Abstract
BackgroundIn Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use.MethodsA before and after qualitative study using key informant interviews (KII) and focus group discussions (FGDs) was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs) were trained in each village to dispense artemeter-lumenfantrine (AL) to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers.ResultsNone of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised.ConclusionOur findings showed that the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.
Highlights
In Nigeria artemisinin based combination therapy (ACT) use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect
Study site This study was conducted in 40 communities in two rural health districts selected by random sampling from the eight health districts that make up Ona-Ara Local Government area (LGA), in south western Nigeria from July 2005 to January 2007
In Ona-Ara LGA there is a Primary Health Care (PHC) unit at the LG headquarters and the coordinator of the unit is usually a medical doctor who oversees the activities of the health facilities in the LGA
Summary
In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. When orthodox treatments are given at home, dosages are often incorrect and inadequate [2,3,4] This may have contributed to the emergence of parasites resistant to the hitherto effective and cheap antimalarial drugs such as chloroquine and more recently sulphadoxine-pyrimethamine [5,6,7,8]. In an effort to stem the worsening morbidity and mortality due to drug resistant malaria, Nigeria changed its malaria treatment policy from chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) to artemisinin based combination therapy (ACT) in line with the WHO recommendation [9], with a preference for artemetherlumefantrine (AL) in January 2005 [8]. Effort during this study was directed at this important issue in order to safe-guard the clinical useful life of this newer and effective antimalarial drug combination
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