Client choice of health care treatment in rural Mali.
Factors influencing choice of type of health care--modern, traditional or self-care--in the Kayes region of rural Mali were subjected to logistic demand analysis. Data were collected from a 1981 survey of 186 households with 2430 persons in 38 villages, where per capita income was below $200, infant mortality was 225/1000 and life expectancy was around 32 years. Cost variables affected choice in terms of distance to a facility and quality of care. Traditional medicine may be chosen if the dispensary were too distant (mean distance was 14 km), or even if it offered quality care, because qualified staff worked fewer hours and often turned down clients. Modern drugs cost 150% as much as the retail price in France, and stocks were limited in variety, but people used them if available, especially if they had remittance income. There were 275 incidents of morbidity reported in 1 year, most often abdominal complaints, pertussis, measles, malaria, onchocerciasis or other parasites. Some illnesses were not reported at all, e.g. goiter. The study implied that public funds be invested in preventive medicine, water and sanitation, and that drug supplies, paid for by individuals, be improved to meet demand for curing symptoms.