Why Don’t Medical Practitioners Treat Malaria Rationally? A Qualitative Study from Pakistan

Malik, Madeeha; Hassali, Maa; Shafie, A.A.

doi:10.4314/tjpr.v11i4.20

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Given the relative affordability and accessibility of non-artemisinin therapies, health workers at private health facilities are likely to choose incorrect and ineffective antimalarial drugs for the treatment of malaria. This finding is in line with the results of a study done by Malik et al [15] which assessed the quality of anti-malarial drugs provided by public and private healthcare providers and found that monotherapies such as chloroquine, SP, quinine, artesunate, and dihydroartemisinin were still widely used for treatment of malaria.…”

Section: Discussionsupporting

confidence: 90%

Assessment of Compliance with National Guidelines on Diagnosis and Treatment of Malaria among Health Workers in Anambra State, Nigeria

Dim,

Nwafia,

Ibeh

et al. 2023

IJTDH

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Background: Malaria case management remains a crucial component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, shreds of evidence have shown some deviations from the guidelines in malaria case management. This study assessed compliance with national guidelines on the diagnosis and treatment of malaria among health workers in Anambra State. Materials and Methods: This comparative, cross-sectional hospital-based study was carried out among 360 healthcare workers selected from six Local Government Areas using a multistage sampling technique. A pre-tested interviewer-administered questionnaire was used to collect data on their socio-demographics and other vital information. Results: The findings of this study revealed that Ninety-eight respondents (54.4%) from public health facilities had adequate knowledge of malaria case management compared to 67 respondents (37.2%) from private health facilities (p=0.001). The overall level of compliance with the national guidelines shows that only 22.2% of the health workers interviewed strictly complied with the national guidelines. It was significantly higher among public healthcare workers (31.7%) compared to 12.8% of private health workers (p<0.001). Training on malaria case management, access to national guidelines, availability of malaria diagnostic tools, and sex of the health workers were associated with compliance with national guidelines in both public and private health facilities (p<0.001). Conclusion: The findings of this study revealed a close similarity between the two health facilities in the level of awareness of the national malaria treatment guidelines, but a remarkable difference in compliance to appropriate case management of malaria between public and private health facilities. Interventions to improve private sector engagement in the implementation of the guidelines, training, and supply of recommended anti-malarial medicines should be intensified.

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Section: Discussionsupporting

confidence: 90%

Assessment of Compliance with National Guidelines on Diagnosis and Treatment of Malaria among Health Workers in Anambra State, Nigeria

Dim,

Nwafia,

Ibeh

et al. 2023

IJTDH

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“…Hence, unless health workers and community members are informed through appropriate channels about the most effective tools for preventing and treating malaria, their welfare will suffer [ 13 ]. Other studies found that health care workers provided inappropriate treatment due to lack of awareness of appropriate malaria treatment guidelines [ 25 , 27 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

A qualitative study on health workers’ and community members’ perceived sources, role of information and communication on malaria treatment, prevention and control in southeast Nigeria

et al. 2015

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BackgroundIt has been widely acknowledged that well-planned and executed communication programmes can contribute to achieving malaria prevention and treatment goals. This however requires a good understanding of current sources and roles of information used by both health workers and communities. The study aimed at determining health workers’ and community members’ sources, value and use of information on malaria prevention and treatment in Nigeria.MethodsQualitative data was collected from six selected communities (three urban and three rural) in Enugu state, southeast Nigeria. A total of 18 Focus Group Discussions (FGDs) with 179 community members and 26 in-depth interviews (IDIs) with health workers in public and private health facilities were used to collect data on where people receive treatment for malaria and access information on malaria. The FGDS and IDIs also provided data on the values, uses and effects of information and communication on malaria treatment seeking and provision of services.ResultsThe findings revealed that the major sources of information on malaria for health workers and community members were advertisements in the mass media, workshops and seminars organized by donor agencies, facility supervision, posters, other health workers, television and radio adverts. Community involvement in the design and delivery of information on malaria control was seen as a strong strategy for improving both consumer and provider knowledge. Information from the different sources catalyzed appropriate provision and consumption of malaria treatment amongst health workers and community members.ConclusionHealth workers and consumers receive information on malaria prevention and treatment from multiple sources of communication and information, which they find useful. Harnessing these information sources to encourage consistent and accurate messages around malaria prevention and treatment is a necessary first step in the design and implementation of malaria communication and behaviour change interventions and ultimately for the sustained control of malaria.

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“…Chloroquine is no longer indicated for treatment of P. falciparum but is recommended in combination with primaquine for treatment of P. vivax . Although the nature of anti-malarial use in Pakistan is not well-characterized, the availability of SP and other drugs as monotherapy has been documented [48] and, along with misdiagnosis of mixed infections [49] and presumptive treatment [50], likely results in P. vivax infections being frequently treated with AS + SP or SP alone. This study sought to characterize the current distribution of chloroquine resistance-associated polymorphisms in pvmdr1 and SP resistance-associated point mutations in pvdhfr and pvdhps in Pakistan.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and patterns of antifolate and chloroquine drug resistance markers in Plasmodium vivax across Pakistan

Khattak

Venkatesan

Khatoon

et al. 2013

Malar J

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BackgroundPlasmodium vivax is the most prevalent malaria species in Pakistan, with a distribution that coincides with Plasmodium falciparum in many parts of the country. Both species are likely exposed to drug pressure from a number of anti-malarials including chloroquine, sulphadoxine-pyrimethamine (SP), and artemisinin combination therapy, yet little is known regarding the effects of drug pressure on parasite genes associated with drug resistance. The aims of this study were to determine the prevalence of polymorphisms in the SP resistance-associated genes pvdhfr, pvdhps and chloroquine resistance-associated gene pvmdr1 in P. vivax isolates collected from across the country.MethodsIn 2011, 801 microscopically confirmed malaria-parasite positive filter paper blood samples were collected at 14 sites representing four provinces and the capital city of Islamabad. Species-specific polymerase chain reaction (PCR) was used to identify human Plasmodium species infection. PCR-positive P. vivax isolates were subjected to sequencing of pvdhfr, pvdhps and pvmdr1 and to real-time PCR analysis to assess pvmdr1 copy number variation.ResultsOf the 801 samples, 536 were determined to be P. vivax, 128 were P. falciparum, 43 were mixed vivax/falciparum infections and 94 were PCR-negative for Plasmodium infection. Of PCR-positive P. vivax samples, 372 were selected for sequence analysis. Seventy-six of the isolates (23%) were double mutant at positions S58R and S117N in pvdhfr. Additionally, two mutations at positions N50I and S93H were observed in 55 (15%) and 24 (7%) of samples, respectively. Three 18 base pair insertion-deletions (indels) were observed in pvdhfr, with two insertions at different nucleotide positions in 36 isolates and deletions in 10. Ninety-two percent of samples contained the pvdhps (S382/A383G/K512/A553/V585) SAKAV wild type haplotype. For pvmdr1, all isolates were wild type at position Y976F and 335 (98%) carried the mutation at codon F1076L. All isolates harboured single copies of the pvmdr1 gene.ConclusionsThe prevalence of mutations associated with SP resistance in P. vivax is low in Pakistan. The high prevalence of P. vivax mutant pvmdr1 codon F1076L indicates that efficacy of chloroquine plus primaquine could be in danger of being compromised, but further studies are required to assess the clinical relevance of this observation. These findings will serve as a baseline for further monitoring of drug-resistant P. vivax malaria in Pakistan.

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Why Don’t Medical Practitioners Treat Malaria Rationally? A Qualitative Study from Pakistan

Cited by 4 publications

References 11 publications

Assessment of Compliance with National Guidelines on Diagnosis and Treatment of Malaria among Health Workers in Anambra State, Nigeria

Assessment of Compliance with National Guidelines on Diagnosis and Treatment of Malaria among Health Workers in Anambra State, Nigeria

A qualitative study on health workers’ and community members’ perceived sources, role of information and communication on malaria treatment, prevention and control in southeast Nigeria

Prevalence and patterns of antifolate and chloroquine drug resistance markers in Plasmodium vivax across Pakistan

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