Influence of Healthcare Costs on Malaria Treatment Choice in Low- and Middle-Income Countries: A Systematic Review with particular focus in Northern Nigeria
TL;DR
It is concluded that healthcare costs remain the major determinant of malaria treatment choice in LMICs and recommends evaluation and expansion of subsidized malaria treatment programs, improved health insurance coverage across the region, and strengthened primary healthcare services to reduce financial barriers and improve malaria treatment outcomes.
Abstract
Malarial disease remains a cornerstone in public health causing greater challenge in lowand middle-income countries (LMICs), in sub Saharan Africa where healthcare cost and financing is predominantly dependent on out-of-pocket (OOP) expenditure. This current systematic review examines the effect of healthcare costs on malarial disease treatment choices in LMICs, with emphasis on self medication, direct and indirect costs, over-thecounter treatment, herbal medicine treatment, and selection of antimalarial drug. This review assessed and utilized evidence from previous pure and empirical studies and the recent peer-reviewed literature published from 2020 to 2026. Online electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, MEDLINE, and Google Scholar were accessed and searched using predefined keywords and Boolean operators. Many studies total to 63 were analyzed where 51 were found eligible and included in the study which included observational, qualitative, and mixed-methods studies conducted in LMICs related to malaria that explored healthcare costs and malaria treatment-seeking behavior. Findings indicated that direct medical costs such as consultation fees, laboratory investigations fees, cost of medications, and hospitalization expenses significantly influenced treatment decisions and options. While indirect costs including transportation, productivity losses, caregiver burden, and time away from work also affected healthcare utilization and influenced treatment choice and recovery outcomes. It is also found that rising healthcare costs contributed to delayed treatment-seeking behavior, increased self-medication, overthe-counter drug purchases, herbal remedy utilization, and preference for cheaper but less effective antimalarial drugs among the vulnerable population. This review concludes that healthcare costs remain the major determinant of malaria treatment choice in LMICs and recommends evaluation and expansion of subsidized malaria treatment programs, improved health insurance coverage across the region, and strengthened primary healthcare services to reduce financial barriers and improve malaria treatment outcomes.