Determinants of Self-Medication in the Management of Severe Malaria in Kamina, DRC
A cross-sectional study conducted in Kamina, DRC, found that 33.3% of patients with severe malaria engaged in self-medication, a practice driven primarily by a lack of information regarding its prohibition, poor perceptions of healthcare quality, low education levels, and low socioeconomic status.
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In many parts of the world, when a person feels sick, the first instinct is often to find a remedy without seeing a doctor. This practice, known as self-medication, involves taking medicine based on one's own judgment of the symptoms rather than following a professional's advice. While this approach can sometimes help with minor ailments, it becomes dangerous when the illness is serious, such as severe malaria. Malaria is a life-threatening disease spread by mosquitoes, and when it progresses to a severe stage, it can cause organ failure, deep confusion, or death if not treated immediately in a hospital. The core problem arises when people treat these severe cases at home with the wrong drugs or delays, hoping to save money or time, only to arrive at the hospital too late for effective care. Understanding why people choose this risky path is essential for public health workers who want to save lives, particularly in regions where the disease is common and access to clinics can be difficult.
A team of researchers set out to understand exactly why this happens in Kamina, a city in the Democratic Republic of the Congo. They focused on patients who had already been admitted to local hospitals with severe malaria, asking them or their families about what they did before arriving. The study took place over five months in 2024, interviewing 231 people who had been treated for the most dangerous form of the disease. The researchers wanted to know how many of these patients had tried to treat themselves first and, more importantly, what factors pushed them to do so. They looked at the patients' education, their financial situation, how far they lived from the hospital, and what they knew about the rules regarding medicine.
The findings revealed that self-medication is a widespread issue in this region. About one-third of the patients, or 33.3 percent, had taken medicine for their severe malaria before being admitted to the hospital. This means that for a significant number of people, the journey to professional care was delayed by their own attempts to manage the illness at home. The researchers discovered that this behavior was not random; it was driven by four specific and powerful factors. The first was a simple lack of knowledge. Many people who did not know that self-medicating for severe malaria was forbidden or dangerous were much more likely to do it. When people are not told clearly that they should not treat severe symptoms on their own, they rely on their own guesses or advice from neighbors, which can be fatal.
The second major driver was how people felt about the quality of care they received at local health centers. Those who believed the hospitals provided poor service were far more likely to try to fix the problem themselves. If a patient feels that a clinic is unhelpful, slow, or neglectful, they may decide that going there is a waste of time and that buying medicine on their own is a better option. This perception of poor quality created a barrier that kept people away from the very place that could save them. The third factor was education. The study showed that people with little or no formal schooling were significantly more likely to self-medicate. Without the tools to understand medical instructions or the risks of the wrong treatment, these individuals often turned to whatever medicine was available to them.
Finally, money played a critical role. People with low socioeconomic status, meaning they had very limited financial resources, were the most likely to resort to self-medication. For families struggling to make ends meet, the cost of a hospital visit, including transport and fees, can be impossible to pay. Self-medication becomes a cheaper, more accessible alternative, even though it carries a high risk of failure. The researchers found that these four factors—lack of information, poor perception of hospital care, low education, and poverty—worked together to create a situation where people felt they had no choice but to treat severe malaria on their own.
The study did not find that the distance to the hospital was a main reason people chose self-medication. However, regarding waiting times, the data showed a borderline association (P=0.05), suggesting that long lines at health facilities may also play a role in the decision to self-medicate, though this was less definitive than the other factors. The decision was rooted more deeply in what people knew, how they felt about the system, and their ability to pay. The researchers also noted that their findings were specific to the Kamina area and that the study design, which looked at a single point in time, could not prove that one factor caused the other, but it clearly showed they were strongly linked. The work highlights that solving this problem requires more than just building more clinics; it demands better education to teach people why self-medication is dangerous, efforts to improve the quality of care so patients trust the system, and support for the poorest families who cannot afford to seek help. Without addressing these underlying causes, the cycle of delay and danger will continue.
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