Abstract / Summary
Abstract Background Quantitative surveys of caregiver home management of malaria describe what caregivers do, but not why . Understanding the reasoning, constraints, and lived experience behind home management decisions is essential to designing interventions that caregivers can realistically adopt. Methods A qualitative study using ten focus group discussions (FGDs) was conducted with 70 caregivers of under-five children in three area councils of the Federal Capital Territory (FCT), Abuja, purposively selected to reflect the age and education range of the wider study population. Each FGD comprised seven participants and lasted approximately 45 minutes. Sessions were audio-recorded, transcribed, and analysed thematically, with two researchers independently coding transcripts to ensure inter-rater reliability. Results Six major themes emerged. Caregivers held partial and mixed knowledge of malaria, correctly identifying mosquito bites as a cause while simultaneously attributing malaria to dirty water and malnutrition. Home management was dominated by paracetamol, used correctly by dose but incorrectly as a substitute for antimalarial treatment, often combined with herbal remedies and followed by a period of observation before facility care was sought. Financial and structural barriers treatment cost, facility deposit requirements, poor health worker attitudes, and drug unavailability were the dominant drivers of home management over formal care. Awareness of national treatment guidelines was almost absent. Prevention knowledge existed but was not practised, most notably the absence of insecticide-treated nets despite caregivers’ awareness of their importance. Caregivers themselves recognised that home management was largely ineffective and proposed community sensitisation, decentralised healthcare access, and health worker training as solutions. Conclusion Caregivers’ home management decisions are shaped less by a lack of awareness than by structural and financial constraints that make formal care inaccessible, pushing caregivers toward a symptomatic, paracetamol-based home response. Interventions that address cost and facility-level barriers, alongside targeted correction of specific misconceptions, are likely to be more effective than knowledge-focused education alone.