to public health
facilities in Nigeria, the uptake of these drugs appear to have remained suboptimal with low improvement in childhood
morbidity and mortality.
Aim: To use a controlled study to estimate the factors affecting the uptake of ACT in public health facilities in Cross River
State (CRS), Nigeria.
Methods: The design of this study was cross sectional analytical. The study was carried out in two sites, Akpabuyo
(experimental) and Obudu (control) Local Government Areas (LGA) in the south and northern parts of CRS, Nigeria,
respectively. Multidisciplinary research team consists of health professionals, biomedical and social scientists who
worked with staff of the target facilities. Validated semi-structured questionnaires were administered by trained
interviewers on respondents of consecutive households selected by multi-stage sampling procedure.
Results: A total of 1250 households (588 in Akpabuyo and 662 in Obudu LGAs) were assessed. More informants in
Obudu had formal education than in Akpabuyo (p<0.0001). Mortality of U5 children was higher in Akpabuyo. Stepwise
regression analysis showed that farmers (p = 0.009) and people without formal education (p = <0.0001) were less likely
than older age group (p = <0.0001) to access anti-malaria drugs in Akpabuyo. Religious beliefs (p=0.003) also predicted
uptake of ACTs in Obudu.
Conclusion: Informants’ occupation, age, education and religious beliefs were key determinants of uptake of ACTs in
public health facilities in Nigeria. We recommend targeted malaria education programmes to explore the belief systems in
treating fevers in children in this population.