Anti-malarial prescribing practices in Sudan eight years after introduction of artemisinin-based combination therapies and implications for development of drug resistance

Abstract

BackgroundThe World Health Organization (WHO) recommends artemisinin-based combination therapies (ACTs) as first-line treatment for uncomplicated malaria. Sudan revised its malaria treatment policy accordingly in 2004. However, eight years after ACTs were introduced in Sudan the patterns of ACT prescribing practices among health care providers remain unclear. We systematically analyzed use of ACTs in a large number of primary health facilities and we discuss the public health implications of our findings.MethodsThis cross-sectional study was based on WHO’s guidance for investigating drug use in health facilities. Data were collected from 40 randomly selected primary health centers in five localities in Gezira State, Sudan. The primary outcome of the study was the proportion of patients who were adequately managed according to Sudan’s recommended malaria treatment guidelines. Twelve drug-use indicators were used to assess key ACT prescribing practices.ResultsOne thousand and two hundred patients diagnosed with uncomplicated malaria were recruited into the study. ACT was prescribed for 88.6%patients and artemether injections were (incorrectly) prescribed in 9.5% of cases. Only 40.9% of patients in the study were correctly diagnosed and 26.9% were adequately managed according to the nationally recommended treatment guidelines. Incorrect prescribing activities included failure to use generic medicine names (88.2%), incorrect dosage (27.7%), and unexplained antibiotic co-prescription (24.2%). Dispensing practices were also poor, with labeling practices inadequate (97.1%) and insufficient information given to patients about their prescribed treatment (50.5%).ConclusionIrrational malaria treatment practices are common in Sudan. This has important public health implications since failure to adhere to nationally recommended guidelines could play a role in the future development of drug resistance. As such, identifying ways to improve the anti-malarial prescribing practices of heath workers in Sudan may be a priority.

Patients’ adherence to antimalarial medication; self-report of patients at the Volta regional hospital of Ho, Ghana

“…As reported by Elmannan et al, cost of drug is a major factor influencing drug adherence. 36 Though Ghana and many other African countries have seen price subsidies on the cost of malaria medication, most (over 53%) of the respondents in this study still agreed that the cost of the medication is a hindrance to their adherence to the medication. The government of Ghana is already working hard at reducing the cost burden of healthcare in Ghana through the national health insurance scheme (NHIS) which will go a long way to reduce cost of most anti-malarial medication.…”

Bibliometric Analysis of Worldwide Publications on Antimalarial Drug Resistance (2006–2015)

“…The ACTs are considered first-line treatment of malaria in most countries and hundreds of millions of ACTs treatment courses were dispensed in the past few years in endemic countries [ 76 ]. Therefore drug use without appropriate combination is one mechanism responsible for the development of AMDR [ 77 ]. Furthermore, unregulated and irrational use of antimalarial drug use as well as counterfeit and poor quality medicines dispensed in Africa and other parts of the world might be responsible for the spread and development of AMDR [ 78 – 80 ].…”

Patients’ Knowledge, Attitudes, and Practices on Uncomplicated Malaria Management in Plateau State, North-Central Nigeria

“…A multistage probability sampling techniques including stratified and simple random approaches were used in selecting 24 public PHC facilities across the state, and 50 patients receiving treatment for uncomplicated malaria during the study period were recruited from each of the selected PHC facilities, totaling 1200 calculated sample size for patients to participate in the study [20]. The sample size for the survey was estimated in accordance with the World Health Organization manual on how to investigate drug use in health facilities [20,21].…”