Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria

Abstract

BackgroundAt primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received.MethodsA cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria.ResultsAlthough 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001).ConclusionFew febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision.

Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy

“…The study by Mangham et al in 2009, about five years after policy change in the same area suggested utilization rate of 24.2% for ACT in medicine outlets using patients’ exit questionnaires [2]. Findings corroborate the results of previous, related studies in the area in terms of availability and utilization of anti-malarial drugs [2,5,6,8]. Prescriptions were mostly adults, while children cases were limited, comprising prescriptions from hospitals.…”

Malaria Case-Management following Change of Policy to Universal Parasitological Diagnosis and Targeted Artemisinin-Based Combination Therapy in Kenya

“…This is of particular concern for simultaneous absence of all four AL packs which precludes effective treatment and is likely to be associated with increased childhood mortality as shown in Western Kenya [11]. Yet, ACT stock-outs revealed in our study are not unique reports – they had been reported from Uganda [12], Zambia [13], Nigeria [14], Sudan [15], Tanzania [16], Senegal [17], and indeed in the previous smaller studies in Kenya [10]. Similarly to AL availability, no significant changes were observed during 2010 in the capacity of health facilities to provide parasitological diagnosis resulting in an overall gap of 42% of facilities unable to provide either malaria microscopy or RDT diagnostic services.…”

Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence

“…The data suggest an association between the use of ACTs for positive mRDTs and baseline preferences for, or use of, ACTs rather than other antimalarials. For example, in Nig1, where ACT use was generally low, prior to the intervention, other antimalarials were asked for by patients, prescribed and purchased more commonly than ACTs 34. In contrast, in Tanz1, where adherence to RDT positive results was higher, according to stakeholder interviews, ACTs were patients' preferred antimalarial.…”