Abstract

BackgroundMalaria still remains a life-threatening disease worldwide causing between 190 and 311 million cases of malaria in 2008. Due to increased resistance to sulphadoxine-pyrimethamine (SP), the Ministry of Health in Malawi, as in many sub-Saharan African countries, changed the malaria treatment policy to use artemisinin-based combination therapy (ACT). In order to optimize the correct use of this drug, and protect against the development of the parasite's resistance, it is important to assess the knowledge and practices of medical practitioners on the use of ACT and its impact on adherence to new treatment policy guidelines.MethodsA cross-sectional survey was conducted to assess the knowledge and perceptions of Malawian medical doctors and pharmacists on the use of ACT and the drivers of treatment choice and clinical treatment decisions. Medical doctors and pharmacists who are involved in managing malaria patients in Malawi were recruited and a self-administered questionnaire was used to obtain information on socio-demographic characteristics of the study participants, knowledge on ACT, source of information on ACT and methods used to decide on the treatment of patients with malaria.ResultsMost of the participants (95.7%) know at least one form of ACT, 67.4% reported that different forms of ACT have different characteristics, 77.3% reported that there are special formulations for children. The most commonly mentioned ACT was artemether-lumefantrine (AL), by 94.6% of the participants and 75.0% of the participants indicated that they prefer to prescribe AL. 73.9% of participants had ever received information on ACT. However, only 31.5% had received training on management of malaria using ACT. There were 71.7% respondents who had heard of ACT causing side effects. Only 25.0% of the participants had received training on how to report SAEs.ConclusionIt was found that most of the participants know about ACT and treatment guidelines for malaria. However, most of the participants have not received any training on how to use ACT and how to report adverse effects arising from the use of ACT. There is need for more training of health care professionals to ensure correct and effective use of ACT.

Highlights

  • Malaria still remains a life-threatening disease worldwide causing between 190 and 311 million cases of malaria in 2008

  • Using a list obtained from the Malawi Medical Council and the Pharmacy Medicines and Poisons Board (PMPB), a random sample of medical doctors and pharmacists who manage patients with malaria or dispense antimalarials in the Demographic characteristics of study participants Data was obtained from 44.9% (92/205) of the doctors and pharmacists listed on the Malawi Medical Council and PMPB register

  • Malaria diagnosis practices and knowledge on malaria treatment guidelines Most respondents reported that they diagnosed malaria using microscopy (73.1%, n = 60/82), some used both Rapid Diagnostic Tests (RDTs) and microscopy (25.6%, n = 21/82)

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Summary

Introduction

Malaria still remains a life-threatening disease worldwide causing between 190 and 311 million cases of malaria in 2008. Due to increased resistance to sulphadoxine-pyrimethamine (SP), the Ministry of Health in Malawi, as in many sub-Saharan African countries, changed the malaria treatment policy to use artemisinin-based combination therapy (ACT). Malaria still remains a major public health problem worldwide. It is estimated that between 190 and 311 million cases of malaria occurred in 2008 (1). Due to the widespread resistance to chloroquine and sulphadoxine-pyrimethamine (SP), the World Health Organization (WHO) currently recommends the use of artemisinin-based combination therapy (ACT) for the treatment of Plasmodium falciparum infection, and Plasmodium vivax infection resistant to chloroquine. There are several forms of ACT that are currently being used for treatment of malaria including artemether-lumefantrine (AL), artesunate-mefloquine, artesunate-amodiaquine, artesunatesulphadoxine-pyrimethamine (SP), and dihydroartemisinin-piperaquine (DHA-PQ)[4]

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