Abstract
BackgroundMalaria treatment policy recommends regular monitoring of drug utilization to generate information for ensuring effective use of anti-malarial drugs in Nigeria. This information is currently limited in the retail sector which constitutes a major source of malaria treatment in Nigeria, but are characterized by significant inappropriate use of drugs. This study analyzed the use pattern of anti-malarial drugs in medicine outlets to assess the current state of compliance to policy on the use of artemisinin-based combination therapy (ACT).MethodsA prospective cross-sectional survey of randomly selected medicine outlets in Enugu urban, southeast Nigeria, was conducted between May and August 2013, to determine the types, range, prices, and use pattern of anti-malarial drugs dispensed from pharmacies and patent medicine vendors (PMVs). Data were collected and analyzed for anti-malarial drugs dispensed for self-medication to patients, treatment by retail outlets and prescription from hospitals.ResultsA total of 1,321 anti-malarial drugs prescriptions were analyzed. ACT accounted for 72.7%, while monotherapy was 27.3%. Affordable Medicines Facility-malaria (AMFm) drugs contributed 33.9% (326/961) of ACT. Artemether-lumefantrine (AL), 668 (50.6%) was the most used anti-malarial drug, followed by monotherapy sulphadoxine-pyrimethamine (SP), 248 (18.8%). Median cost of ACT at $2.91 ($0.65-7.42) per dose, is about three times the median cost of monotherapy, $0.97 ($0.19-13.55). Total cost of medication (including co-medications) with ACT averaged $3.64 (95% CI; $3.53-3.75) per prescription, about twice the mean cost of treatment with monotherapy, $1.83 (95% CI; $1.57-2.1). Highest proportion 46.5% (614), of the anti-malarial drugs was dispensed to patients for self-treatment. Treatment by retail outlets accounted for 35.8% while 17.7% of the drugs were dispensed from hospital prescriptions. Self-medication, 82%, accounted for the highest source of monotherapy and a majority of prescriptions, 85.6%, was adults.ConclusionFindings suggest vastly improved use of ACT in the retail sector after eight years of policy change, with significant contributions from AMFm drugs. However the use of monotherapy, particularly through self-medication remains significant with increasing risk of undermining treatment policy, suggesting additional measures to directly target consumers and providers in the sector for improved use of anti-malarial drugs in Nigeria.
Highlights
IntroductionIn recognition of the role played by the private sector and the drug supply chain on the high cost of anti-malarial drugs, the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), in collaboration with malaria partners, introduced the Affordable Medicine Facility-malaria (AMFm) in 2009, to reduce the cost of supply and improve access to the utilization of quality artemisinin-based combination therapy (ACT) in low-income countries [10]
Malaria treatment policy recommends regular monitoring of drug utilization to generate information for ensuring effective use of anti-malarial drugs in Nigeria
In Nigeria, artemisinin-based combination therapy (ACT) has been adopted for first-line treatment of uncomplicated malaria since 2005, evidence abounds on the improper use of anti-malarial drugs, such as the use of monotherapy and other less effective anti-malarial drugs, as well as inappropriate use of ACT [2]
Summary
In recognition of the role played by the private sector and the drug supply chain on the high cost of anti-malarial drugs, the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), in collaboration with malaria partners, introduced the Affordable Medicine Facility-malaria (AMFm) in 2009, to reduce the cost of supply and improve access to the utilization of quality ACT in low-income countries [10] This was complemented with public campaigns and targeted provider-training to increase uptake of effective anti-malarial drugs. This study aimed to analyse the current demand and utilization pattern of anti-malarial drugs in medicine retail outlets in Enugu urban, in relation to ACT policy in order to generate information for improving effective implementation of malaria treatment policy
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