Knowledge and perspectives in management of common childhood illnesses by caregivers to under-five children in southwestern nigeria: synopsis of self-medication practices

Abstract

The information and opinions of the caregivers about various childhood ailments serve as a fundamental foundation for the practice of self-medication among under-five-year-old children. The outcome of the health status of children under five is greatly influenced by the scope of such knowledge and perception. The usage of medications for children is a major global problem since they are viewed as a vulnerable population. Although self-medication behaviors are widespread in Nigeria, little is known about how they affect the youngest, most vulnerable children. The knowledge and perceived management of common pediatric disorders among children under the age of five by their caregivers in southwest Nigeria were the subjects of this study. Based on their degree of cosmopolitanism and lack of cosmopolitanism, two local government areas from the states of Lagos and Osun were chosen for the study. Nine hundred and sixty-eight caregivers to under-five children were systematically randomly selected for the study. Data were collected with the aid of structured interviewer-administered questionnaire through the use of Open Data Kit. The knowledge and the perception of caregivers were assessed via vignette-designed questions that were explained to the respondents by the trained research assistants. The data were analyzed using the STATA Package software. The unit of analysis was frequency distribution and percentages. The common childhood illnesses identified by the respondents were malaria, otitis media (ear infection), gastro-enteritis (diarrheal and vomiting), measles, mumps, respiratory tract infection, and febrile convulsion. In general, the caregivers showed a very good knowledge of the CCI presented to them. They identified correctly the illnesses associated with the symptoms. In assessing the possible causes of these CCI, the caregivers commonly attributed the cause to natural phenomena like weather, seasonal changes, dust, and sunny environment. Also, poor hygienic conditions and infection by parasites were identified to be responsible for these CCI. However, their perceived causes of some CCI were very poor. The most visited source of procurement of medicaments was pharmacy or chemist shops in their locality. Pharmacists, friends, and parents were the sources of medication by adolescents as they procured over-the-counter drugs, analgesics, and antibiotics to self-medicate. The classes of products used mostly were drugs prescribed by doctors and any available medicine in their home. The predominant reason given by a greater proportion of the respondents is their affordability of the products which was represented by the cheap cost of self-medication practice in this study. In conclusion, the caregivers in this study are very knowledgeable on the various CCI affecting their under-five children and their belief in the probable causes of the CCI are tuned towards natural causes, infection by parasites, and environmental causes. It is believed that the degree of the caregiver’s knowledge will determine the quality of childcare practice to their under-five children.

Keywords:

• Caregiver
• under-five children
• common childhood illnesses
• self-medication practices

Public Interest Statement

The perception and knowledge of caregivers in identifying the causes of common childhood illnesses (CCI) will translate to the management of these ailments among the under-five children. This study investigated; the classes of the products used to manage the CCI; possible or perceived cause of the illnesses; means of the managing the CCI; and the caregivers’ rationale for performing self-medication to treat the CCI.

This paper revealed the caregivers were knowledgeable in noticing various signs and symptoms pertaining to their children’s illnesses. Herbs, concoctions, and some other home remedies were used for under-five children. Caregivers commonly attributed the causes to natural phenomena, hygienic conditions, environmental factors and infection by parasites. The most visited source of procurement of medicaments was pharmacy or chemist shops in their locality. These caregivers self-medicate with orthodox drugs in managing CCI in this study. Caregivers’ affordability and belief systems accounted for their choice of self-medication.

1. Introduction

Self-medication practices do not occur in isolation, they are premised upon the occurrence of illnesses or diseases among the individual or human subject. To understand the numerous self-medication techniques for young toddlers under five through caregiver, the common childhood illnesses or diseases affecting this age group need to be discussed. According to UNICEF,2017 the common illnesses among them include malaria, diarrhoea, pneumonia, measles, and HIV/AIDS account for more than 70% of the estimated 1 million under-5 deaths in Nigeria. The presentation of these illnesses among under-five majorly is fever which is noticed by caregivers as the increase in body temperature or body getting hot. It serves as a useful diagnostic and prognostic marker. It is this perceived presentation or symptoms by the caregivers that informs seeking healthcare. However, the seeking of this care in form of self-medication i.e. outside the healthcare sector is what this study dwells on.

2. Literature Review

2.1. Caregivers’ understanding of common illnesses among under-five children

Malaria which is known to be an infestation of the body by female anopheles mosquito of Plasmodium falciparum has led to the deaths of many children in sub-Saharan African. Its mode of presentation is fever which is noticed by most caregivers. Apart from fever, it can present with vomiting, restlessness, and convulsion. These are the other symptoms noticed by the caregivers that prompt them to seek care for the under-five children.

Parental seeking behaviour for febrile sickness in children under five was examined in a cross-sectional study in Nigeria by Abdulkadir and Abdulkadir (2017), 12.6% of under-five children had a fever in the preceding 2 weeks before the study. The data was from the NDHS 2013 which is a national demographic and health survey. Abdulkadir and Abdulkadir (2017) reported that caregivers seeking care for fever in under-five children in Nigeria were poor.

Another common childhood illness among children less than five years of age in Nigeria is pneumonia. The most common presentation is a cough associated with fever. Pneumonia is responsible for more than two million deaths of children each year and causes almost one in five under-five deaths worldwide (Marsh et al., 2008). It is also recognized to be the leading infectious cause of death among under-five age groups globally. Also, it kills about 2000 children every day and accounted for 15% of all under-five deaths in 2015 (UNICEF, 2016). Most of the death from pneumonia occur in developing countries and about ¾ takes place in 15 countries as more than half of them occur in Nigeria, China, India, Bangladesh, Pakistan (WHO 2016). In 2016, 60% of all neonatal and under-five deaths occurred in the sub-Saharan African region (Golding et al., 2017; Treleaven et al., 2015). Of about 2300 under-five death that occurs every day in Nigeria (UNICEF, 2016) 328 die of pneumonia (Treleaven et al., 2015). Pneumonia’s presentation to caregivers is mostly cough followed by fever. In the Yoruba speaking of south-western Nigeria, it is called “otutu aya”. In a study by Ekure, Esezobor, Ojo, Omoigberale, Oviawe, Ezechukwu, and Esangbedo (Ekure et al., 2013), 75.6% of the mother surveyed in Lagos believe that cold was the main cause of pneumonia which is a misconception.

Malaria infection and death are most likely to affect children under the age of five. An estimated 303,000 children under the age of five died from malaria in 2015, including 292,000 throughout the continent of Africa. The death rate from malaria among children under five is thought to have decreased by 35% between 2010 and 2015. Nevertheless, malaria continues to be a leading cause of death for children under five, taking a child’s life every 2 min (WHO, 2016). About 440,000 people died in 2016 from the 216 million instances that occurred. About 70% of these were kids under the age of five. This equals a daily toll of nearly 800 kids under the age of five. According to UNICEF (2016), 90% of all malaria-related deaths take place in sub-Saharan Africa.

Approximately 8% of all fatalities among children under the age of five globally occurred in 2016, making it the world’s top killer of kids. This corresponds to over 450,000 children per year, or more than 1200 young children per day. It kills 2195 children every day more than AIDS, malaria, and measles combined. Diarrhoea is a common symptom of gastrointestinal infections caused by a wide range of pathogens, including bacteria, viruses, and protozoa. Diarrhoea disease poses a major public health problem in most developing countries of the world. Contributing to its morbidity and mortality is overcrowd settlement, poor access to clean water, and good sanitation.

In high burden sub-Saharan African countries, too many children are not receiving adequate care for diarrhoea, even among those seeking care at health facilities (Carvajal-vélez et al., 2016). Intensify endeavours to increase care-seeking and enhance good care for diarrhoea in children in both community level and health facilities is a critical need. Further research utilizing qualitative techniques is necessary to examine the impact of regional and cultural beliefs and practices on caregiver perceptions of diarrhea (Carvajal-vélez et al., 2016). Appropriate reactions are also crucial and will necessitate further study. Further research utilizing qualitative techniques is necessary to examine the impact of regional and cultural beliefs and practices on caregiver perceptions of diarrhea (Carvajal-vélez et al., 2016). Appropriate reactions are also crucial and will necessitate further study. Hence, giving credence to this research objective.

Despite the widespread acceptance of scientific and public health approaches to illness causation, knowledge of the mechanisms underlying disease processes and therapies is frequently lacking (Colvin et al., 2013). In the management of childhood diarrhoea, caregivers reported that care-seeking behaviour was based on their observations or understanding of the efficacy of some diarrhoea treatment as well as on the advice of others (health workers, relatives, community members; Carter et al., 2015). This may suggest that there are socio-cultural or traditional held beliefs on the care-seeking pattern in the management of childhood diarrhoea.

The healthcare-seeking behaviour of caregivers depends on the nature of children’s illnesses. Various childhood diseases or illnesses have different meanings or understanding to the caregivers. It is believed that their perception dictates the extent to which healthcare is sought among the caregivers for their under-5 children. Mothers in rural communities of Ise-Orun had poor perception and misconceptions about malaria in children, and they practiced self-medication, according to a study conducted by Orimadegun and Ilesanmi (2015) among mothers of under-5 children in the Ise-orun community in one of the South-Western states of Nigeria. 14.2% of the respondents cited mosquito bites as the only cause of malaria in children. Only a few moms were familiar with the signs and symptoms of severe malaria cases, although several mothers were aware of the moderate cases’ characteristics. The mother cited some untrue causes of malaria, such as consuming contaminated water, consuming excessive amounts of oil, being exposed to cold weather, stress, witchcraft, and curses from the seniors in the village, and working and strolling in the sunshine.

They also perceived malaria as a non-communicable disease because mosquito bite was not considered as a means of contracting malaria. This led them to engage in unproven traditional or local prevention practices for malaria prevention such as “burning of cow drug”, “burning of herbs”, a sprinkling of kerosene and water, and “burning of dry orange peel”. With this poor misconception, care-seeking practices were negatively influenced. The level of education among mothers was noted to be positively correlated with poor perceptions of malaria. It was also emphasized that the moms were advised to treat malaria with alternative measures by the widespread beliefs of the community regarding the efficacy of locally available treatment choices along with experience from comparable illnesses. Orimadegun and Ilesanmi (2015) opined that misconception of illnesses led to self-medication that caused a delay in seeking appropriate health care, exacerbation of malaria illness, treatment failure, and development of drug resistance. Hence, the caregivers, perception of illness has led to the form of care-seeking and the medication or treatment practices involved.

However, caregivers’ perception of malaria illness in south-western Nigeria was very good as the study revealed a very high level of knowledge of the causal agent of malaria. The electronic media contributed immensely to the source of information on their management of malaria, though the population studied were adults not the under-five children in the community. The authors further revealed that both traditional and orthodox medication was used by the caregiver for treating malaria (Amaechi & Ukpai, 2013). Despite their level of good perception, the nature of care-seeking involved multiple sources. This tells us that aside from the perception of illness, the caregivers’ attitude and knowledge of care-seeking are still influenced by some societal indices. Also, the study assessed the perception of malaria among mothers but was not targeted to the under-five children, maybe this was the reason for the good perception, therein need to assess the perception by caregivers to the under-five children.

Ogunlesi et al. (2010) in a hospital-based study to determine healthcare-seeking behaviour for childhood illnesses in a resource-poor setting reported that mothers perceived fever as a more serious illness that deserves immediate attention, with less attention to the passage of watery stool and cough. This however is a misconception as stooling and cough too portend to be dangerous signs in childhood illnesses. Therefore, caregivers needed to be educated on recognising other danger signs in childhood, illness. Also in care-seeking, more than half of the mothers sought care within their homes, despite their proximity to health facilities. The author, therefore, emphasized the need to seek extensive sociological research to explain participants’ ability to non-use orthodox medications. Even with a good perception of illness and having good health-seeking behaviour, caregivers still involve in self-medication practices, hence this is a pointer to some socio-cultural contexts that need to be researched.

Owumi et al. (2016) stated perceived causes of childhood illnesses among mothers of the child—patients in North-central Nigeria to be familial or hereditary causes, due to germs, and bad weather situations. Supernatural forces like witchcraft, sorcerer, and angry ancestors and deities cause illness in children like measles, malaria, diarrhoea among others. The study also pointed out that despite being a Muslim or Christian, mothers do engage in mixed religious activities in times of persistent challenging health problems. Evidently from this study, it can be inferred that religion or faith belief perception to childhood illness defiled treatment using orthodox medicine, hence giving credence to self-medication practices. The authors also affirmed that people are influenced by religion and this has been extended to the perception of disease aetiologies.

Furthermore, religion is ascribed to be a cultural instrument that satisfies human needs. Regardless of religious affiliations by mothers or caregivers, the practice of self-medication by using herbal medicines was noted in the study (Ekpo, 2017). This means that perception of childhood illness and care-seeking behaviour goes beyond individual religiosity to attain better health for their children. Hence, the need to be concerned with socio-cultural predictors of health seeking behaviour and perception of disease to address self-medication practices among caregivers to under-five children.

2.2. Objective

To investigate knowledge and perceived management of common childhood illnesses among under-five children by their caregiver in the study area.

2.3. Research Design

The study adopted a cross-sectional survey among the caregivers to under-five children in the selected communities.

2.4. Study Location

Based on the states’ cosmopolitanism and lack thereof, two states were specifically chosen for the study. Six states in the south-western (SW) region of Nigeria are predominately Yoruba. Generally speaking, Yoruba is the language spoken in this area. These states are uniform in terms of culture. However, various characteristics, such as the degree of commercialization, urbanization, population density, religion, landmass, exposure to social amenities, and different cultural practices, distinguish the states. Lagos, Ogun, Oyo, Osun, Ekiti, and Ondo are the six states in this area. Lagos and Osun states were specifically chosen for the study out of those.

Each of these states has three senatorial districts which consist of various local governments. The senatorial districts in Lagos state are Lagos Central senatorial district which has five local governments; Lagos East Senatorial District which has five local governments and Lagos West senatorial district which has ten local governments. From these districts, Lagos West senatorial which has the highest number of local governments were selected. Then the local government with the largest population was selected for the study, which is Alimosho local government with a population of 1,319,571 people according to the 2006 National Census. From this level, the local government was divided into Enumeration Areas (EAs) where the two enumeration areas which were randomly selected were finally chosen for the study. Then house listing was conducted to identify the households from which the eligible respondents were picked for the study.

Also, Osun State has three senatorial districts as Osun Central senatorial district, Osun East senatorial district, and Osun West senatorial district. Each of these districts has ten local governments. However, Osun West has the largest population in the district and was selected. Thereafter, the local government with the largest population in the district which is the Ife East local government with a population of 188,614 people according to the 2006 National Census was chosen for the study. Subsequently, two enumeration areas were randomly selected for the study, and a house listing was conducted to elicit the eligible respondents for the study.

2.5. Study Population

The study included the household caregivers of children under the age of five. Any person who is actively involved in the care of the under-five children at a time of illness or disease in the home is referred to as a caregiver in this study. This could include mothers, fathers, siblings, housemaids, grandparents, neighbors, foster parents, or whatever is present at the time the study is being conducted.

2.6. Sampling Technique

This study used a multi-stage sampling technique in selecting participants for the quantitative aspect of the design. The respondents were caregivers who are currently nursing or caring for any child below the age of five years in the selected household. Stage one involved the selection of two states in the South Western region based on their metropolitan and non-metropolitan nature. The two states were Lagos and Osun states, respectively. Each of these states has three senatorial districts which consist of various local government areas. In each state, the senatorial district with the highest population was selected. Then, the most populated local government was chosen from the selected senatorial district. Thereafter, two enumeration areas were randomly selected from each local government for the study location and sampling. From here, the household listing was conducted in each enumeration area using households with under-five children as the major criterion.

Households with child (ren) less than five years of age were chosen within the selected household units until the desired sample size was reached in each local government area.

2.7. Sample Size

According to Salami and Adesanwo (2015) in a study to examine the practice of self-medication for the treatment of illnesses for under-five children by mothers in Ibadan, southwestern Nigeria, reported a prevalence of 81.4% for self-medication practices among the mothers.

Since there is no evident database for the population of caregivers of under-five children in this region, the prevalence from the above-mentioned study was used to determine the sample size for this study.

The sample size was calculated using Fischer’s formula

n = z² (pq)/d²

Where

n = minimum sample size required in the study design

z = standard normal deviation or z-score

p = prevalence of the self-medication by (Salami and Adesanwo, 2015)

q = 1- p

d = the acceptable error level

The calculation is done using a z-score of 1.96 corresponding to 95% confidence interval and the allowable error level of 2.5% (0.025). . Hence, calculating the sample size as:

p = 0.81

q = 1–0.81 = 0.19

n = (1.96)² (0.81 x 0.19)/(0.025)²

= 3.8416 × 0.1539/0.000625

= 0.591222/0.000625

= 945.96

Approx. to 946 respondents

Assuming 10% of incomplete responses or non-response rate, 10% of 946 was calculated to approximately 95, and was added to the sample size of 946 to make a total sample size of 1041.

The chosen local government for Lagos is Alimosho local government with a population of 1,319,571 while the local government from Osun state is Ife East local government with a population of 188,614. Using a proportion ratio of 80/20 to distribute the sample size in the two study locations will make the sample skewed too much towards Alimosho local government, hence, the proportion ratio of 60/40 was used to arrive at how to distribute the sample size among the chosen study sites. Hence, 624 respondents were picked from Alimosho local government while 416 respondents were chosen from Ife East local government, respectively.

2.8. Data Collection

Data collection was done with the aid of Open Data Kit, in which the interviewer-administered questionnaires were encrypted. The fieldwork was conducted with the support of six research assistants that were employed for this study. These are sets of trained postgraduate students in the Department of Sociology and Anthropology and the Department of Demography and Social Statistics of Obafemi Awolowo University, Ile-Ife. These research assistants were trained for a week on the use of ODK that was used on the field to collect data. The second stage of the data collection was the quantitative design by obtaining information from the respondents that had initially been earmarked for the study. Interviewer-administered questionnaires through the ODK were administered to the randomly selected caregivers in the households by the research assistants.

To ensure the internal validity of the questionnaire, the researcher employed a peer review among experts in the field of Sociology, Pediatrics, Demography, and Political science. To check for external validity, a pilot study was conducted among the caregivers attending immunization and clinic in OAUTHC, Ile-Ife.

2.9. Data Analysis

The data from the quantitative design were analyzed using the STATA Package software. The unit of analysis was frequency distribution and percentages.

2.10. Ethical Considerations

The rights of the informants or participants were protected by the following measures. The informant was given verbal and written explanations of the research aimed to ensure that she understood them. The informants provided their written consent in order to carry out the study as planned. The Ethical and Research Committee at the Institute of Public Health at Obafemi Awolowo University in Ile-Ife, Osun State, Nigeria, was consulted for ethical approval. All tools and procedures for gathering data were disclosed to the informant.

3. Theoretical application

3.1. Theory of Planned Behavior

Created by Icek Ajzen in 1985, the theory of planned behavior (TPB) is today maybe the most well-known social-psychological model for the forecast of behavior. It has its underlying foundations in Martin Fishbein and Ajzen’s theory of reasoned action, which was produced because of the observed absence of correspondence between general demeanors, for example, racial or religious states of mind, and real behavior. Rather than managing general states of mind of this kind, the TPB centers around the behavior itself and goes past attitudes to think about such different impacts on behavior as apparent social norms and self-efficacy convictions (Albarracin, Johnson, and Zanna, 2005).

Many of the influences on self-medication are likely to be mediated by the beliefs and attitudes held by the individual. These beliefs about efficacy and effectiveness of orthodox/unorthodox medicines, herbs, concoctions, traditional or religious practices in self-medication may be more important than actual effectiveness and consequences in determining a caregiver’s medication practices. Likewise, various economic, social, cultural, religious, or demographic factors will act through the attitudes and beliefs held by the person. As such the study of the relationship between these sociological factors and the beliefs and attitudes held by a person offers one possible route towards a better understanding of the influence of different sociological factors on self-medication practices.

With volitional practices, it is contended that expectation to play out conduct is the best indicator of behavior. The expectation is anticipated by two segments: the individual’s mentality (e.g., regardless of whether the individual sees the conduct as great, advantageous, charming, and so on) and saw social strain to carry along with these lines (named subjective norm). The theory of planned behavior incorporates a part of perceived control, which is theorized alongside mentality and subjective standard, to foresee conduct expectations and may likewise impact the intention-behavior link.

Attitude thus is anticipated by the total of results of convictions about results of the behavior and the individual’s assessments of these results as great or awful. The subjective standard is anticipated by the whole of results of regularizing convictions which are perceived pressure from particular powerful individuals or gatherings (e.g., specialists, family) and the individual’s inspiration to consent to the desires of these individuals or gatherings. Comparably, perceived control is dictated by the entirety of particular control convictions adjusted by the apparent intensity of the control variables to encourage or repress execution of conduct (Ajzen, 1991).

The first origination of the theory of reasoned action expected that impacts other than beliefs, attitudes, social pressure, and intention would act through these factors (Ajzen and Fischbein, 1980); this would likewise apply to the theory of planned behavior, albeit here perceived control would be an extra segment of the model. Subsequently, demographic factors for example, age or social class, should impact behavior just through the model factors and not act as independent behavior. According to the theory of planned behavior, a person’s intention to perform a certain behavior is influenced by his or her attitude toward the behavior, subjective norms (perceived social pressure about the behavior), and perceived control over performing the behavior (Ajzen, 1991).

4. Application of the TPB to this study

Self-medication practice is assumed to be a form of behavioral practice action done in the area of seeking healthcare treatment for a particular disease or illness. In this case, it is the self-medication practice by the caregivers and how it is done to the under-five children. It is observed that there are some influences in society that predispose the caregiver to engage in this practice of self-medication. These are mostly socio-cultural, demographic, economic, and political factors. The extent and pattern to which they affect this self-medication practice are what will be explained by this theoretical framework using the TPB. Behavioral and normative beliefs are derived from individuals’ perceptions of the social world they inhabit and are hence likely to reflect how economic or other external factors shape behavioral choices.

5. Results

5.1. Socio-demographic characteristics of the respondents

Table 1 contains the socio-demographic characteristics of the caregivers of under-five children who participated in the study. The age of the respondents varied from 10 years to 69 years. About two-fifth (47%) of the respondents are between age of 30–39 years while one-fifth (23%) were between 20 and 29 years. The implication is that the majority of the study participants clustered around the age of 30–39 years. Very few 7% and 6% of the respondents were of the extreme of ages 10–19 years and 60–69 years, respectively. This could be due to less energetic level in taking care of under-five children among these age groups. Considering the gender of the caregivers, 3 out of 10 (30%) of them were male and the majority (70%) were female. This is not farfetched as traditionally in the study area, females are mostly saddled with the responsibility of child caring.

Table 1. Socio-demographic Characteristics of the under-five caregivers

Caregiver of Under-five	Location
	Lagos (636)		Osun (332)
	Rural (221)	Urban (415)	Rural (228)	Urban (104)
Characteristics	Freq. (%)	Freq. (%)	Freq. (%)	Freq. (%)
Age group
10–19	22 (9.95)	31 (7.47)	6 (2.63)	10 (9.62)
20–29	26 (11.76)	108 (26.02)	70 (30.70)	22 (21.15)
30–39	94 (42.53)	218 (52.53)	74 (32.46)	64 (61.54)
40–49	40 (18.10)	29 (6.99)	50 (21.93)	4 (3.85)
50–59	23 (10.41)	15 (3.61)	4 (1.75)	-
60–69	16 (7.24)	14 (3.37)	24 (10.53)	4 (3.85)
Gender
Male	73 (33.03)	90 (21.69)	104 (45.61)	16 (15.38)
Female	148 (66.97)	325 (78.31)	124 (54.39)	88 (84.62)
Marital Status
Unmarried	37 (16.74)	62 (14.94)	4 (1.75)	8 (7.69)
Married	146 (66.06)	327 (78.80)	194 (85.09)	92 (88.46)
Widowed	32 (14.48)	15 (3.61)	30 (13.16)	-
Separated	6 (2.71)	11 (2.65)	-	4 (3.85)
Occupation
Civil servant	-	98 (23.61)	-	28 (26.92)
Artisan	39 (17.65)	85 (20.48)	52 (22.81)	22 (21.15)
Trader	56 (25.34)	114 (27.47)	26 (11.40)	34 (32.69)
Housewife	9 (4.07)	15 (3.61)	28 (12.28)	4 (3.85)
Farmer	59 (26.70)	24 (5.78)	54 (23.68)	8 (7.69)
Self employed	30 (13.57)	39 (9.40)	64 (28.07)	8 (7.69)
Others	16 (7.24)	40 (9.64)	4 (1.75)	-
Relationship of caregiver to U-5 children
Biological mother	87 (39.37)	227 (66.75)	104 (45.61)	78 (75.00)
Biological father	67 (30.32)	53 (12.77)	92 (40.35)	14 (13.46)
Foster mother	6 (2.71)	4 (0.96)	2 (0.88)	-
Foster father	-	4 (0.96)	-	-
Housemaid	-	-	-	2 (1.96)
Grandmother	39 (17.65)	9 (2.17)	28 (12.28)	-
Sibling	22 (9.95)	39 (9.40)	2 (0.88)	2 (1.96)
Neighbor	-	19 (4.58)	-	4 (3.85)
Others	-	10 (2.41)	-	4 (3.85)
Religion
Christianity	132 (59.73)	152 (36.63)	112 (49.12)	56 (53.85)
Islam	64 (28.96)	257 (61.93)	88 (38.60)	48 (46.15)
Traditional	25 (11.31)	6 (1.45)	28 (12.28)	-
Level of education
No formal education	35 (15.84)	23 (5.54)	48 (21.05)	4 (3.85)
Primary school	33 (14.93)	53 (12.77)	56 (24.56)	24 (23.08)
Secondary school	119 (53.85)	187 (45.06)	120 ()52.63	44 (42.31)
Polytechnic	28 (12.67)	94 (22.65)	4 (1.75)	20 (19.23)
Graduate degree	6 (2.71)	36 (8.67)	-	8 (7.69)
Post graduate	-	22 (5.30)	-	4 (3.85)
Family income in Naira
1.000–20,000	70 (31.67)	145 (34.94)	124 (54.39)	56 (53.85)
21,000–40,000	77 (34.84)	161 (38.80)	88 (38.60)	32 (30.77)
41,000–60,000	36 (16.29)	74 (17.83)	12 (5.26)	12 (11.54)
61,000–80,000	17 (7.69)	4 (0.96)	4 (1.75)	-
81,000+	21 (9.50)	31 (7.47)	-	4 (3.85)
Family size
<3	22 (9.95)	105 (25.30)	16 (7.02)	28 (26.92)
4–6	160 (72.40)	275 (66.27)	184 (80.70)	68 (65.38)
7+	39 (17.65)	35 (8.43)	28 (12.28)	8 (7.69)

Also, four-fifth (78%) of the participants were married, 11.5% remained unmarried with only 2% separated. This vividly shows that majority of the caregivers are most likely of good parenting values as they are responsibly married. With reference to the occupation of the respondents, more than 90% were gainfully employed as 14% are civil servants, 20% skill fully engaged, 23% involved in trading activities while only 5% are full-time housewives. This reflects that most caregivers have a source of livelihood. In examining the relationship of the caregivers to these under-five children, more than half (55%) of the participants were the biological mother of these children, as 25% were biological father in given care to the under-five children. Only 8% of the respondents were grandmother who directly give care to the under-five children. This shows that mothers are majorly responsible in the art of giving care to their children in the study region. With religion affiliation, both Christianity and Islam were equally shared by the caregivers as 47% and 47%, respectively. Only 6% were of the traditional religion. Educational level showed that 90% of the caregivers had formal education while 10% had no formal education. Assessing the economic status of the family of the caregiver, 80% of them generated an income of less than 40,000 naira monthly while 6% earned above 80,000 naira monthly.

5.2. Malaria illnesses

Table 2 displays the level of knowledge of common childhood illnesses among the respondents. Revelation from this table shows that majority (63%) of the caregivers are very knowledgeable on the scenario depicting a case of malaria in the children. Thirty percent of the respondents considered the case to be representative of measles. This connotes that the caregivers have a very good knowledge of the malaria illness presentation whenever it occurs among their wards. It further means most of them can readily and easily identify malaria illness whenever their children show the symptoms.

Table 2. Caregivers’ knowledge and perceived management on Malaria illnesses

The baby is likely to be having:	Frequency	Percentage
Pneumonia	12	1.24
Measles	296	30.6
Malaria	617	63.7
Ear infection	7	0.7
Gastro-enteritis	3	0.3
Don’t know	33	3.4
Classes of products used for under-five children upon noticing the above symptoms of Malaria
What type of medication do you give your child(ren) immediately you noticed the above symptoms of malaria.	Frequency	Percentage
Herbal concoctions	215	22.2
Over-the-counter drugs	138	14.3
Drugs prescribed by doctors	315	32.5
Drugs from faith-based healing homes	14	1.5
Any medicine available	283	29.2
Others	3	0.3
Possible causes of malaria symptoms
What do you think are the causes of the symptoms of malaria?	Frequency	Percentage
Poor hygiene	190	19.6
Malnutrition	56	5.8
Infection by parasites	162	16.7
Natural cause-weather	324	33.5
Staying in the sun	193	19.9
Don’t know	11	1.1
Others	32	3.3
Means of managing the symptoms of malaria
How do you manage these symptoms of Malaria?	Frequency	Percentage
Use home-made solution	184	19.0
Consult neighbours	11	1.1
Go to parents	54	5.6
Go to chemist shop	191	19.7
Go to pharmacy	200	20.7
From faith-based healing homes	55	5.7
Go to traditional healers	154	15.9
Use left over from previous illness	113	11.7
No idea	6	0.6
Influencers of decision making in self-medication to the symptoms of malaria
What influence your decision making self-medication to these symptoms of malaria?	Frequency	Percentage
Experience from past illnesses	147	15.2
Severity of symptoms by the child(ren)	36	3.7
What influence your decision making self-medication to these symptoms of malaria?	Frequency	Percentage
Accessibility to healthcare facility	77	7.9
Cheap cost of self-medication	272	28.1
Beaurecractic process in health facility	53	5.5
Beliefs in traditional medicine	374	38.6
Others	9	0.9

The types of medication given to under-five children whenever their caregivers noticed the identified symptoms of malaria in them were assessed. About 33% of the participants give drugs prescribed by doctors to their under-five children as 29% used any medicine that is available at home for their wards. Some 22% employed the use of herbal concoctions in treating malaria among their children and 14.3% subscribed to using over-the-counter drugs. Very few 1.5% and 0.3% of the caregivers used drugs from faith-based healing homes and other products respectively as revealed from the study. Direct implication of this is that the respondents largely use prescribed drugs for treating malaria in their under-five children while the use of any available medicine at their disposable was also mentioned. This also connotes that apart from employing orthodox drugs, herbs and products from other healing homes were engaged in the practice of self-medication to treat malaria illness in under-five children by caregivers.

The caregivers perceived causes of the symptoms of malaria in their under-five children by caregivers were also assessed. Most caregivers (33%) opined to natural causes as the causative agent involved in malaria illness while relatively 19% of the respondents both affirmed the cause to poor hygiene and staying in the sun. Only 16% of the participants ascertained infection by parasites to be the cause of malaria illness in their children. Implication from this reveals a very poor understanding or perception of the causes of malaria illness in under-five children among the respondents as only very few identified the correct cause as infection by parasites. Most caregivers attributed the cause to natural phenomenon, which represents a very poor perception of causative agents of malaria.

The various ways that was engaged by the caregivers in attempt to manage malaria disease among the under-five children were also reported. About 391 out of the 968 respondents, 40%, present at a formal drug shop to procure medicines for treating malaria in under-five children in the study. Others, about 30% result in using homemade solution and left-overs from previous illnesses with 16% of caregivers visit the traditional healers for management of malaria. Arising from this finding is the use of varieties of means to manage the symptoms attributed to the cause of malaria.

The findings explain the responses by caregivers on what influence their decision in making self-medication towards the management of malaria illness. Among the respondents, 38% largely attribute beliefs in traditional medicine as pointer to making decision to self-medication to treat malaria affecting under-five children. Cheap cost was associated with self-medication as this influence their decision-making in treating malaria, this constitutes 28% of the influencing factors. Experience from previous or past illnesses carries 15% of the factors contributing to decision-making is self-medication to treat the malaria illness. Other options, including severity of the illness symptoms (3.7%), accessibility to healthcare facility (7.9%), and bureaucratic process in health facility (5.5%), were highlighted to be influencing factors. The inference drawn from this is that economic, belief system and individual factors most likely dictate decision-making in self-medication practice towards the treatment of malaria in under-five children among the respondents.

6. Otitis Media (Ear Infection)

Table 3 brings another case scenario depicting the symptoms associated with ear infection among the under-five children. It assesses the knowledge level of the caregivers on the recognition and identification of such disease as it affects their wards. More than half, 644 out of 968 respondents, correctly identify, otitis media (ear infection) as, the illness depicting the scenario that was played to them. This vividly demonstrates a very high degree of identification of the symptoms in ear infection as it affects their children among the caregivers.

Table 3. Caregivers’ knowledge and perceived management of Otitis Media

The baby is likely to be having:	Frequency Distribution	Percentages
Pneumonia	3	0.3
Ear infection(Otitis media)	644	66.5
Malaria	62	6.4
Measles	79	8.2
Mumps	22	2.3
Don’t know	158	16.3
Classes of products used for under-five children upon noticing the above symptoms of Ear infection (Otitis media)
What type of medication do you give your child(ren) immediately you noticed the above symptoms of ear infection	Frequency Distribution	Percentages
Herbal concoctions	87	8.9
Over-the-counter drugs	164	16.9
Drugs prescribed by doctors	420	43.4
Any available medicine	226	23.4
Don’t know	68	7.0
Others	3	0.3
Possible causes of ear infection (otitis media) symptoms
What do you think are the causes of the symptoms of ear infection?	Frequency Distribution	Percentages
Poor hygiene	66	6.8
Malnutrition	14	1.5
Infection by parasites	593	61.3
Natural cause-weather	14	1.5
Staying in the sun	34	3.5
Don’t know	93	9.6
Others	11	1.1
Table 5.19: Means of managing the symptoms of ear infection (otitis media)
How do you manage these symptoms of Ear infection?	Frequency Distribution	Percentages
Use home-made solution	227	23.5
Consult neighbours	5	0.5
Go to parents	49	5.1
Go to chemist shop	157	16.2
Go to pharmacy	364	37.6
From faith-based healing homes	13	1.3
Go to traditional healers	24	2.5
Use left over from previous illness	70	7.2
No idea	59	6.1
Table 5.20: Influencers of decision making in self-medication to the symptoms of ear infection
What influence your decision making self-medication to these symptoms of ear infection?	Frequency Distribution	Percentages
Experience from past illnesses	141	14.6
Severity of symptoms by the child(ren)	47	4.9
What influence your decision making self-medication to these symptoms of ear infection?	Frequency Distribution	Percentages
Accessibility to healthcare facility	99	10.2
Cheap cost of self-medication	328	33.9
Beaurecractic process in health facility	107	11.1
Beliefs in traditional medicine	178	18.4
Don’t know	68	7.0

The classes of products or drugs used by the caregivers as they identified with the symptoms of ear infection in their children were examined. Notably, 43% of the caregivers affirmed that they use drugs prescribed by doctors for treating ear infection while 23% used any medication that is available at their disposal during the occurrence of the disease. Some of them subscribed to the use of over-the-counter drugs (16%) and herbal products (8%). Probable reasons for this outcome may be most respondents present their children to health facility for doctors’ attention as they do not engage in self-medication. However, others self-medicate with various products they identified with.

The findings also show the respondents’ thinking on the probable causes of the ear infection in under-five children. More than half, 61% of the caregivers believe that parasites are responsible for the ear infection, however 9.6% of the participants do not know what causes the infection. But 6% were of the opinion that the infection is caused by poor hygienic condition and only 1.5% of them subscribed to the infection been caused by the nature. It is evident from the analysis that majority of the caregivers are knowledgeable on the best likely cause of ear infection in their children. This implies that their belief system on the causative agents tend toward scientific basis.

A summary of the methods identified with procurement of solutions to the symptoms of ear infection among their under-five children goes thus. More than half,53%, of the respondents present to the pharmacy or chemist shop to find solutions to the ear infection in the children, with 3.7% resulting to their faith or belief system by visiting traditional healers or faith-based healing homes. Others (31%) manage the symptoms of ear infection by using home-made solutions and leftover from previous illnesses. It can be discerned that the management of ear infection among the respondents were based on using orthodox products. However, making use of home remedies and faith /belief system still featured among the means of treating such ailment.

It also displays the possible factors underpinning the use of self-medication to treat ear infection occurring in the under-five children by their caregivers. About one-third, 33%, of the respondents attributed it to the low cost of procuring self-medication items, while about 18% of the caregivers opined that their preference for the traditional medicine made them to subscribe to self-medication in order to manage ear infection. The bureaucratic procedures in various health facilities which was accounted for by 11% of the participants attracted them to self-medication. The degree of the critical state of the illness as displayed by the children during the sick role accounted by 5% of the respondents dictate their choice to self-medicate. It was noted that, 14%, of the participants also based their decision-making to self-medicate on the experiences they garner from managing previous illnesses. As only 10% of them perform self-medication because of the difficulty encountered in accessing healthcare facility. This confirms the interplay between economic influence and participants’ belief system towards the practice of self-medication in managing ear infection. Also, it connotes the inadequacies of the health facility and healthcare system as it contributes to self-medication practices.

6.1. Gastro-Enteritis

Table 4 indicates the assessment of the respondents’ knowledge level in successfully identifying a case of gastro-enteritis (vomiting and diarrhoea) as it occurs in their under-five children. More than two-third, 62%, of the participants acknowledge the case scenario to be that of gastro-enteritis. Though 18% of the caregivers opined that the presented symptoms are exemplar of food allergies and only few attributed it to be a case of malnutrition. It can be inferred that the respondents have a very good knowledge of identifying the symptoms of gastro-enteritis.

Table 4. Caregiver’s knowledge and perceived management of Gastro-Enteritis

The baby is likely to be having:	Frequency Distribution	Percentages
Gastro-enteritis	607	62.7
Food allergies	172	17.8
Pneumonia	12	1.2
Malaria	92	9.5
Malnutrition	3	0.3
Don’t know	82	8.5
Table 5.24 Classes of products used for under-five children upon noticing the above symptoms of gastro-enteritis (vomiting and diarrhoea)
What type of medication do you give your child(ren) immediately you noticed the above symptoms of gastro-enteritis?	Frequency Distribution	Percentages
Herbal concoctions	92	9.5
Over-the-counter drugs	171	17.7
Drugs prescribed by doctors	352	36.4
Any available medicine	308	31.8
Don’t know	28	2.9
Others	7	0.7
Table 5.25: Possible causes of gastro-enteritis symptoms
What do you think are the causes of the gastro-enteritis?	Frequency Distribution	Percentages
Poor hygiene	342	35.3
Malnutrition	134	13.8
Infection by parasites	269	27.8
Natural cause-weather	106	10.9
Staying in the sun	26	2.7
Don’t know	65	6.7
Others	12	1.2
Table 5.26: Means of managing gastro-enteritis
How do you manage these symptoms of gastro-enteritis?	Frequency Distribution	Percentages
Use home-made solution	217	22.4
Go to parents	20	2.1
Go to chemist shop	209	21.6
Go to pharmacy shop	300	30.9
From faith-based healing homes	21	2.2
Go to traditional healers	67	6.9
Use left over from previous illness	87	8.9
No idea	59	6.1
Don’t know	24	2.5
Table 5.27: Influencers of decision making in self-medication to the symptoms of gastro-enteritis.
What influence your decision making self-medication to these symptoms of gastro-enteritis?	Frequency Distribution	Percentages
Experience from past illnesses	79	8.2
Severity of symptoms by the child(ren)	71	7.3
What influence your decision making self-medication to these symptoms of gastro-enteritis?	Frequency Distribution	Percentages
Accessibility to healthcare facility	117	12.1
Cheap cost of self-medication	416	42.9
Bureaucratic process in health facility	135	13.9
Beliefs in traditional medicine	119	12.3
Don’t know	28	2.9
Others	3	0.3

The table also highlights the different types of medication involved used in managing the symptoms attributed to a case gastro-enteritis as it occurs among under-five children by their caregivers. Drugs prescribed by the doctors carried 36% of the respondents’ options as part of medication they give to their under-five children during episode of gastro-enteritis. Another 31% of the caregivers affirmed the use of any available medicine within the household to manage the ailment as such. Drugs without doctor’s prescriptions in treating gastro-enteritis contributed 17% of responses by caregivers. Nine percent of the participants preferred to use herbal concoctions for managing the above mentioned ailment in the children. This depicts that a greater proportion of the caregivers self-medicate with the different methods as they manage the symptoms of vomiting and diarrhoea in their children.

It further describes the participants’ perceived causes of gastro-enteritis (stooling and vomiting) in their under-five children. Out of the 968 respondents, 342 of them attributed the causes of gastro-enteritis among their under-fives to poor hygiene in their vicinity. Meanwhile, 27% of the caregivers are of the perception that the illness is caused by infection from parasites. Other perceived causes include, malnutrition, natural causes, staying in the sun while some do not even know the likely causes as indicated by 13%, 10%, 2% and 6%, respectively. Implication of this is that majority of the proportion strongly believe that for gastro-enteritis to occur, contamination of the food products must be either of bad home sanitation or parasitic infection.

Furthermore, it displays the sources of managing gastro-enteritis in their under-five children by their caregivers. A greater proportion, 52%, of the respondents presented at either in the chemist shop or pharmacy shop with the aim of treating the symptoms of vomiting and diarrhoea. The use of home-made solution was highlighted by 22% of the caregivers as they manage this ailment in their children. This points to the fact that self-medication practice is done in the management of this childhood disease by the participants in the study area.

The results present the categories of rationale for choosing to engage in self-medication practice to treat gastro-enteritis in under-five children by the caregivers. The cheap cost of procuring self-medication endears about 43% of the respondents influence them to the practice in treating the ailment in question. Also, in affecting their choice making is the bureaucratic processes which serve as barrier to healthcare delivery; this represents 13% of the caregivers. Furthermore, 12% of the participants are influenced by their beliefs in traditional medicine to manage the ailment as about 12% of them agreed to accessibility to healthcare facility as factor that lured them to the practice. The inference from this finding is that economic status of the respondents, institutional mechanisms within the healthcare institution and the belief system of the caregivers strongly influence self-medication practices among the caregivers.

6.2. Measles

Table 5 examines the level of knowledge of the caregivers in identifying the occurrence of measles illness among their under-five children. At least 7 out of 10 respondents correctly identify measles as their option when the case scenario on symptoms of measles was played out to them. However, 11% of them associated the symptoms with malaria disease while 10% of the caregivers chose skin rashes as their choice depicting the illness. Implication of this finding is that the highest number of participants are highly knowledgeable in identifying the symptoms attributed to measles illness whenever their under-fives present with such.

Table 5. Caregivers’ knowledge and perceived management of Measles

The baby is likely to be having:	Frequency Distribution	Percentages
Measles	703	72.6
Malaria	113	11.7
Skin rashes	97	10.0
Pneumonia	8	0.8
Don’t know	47	4.9
Classes of products used for under-five children upon noticing the above symptoms of measles
What type of medication do you give your child(ren) immediately you noticed the above symptoms of measles?	Frequency Distribution	Percentages
Herbal concoctions	343	35.4
Over-the-counter drugs	73	7.5
Drugs prescribed by doctors	139	14.4
Drugs from faith-based healing homes	16	1.7
Any medicine available	375	38.7
Don’t know	19	1.9
Others	3	0.3
Possible causes of Measles symptoms
What do you think are the causes of measles?	Frequency Distribution	Percentages
Poor hygiene	73	7.5
Malnutrition	51	5.3
Infection by parasites	227	23.5
Natural cause-weather	444	45.9
Staying in the sun	127	13.1
Don’t know	43	4.4
Others	3	0.3
Means of managing measles illness
How do you manage these symptoms of measles?	Frequency Distribution	Percentages
Use home-made solution	144	14.8
Consult neighbours	24	2.5
Go to parents	24	3.5
Go to chemist shop	98	10.1
Go to pharmacy shop	191	19.7
From faith-based healing homes	4	0.4
Go to traditional healers	250	25.8
Use left over from previous illnesses	203	20.9
No idea	6	0.6
Don’t know	14	1.5
Influencers of decision making in self-medication to the symptoms of measles.
What influence your decision making self-medication to these symptoms of measles?	Frequency Distribution	Percentages
Experience from past illnesses	48	4.9
What influence your decision making self-medication to these symptoms of measles?	Frequency Distribution	Percentages
Severity of symptoms by the child(ren)	71	7.3
Accessibility to healthcare facility	40	4.1
Cheap cost of self-medication	421	43.5
Beaurecractic process in health facility	49	5.1
Beliefs in traditional medicine	317	32.8
Don’t know	19	1.9
Others	3	0.3

It indicates the classes of medication and sources of those drugs used in managing the symptoms associated with measles illness as it occurs in their under-five wards. About 38% of the participants were of the opinion that they use any medicine that is available in their homes in managing the case of measles in their children. Also, 35% of the caregivers used herbal concoctions to treat measles while 14% of the solely engaged with the use of drugs prescribed by doctors to manage measles illness. Others 7% and 1% subscribed to over-the-counter drugs and products from faith-based healing homes respectively in managing measles disease. This shows that the majority of the caregivers practice self-medication during the course of measles diseases in their children probably for curative purpose.

The table also brings out the perceived causes of symptoms of measles among the under-five children by their caregivers. The likely causes of measles were attributed to natural causes by 45% of the participants, while 23% perceived it to be caused by infection from parasites. Staying in the sun was presented by 13% of them and very few opted for poor hygiene as the likely causative factor of measles disease. The inference from this is that most caregivers believe that measles illness occur naturally as few believe in parasitic cause.

The summary of various sources of procurement in managing measles illness was assessed. Seeking management from the traditional healers was consented to by 25% of the respondents as about 35% subscribe to the use of products remaining from the past illnesses and home-made solutions. Moreover, about 29% access either chemist shop or pharmacy shop to achieve cure to measles illness in their wards. Very few, 0.4% patronize faith-based healing homes for treatment of this ailment. This finding vividly reveals that most management are done using home remedies within caregivers’ immediate reach and also approach orthodox sources to procure medicines. It also connotes that the respondents cultural approach to measles treatment.

The below table examines the respondents’ factors influencing decision-making on self-medication practice done to their under-five children whenever they experience measles disease. Among the factors mentioned include: the cheap cost involved in the procurement of self-medication practice which accounted for 43% responses; about one-third (33%) of caregivers based their influence on belief in traditional medicine and 7% attributed it to the severity of the illness as presented by the children. Also, the procedural process involving health facilities during healthcare delivery was adjudged by 5% of the caregivers to affect their decision-making towards self-medication to measles illness. Others factors identified were experience from past or previous illnesses and difficult accessibility to healthcare facility with 5% and 4%, respectively. This revelation signifies the factors contributing to decision-making by caregivers in managing measles as economic, cultural or belief system, individual and institutional basis.

6.3. Mumps

Table 6 highlights the caregivers’ understanding of mumps disease in under-five children. More than half, 52%, of the participants identify the disease by the case scenario as mumps. Also, 29% of them ascribed it to malaria illness. The respondents’ views succinctly show that they have a very good knowledge and understanding of symptoms attributed to mumps.

Table 6. Caregivers’ knowledge and perceived management of Mumps

The baby is likely to be having:	Frequency Distribution	Percentages
Mumps	503	51.9
Malaria	277	28.6
Measles	106	10.9
Hunger	82	8.5
Don’t know	47	4.9
Classes of products used for under-five children upon noticing the above symptoms of mumps
What type of medication do you give your child(ren) immediately you noticed the above symptoms of mumps?	Frequency Distribution	Percentages
Herbal concoctions	210	21.7
Over-the-counter drugs	158	16.3
Drugs prescribed by doctors	187	19.3
Any medicine available	387	40.0
Don’t know	23	2.4
Others	3	0.3
Table 5.36 Classes of products used for under-five children upon noticing the above symptoms of mumps
What type of medication do you give your child(ren) immediately you noticed the above symptoms of mumps?	Frequency Distribution	Percentages
Herbal concoctions	210	21.7
Over-the-counter drugs	158	16.3
Drugs prescribed by doctors	187	19.3
Any medicine available	387	40.0
Don’t know	23	2.4
Others	3	0.3
Possible causes of Mumps
What do you think are the causes of Mumps?	Frequency Distribution	Percentages
Poor hygiene	73	7.5
Malnutrition	51	5.3
Infection by parasites	227	23.5
Natural cause-weather	444	45.9
Staying in the sun	127	13.1
Don’t know	43	4.4
Others	3	0.3
Means of managing mumps
How do you manage these symptoms of Mumps?	Frequency Distribution	Percentages
Use home-made solution	153	15.8
Consult neighbours	26	2.7
Go to parents	54	5.6
Go to chemist shop	188	19.4
Go to pharmacy shop	129	13.3
Go to traditional healers	237	24.5
How do you manage these symptoms of Mumps?	Frequency Distribution	Percentages
Use left over from previous illnesses	152	15.7
No idea	17	1.8
Don’t know	12	1.2
Influencers of decision making in self-medication to the symptoms of mumps.
What influence your decision making self-medication to these symptoms of mumps?	Frequency Distribution	Percentages
Experience from past illnesses	62	6.4
Severity of symptoms by the child(ren)	59	6.1
Accessibility to healthcare facility	80	8.3
Cheap cost of self-medication	365	37.7
Beaurecractic process in health facility	123	12.7
Beliefs in traditional medicine	256	26.5
Don’t know	23	2.4

The table also elicits the type of medications involved in the immediate management of mumps in under-five children by their caregivers. One-quarter, 40%, of the respondents confirmed the use of any medicine available within the household for treating mumps amongst the under-fives. The use of herbal concoctions was allotted to 21% of the caregivers for treating mumps and only 19% engaged with the prescribed drugs from doctors to manage mumps. However, over-the-counter drugs were preferred by 16% of the participants. Inference drawn from this finding strongly indicates the involvement of self-medication products in the management of mumps in under-five children by their caregivers.

It represents the caregivers’ perceived causes of mumps among the under-five children. More than a quarter (46%) of the participants believed that mumps occur from natural causes while another 24% of them attributed the cause to infection by parasites. Staying in the sun by the children accounted for 13% of the possible causes of mumps. Inadequate feeding process and poor healthy environment carried 5% and 7% respectively as the caregivers opined to them as the likely cause of mumps. The responses indicated that caregivers perceived cause of mumps varies from natural cause to parasitic infections.

Furthermore, this table lists the participants’ views on the sources of medicaments to treat mumps infection among their under-five children. In the respondents’ choices of where they obtain solutions to manage mumps, 19% chose chemist shop, 13% presented at the pharmacy shop while 25% visited the traditional healers and about 32% made use of home remedies and left over from previous illnesses. This finding signify that self-medication practice to mumps treatment is done mostly by employing homemade or left over remedies which can be orthodox based or culturally based.

The opinions given by the caregivers on the factors responsible for their decision to self-medicate in treating mumps were also included in this table. About one-third (38%) of the respondents opined to the low cost incurred by the practice, 27% affirmed their preference for traditional medicine in treating mumps. About 21% of them ascribed the various difficulty processes encountered in the healthcare facilities to their reason for self-medicating. However, 6.4% and 6.1% of the caregivers mentioned their views as experience from past illnesses and severity of the symptoms by the children respectively. The implication of this is that financial constraint, cultural factor, and inadequate hospital structures are contributory influencers to self-medication practice in treating mumps.

6.4. Acute Respiratory Tract Infection

Table 7 highlights the caregivers’ knowledge in identifying symptoms depicting case scenario of respiratory tract infection in under-five children. Almost (95%) all the respondents identified the case scenario to be that of respiratory tract infection. However, about 3% of them claimed that they do could not make sense of what the scenario represents while very few (0.7%) inferred it to be mumps. Evidently, it can be said that the caregivers are highly knowledgeable on the symptoms of respiratory tract infection among their under-five children.

Table 7. Caregivers’ knowledge and perceived management of Acute Respiratory Infection

The baby is likely to be having:	Frequency Distribution	Percentages
Mumps	7	0.7
Acute respiratory tract infection	917	94.7
Don’t know	44	2.6
Classes of products used for under-five children upon noticing the above symptoms of respiratory tract infection.
What type of medication do you give your child(ren) immediately you noticed the above symptoms of respiratory tract infection?	Frequency Distribution	Percentages
Herbal concoctions	60	6.2
Over-the-counter drugs	168	17.4
Drugs prescribed by doctors	340	35.1
Drugs from faith-based healing homes	6	0.6
Any medicine available	368	38.0
Don’t know	23	2.4
Others	3	0.3
Possible causes of acute respiratory infection
What do you think are the causes of acute respiratory infection?	Frequency Distribution	Percentages
Poor hygiene	157	16.2
Malnutrition	30	3.1
Infection by parasites	327	33.8
Natural cause-weather	347	35.9
Staying in the sun	64	6.6
Don’t know	43	4.4
Means of managing acute respiratory infection
How do you manage these symptoms of respiratory infection?	Frequency Distribution	Percentages
Use home-made solution	84	8.7
Go to parents	20	2.1
Go to chemist shop	253	26.1
Go to pharmacy shop	203	20.9
From faith-based healing homes	23	2.4
Go to traditional healers	184	19.0
Use of left over from previous illnesses	169	17.5
No idea	26	2.7
Don’t know	6	0.6
Influencers of decision making in self-medication to the symptoms of respiratory tract infection.
What influence your decision making self-medication to these symptoms of respiratory tract infection?	Frequency Distribution	Percentages
Experience from past illnesses	33	3.4
Severity of symptoms by the child(ren)	44	4.5
Accessibility to healthcare facility	63	6.5
Cheap cost of self-medication	472	48.8
Beaurecractic process in health facility	28	2.9
Beliefs in traditional medicine	301	31.1
Don’t know	27	2.8

It shows the type of drugs given by the caregivers to their under-five children whenever they noticed symptoms pertaining to respiratory tract infection. Only one-third (35%) of the participants do not self-medicate as they use drugs prescribed by doctors to treat the ailment mentioned above. Though another one-third (38%) of them gave any medication available at home during the ailment to their children while 17% account for the usage of over-the-counter drugs. Also the use of herbal concoctions was employed by 6.2% of the caregivers in managing respiratory tract infection affecting their under-five children. This clearly depicts that majority of the caregivers do self-medicate with various types of medicaments to treat respiratory tract infection in their wards.

The table also examines the participants’ perceived causes of respiratory tract infection among their under-five children. The probable cause of the infection was attributed to nature by about 36% of the caregivers while the other one-third (34%) subscribed to infestation from parasites. As 157 out of 968 respondents believe in the unhygienic situation their environment to be the cause of infection, so do 3.1% attributed the cause to poor dietary pattern of the under-fives. While only 6.7% assigned the infection can arise as a result of the children playing under a sunning environment. It can be inferred that most caregivers have a poor perception of the causes of the respiratory infection in their under-five children.

Also, the various sources of medicaments used in managing respiratory infection among by the caregivers among their under-five children were examined. Most respondents (46%) presented at different chemist and pharmacy shops to procure medications for treating respiratory infection while about 19% of them preferred visiting the traditional healers. The use of available medicaments at home from previous illnesses was applauded by about 26% of the respondents. Very few proportion of the participants 2.1%, 2.4% obtained their medications from their parents and faith-based healing homes respectively. The finding from this implies that more than half of the respondents prefer to procure medicaments used in self-medication to their under-five children from sources other than chemist or pharmacy shops.

It shows the respondents’ views on what influence their decision-making of self-medication to treat respiratory tract infection in their children. Nearly half (49%) of the caregivers attributed very low or cheap cost of procuring the medicaments to the practice of self-medication to treat respiratory tract infection. About a third (31%) of the participants clearly submit to their belief in the use of traditional medicaments to manage the above mentioned ailment in their children. Also, other factors contributing to self-medication practice among the respondents include: bureaucratic processes in health facility, difficulty in accessing healthcare services, degree of the child’s illnesses and the caregiver’s experiences from past illnesses in this proportion 2.9%, 6.5%, 4.5% and 3.4%, respectively. This signifies that the most probable factors influencing caregivers’ decision to self-medicate are economic reason and their faith/belief system which is deeply rooted in their culture.

6.5. Febrile Convulsion

Table 8 describes the caregivers’ assessment of symptoms associated with a case scenario of febrile convulsion in under-five children. In examining the knowledge of the respondents on identifying a case of febrile convulsion in under-five children, 64% of them have a good understanding of it while 25% of the caregivers perceived the symptoms to be that of measles. Only 7% of the participants were of the opinion that it exemplifies malaria case. This suggests that majority of the caregivers are highly knowledgeable in recognising case of febrile convulsion presentation in their under-five children.

Table 8. Caregivers’ knowledge and perceived management of Febrile Convulsion

The baby is likely to be having:	Frequency Distribution	Percentages
Malaria	68	7.0
Measles	241	24.9
Febrile convulsion	618	63.8
Don’t know	41	4.2
Classes of products used for under-five children upon noticing the above symptoms of febrile convulsion.
What type of medication do you give your child(ren) immediately you noticed the above symptoms of febrile convulsion?	Frequency Distribution	Percentages
Herbal concoctions	208	21.5
Over-the-counter drugs	82	8.5
Drugs prescribed by doctors	334	35.0
Drugs from faith-based healing homes	6	0.6
Any medicine available	317	32.8
Don’t know	18	1.9
Others	3	0.3
Possible causes of febrile convulsion
What do you think are the causes of febrile convulsion?	Frequency Distribution	Percentages
Poor hygiene	74	7.6
Malnutrition	158	16.3
Infection by parasites	151	15.6
Natural cause-weather	486	50.21
Staying in the sun	53	5.5
Don’t know	37	3.8
Others	9	0.9
Means of managing febrile convulsion
How do you manage these symptoms of febrile convulsion?	Frequency Distribution	Percentages
Use home-made solution	124	12.8
Go to neighbours	10	1.0
Go to parents	14	1.5
Go to chemist shop	181	18.7
Go to pharmacy shop	258	26.7
From faith-based healing homes	27	2.8
Go to traditional healers	105	10.9
Use left over from previous illnesses	235	24.3
No idea	14	1.5
Influencers of decision making in self-medication to the symptoms of febrile convulsion.
What influence your decision making self-medication to these symptoms of febrile convulsion?	Frequency Distribution	Percentages
Experience from past illnesses	88	9.1
Severity of symptoms by the child(ren)	44	4.6
What influence your decision making self-medication to these symptoms of febrile convulsion?	Frequency Distribution	Percentages
Accessibility to healthcare facility	74	7.6
Cheap cost of self-medication	421	43.5
Beaurecractic process in health facility	48	5.0
Beliefs in traditional medicine	276	28.5
Don’t know	14	1.5
Others	3	0.3

It also depicts the type or brand of medication given to under-five children that are likely to experience febrile convulsion by their caregivers. About a third (35%) of the caregivers used orthodox medications in the management of febrile convulsion and another one-third (33%) of them apply any medicine that is available within the household to their wards. Also, 208 out of 968 respondents apply herbal concoctions on their under-five children during episode of febrile convulsion while only very few (0.6%) obtained their medication from faith-based healing homes. This infers that caregivers mostly engage in the use of medications other than the ones prescribed by the doctor to manage febrile convulsion in their under-five children.

The table also describes the potential reasons for febrile convulsion among under-five children by their caregivers. Half, 50% of the respondents attributed febrile spasm to be caused by natural phenomenon as almost the same proportion (16%) of caregivers perceived disease by infection and malnutrition as causes of febrile convulsion. However, minority (7.6%) of the participants subscribed to poor cleanliness as the probable cause of the ailment. The implication is that greatest number of caregivers believe that febrile convulsion happens as a result of supernatural occurrences.

It elicits methods of managing febrile convulsion occurring in under-five children by their caregivers. As evident from the table, 439 out of 968 respondents visited licensed drug shops to get their medications in treating the above mentioned ailment in under-fives, while about one-third (37.1%) of them do not go to anywhere as they use the available means within their home premises. However, 11% of caregivers present at native healing homes to get cure towards febrile convulsion in their children. The participants also mentioned the involvement of their neighbours (1%), parents (1.5%) and religious homes (2.8%) as they were also approached to seek treatment to this ailment. The significance of this finding is that caregivers self-medicate with western medications in the treatment of febrile convulsion in children less than five years of age.

Furthermore, it explains the various rationales propelling caregivers to self-medication in treating febrile convulsion among their under-five children. About a quarter (44%) of the caregivers involve in self-medication practice because of the cheap cost of obtaining the medicaments. More so, 29% strongly believe in the use of traditional medicine in managing febrile convulsion occurring in their children while the experiences garnered by 9% of the participants from past illnesses contributed to self-medicating to treat this ailment. The extent of the nature of the symptoms exhibited by the under-five children during illness accounted for about 5% of the reasons the respondents practice self-medication. Also, 8% of the caregivers attributed their rationale for engaging in the practice to difficulty encountered in accessing healthcare services. These findings connote the interplay of economic factor, belief system, individual factor and healthcare structures in self-medicating towards the management of febrile convulsion by caregivers to their under-five children.

7. Discussion

The caregivers’ knowledge of common childhood illnesses (CCI) among their under-five children was assessed. The common childhood illnesses identified by the respondents were malaria, otitis media (ear infection), gastro-enteritis (diarrheal and vomiting), measles, mumps, respiratory tract infection, and febrile convulsion. Based on these CCI, the caregivers’ knowledge was investigated. This objective was approached by employing quantitative method. As most respondents may not be familiar with the terminology of the illnesses in the medical parlance, a case scenario depicting the significant associated symptoms of each of the CCI was demonstrated to them by the interviewers. Various options were made available to the respondents, from which they now identified the most likely illnesses that depicted the case scenario. Also, in investigating their knowledge and beliefs on CCI, four criteria were further designed. They are: classes of the products used to manage the CCI, possible or perceived cause of the illness, means of managing the CCI, and the caregivers’ rationale for performing self-medication to treat the CCI.

The findings from this research also showed how knowledgeable the respondents were concerning CCI and the sources of information. In general, the caregivers showed a very good knowledge of the CCI presented to them. They identified correctly the illnesses associated with the symptoms. Because these symptoms translated to the disease which they could depict easily. This is similar to findings by Anderson et al. (2013) and Oshikoya and Senbanjo (2008) where mothers were knowledgeable of their children’s ailments. Most respondents attributed their identification of the CCI to perceived symptoms which include, fever, cough, running nose, skin rashes, stooling, vomiting, and convulsion to mention a few. The participants were knowledgeable that their children took ill based on subjective means and observation in changes in behaviour or activities of the children. Though, their observed symptoms may not translate to the actual disease or illness. At least the insight is there that something wrong is happening or is likely to happen to their children.

In assessing the possible causes of these CCI, the caregivers commonly attributed the cause to natural phenomena like weather, seasonal changes, dust, and sunny environment. Also, poor hygienic conditions and infection by parasites were identified to be responsible for these CCI. However, their perceived causes of some CCI were very poor. Their views on the causes of CCI were divergent ranging from seasonal changes, parasites, human behaviour to environmental causes. For instance, in childhood malaria illness most caregivers adjudged the cause to be of natural origin. Finding by Orimadegun and Ilesanmi (2015) similarly reported poor perception and misconception of malaria mainly due to lack of education among the mothers. This represents a poor possible perception of such illness whereas their commonest choice of the cause of ear infection is by parasites, which showed a very good perception of the likely cause of the infection. In addition, poor hygiene was generally attributed to causing vomiting and diarrheal among their under-five children in the study. This however portrayed the correct perception of the probable cause of the illness. The rationale for assessing their views on the causative agents of CCI will determine the form of managing or treating such diseases.

To further understand how knowledgeable, the respondents are on CCI, the sources of managing the ailments were also assessed. The most visited source of procurement of medicaments was pharmacy or chemist shops in their locality. Pharmacists, friends, and parents were the sources of medication by adolescents as they procured over-the-counter drugs, analgesics, and antibiotics to self-medicate (Shehnaz et al., 2014). Chemist shops and drug vendors are the first sources of healthcare among mothers of under-five children as they classified disease conditions before seeking treatment (Amuyunzu-nyamongo & Nyamongo, 2006). Others attended traditional healer homes because the perceived cause of their children’s illness is from natural cause and the belief that only traditional means can be used to manage as such.

In managing malaria, ear infection, diarrheal and vomiting, respiratory infection and febrile convulsion, the majority of the caregivers patronise chemist or pharmacy shops. Whereas, the caregivers visited traditional healers in treating measles and mumps among their under-five children. This might be as a result of their possible perceived causes of such illnesses by the caregivers. In another vein, caregivers patronised faith-based healing homes, traditional healers, and various health facilities. The significance of this is that most caregivers preferred to present at these locations due to the proximity, trust in the providers, and cheap cost of rendering such services. This shows the interplay on the influence of social factors on the method or sources of managing CCI through self-medication practices.

In addition, the classes or types of medicaments/products used by the caregivers to treat the CCI were examined to assess their knowledge of managing CCI. The classes of products used mostly were drugs prescribed by doctors and any available medicine in their home. These majorly are orthodox medicines. In a similar study, the majority of the caregivers to under-five children sought medical attention from hospitals during their sickness episodes (Agbede et al., 2016). This implies that most caregivers prefer to use medicines prescribed by doctors during previous illnesses based on their experience. These caregivers self-medicate with orthodox drugs in managing CCI in this study.

The use of herbs, concoctions, urine, palm oil, and some other home remedies was widely mentioned in this research. Such remedies are essential and common among women or mothers in different Nigerian communities. These are easy to access, considered potent, and cheaper in treating common health conditions among under-five children (Swati et al., 2019). Reports from studies by (Bello et al., 2011; Fakeye et al., 2009; Gedefaw et al., 2015; Joseph et al., 2017; Oshikoya et al., 2007; Yusuff & Omarusehe, 2011) supported the use of herbs and herbal products to self-medicate their under-five children. In the case of managing the umbilicus of a newborn baby, mentioned was made of soaking beads in water and use of various indigenous products. Other local products highlighted were; adin Dudu, kafra, black soap, honey, onions, ose eyin, pawpaw leaves to mention a few. These might arise from their belief system in the likely cause of the CCI, lack of health facilities, and affordability of such medicaments.

Consequent to the aforementioned views by the caregivers in choice of products to manage CCI, the various rationales for self-medicating with such products were examined. The predominant reason given by a greater proportion of the respondents is their affordability of the products which was represented by the cheap cost of self-medication practice in this study. This corroborated findings by (Oluwole et al., 2016; Omolase et al., 2007) where respondents reported financial constraints as the major reason for their self-medication practices. Followed by the caregivers’ belief in traditional medicine towards managing CCI among their under-five children. Pregnant mothers used herbal medications because they perceived better safety of herbs and they considered the efficacy than the conventional drugs (Bello et al., 2011). This connotes that economic factors and belief systems appreciably account for influencing decision-making in self-medication to treat under-five children by their caregivers in this study.

8. Conclusion

In summary, the caregivers in this study are very knowledgeable on the various CCI affecting their under-five children and their belief in the probable causes of the CCI are tuned towards natural causes, infection by parasites, and environmental causes. It is believed that the degree of the caregiver’s knowledge will determine the quality of childcare practice to their under-five children.

Proposed strategy For parental decision enhancement derived From this study

This study proposes the below strategies for parental decision enhancement on the practice of self-medication to their under-five children:

1. Considering the various interplay of the social factors in the delivery of healthcare to under-five children, different informal or non-medical sources of seeking healthcare for the children should be identified and subsequently trained or enlightened on the need for a safe and responsible self-medication practice especially to the under-five children population. This can be achieved through a very strong and committed synergy among specialist healthcare practitioners and other informal healthcare practitioners in the community.

2. Also, health education on self-medication should be introduced at the community level to enlighten the parents and other community members on the risks and benefits of self-medication, especially for under-five children. This could be done through community awareness and public enlightenment in the form of town hall meetings or community outreach. This gives community members the opportunities to get involved and be part of the solution to under-five self-medication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Consortium for Advanced Research Training in Africa provided funding for this study (CARTA). In addition to being supported by the Carnegie Corporation of New York Grant No. G-19-57145 (Grant No. B 8606.R02), Sida (Grant No:54100113) (Grant No. 54100113), the DELTAS Africa Initiative (Grant No. 107768/ Z/15/Z), and Deutscher Akademischer Austauschdienst, CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand (DAAD). The DELTAS Africa Initiative is a stand-alone funding initiative of the Alliance for Accelerating Excellence in Science in Africa (AESA) of the African Academy of Sciences (AAS), and it is funded by the NEPAD Agency, which receives funding from the UK’s Wellcome Trust 107768/Z/15/Z and the UK government.

Notes on contributors

Oluseye Ademola Okunola

The author is a public health physician who specializes in medical sociology researches with interest in health systems and behavioral health studies. My research interests involve research design using both qualitative and quantitative methods to explore or explain the social context of public healthcare or services delivery. This would help mitigate the ravaging effects of epidemic and deepen strategic interventions aimed at improving the well-being of the populace. I have conducted various researches that focused on health behaviors to illnesses and towards healthcare services in all. I have a desire to understand how human beings in society function on an individual, group and societal level and how culture, religion and ethnicity influence the health and illness within society. I believe that socio-cultural context of illness and health, if well researched in the Sub-Saharan region will help in reducing the burden of most communicable and non-communicable diseases ravaging our continent.