Caregivers’ experience in pediatric malaria treatment acceptability and cost: a mixed methods study in South Ethiopia

<title>Abstract</title> <p> Background Malaria remains a major cause of childhood morbidity and mortality, particularly in Africa, which accounts for 95% of global malaria death, with 75% occurring in children under five years of age. As primary decision-makers, caregivers play a pivotal role in healthcare-seeking and treatment-adherence for children with malaria. However, the influence of caregivers’ knowledge, attitudes, lived experiences, and economic burden on treatment behaviors remains poorly understood. This study examined how these factors shape healthcare-seeking, treatment acceptability, and adherence among caregivers of children with malaria. Methods A concurrent mixed-methods design was embedded within a clinical trial of pediatric <italic>P. vivax</italic> , which assessed the efficacy of a radical cure regimen of flavored pediatric primaquine formulations. Knowledge, attitude, and practice (KAP), and household costs of pediatric malaria data were collected from 120 caregivers using structured questionnaires and analyzed descriptively. Qualitative data were generated through focus group discussions with 29 caregivers, to explore lived experiences related to medication taste, packaging, dosing, and adherence. Quantitative and qualitative findings were triangulated and integrated during interpretation to develop a comprehensive understanding of caregivers’ knowledge, attitudes, practices, experiences, and treatment behaviors. Results Overall, there was high knowledge-practice gap. Caregivers possessed high awareness of malaria transmission and prevention; most recognized it as preventable (97%) and potentially fatal if untreated (95%). However, this failed to translate into preventive practices: only 48.3% reported good prevention behaviors and 13.3% sought timely healthcare. The critical knowledge-practice gap is influenced by systemic and socioeconomic barriers. Self-medication and traditional remedies were common, and some households experienced catastrophic expenditure. Although caregivers emphasized the importance of completing treatment, adherence was influenced by challenges related to drug taste, dosing, and packaging. The flavored pediatric primaquine formulation was well accepted because of its improved palatability and supportive communication from healthcare workers. Conclusion The study revealed a critical knowledge–practice gap whereby high caregiver awareness did not consistently translate into appropriate actions because of systemic and socioeconomic barriers, as well as challenges related to medication palatability and lack of fit-for-purpose packaging. Tailored community education, child-friendly drug formulations, and appropriately designed packaging were seen as positive steps to strengthening radical cure implementation. </p>