Abstract
Following highly prevalent Plasmodium resistant strains to antimalarial monotherapies in malaria endemic countries, uncomplicated malaria treatment policy changed to artemisinine-based combination therapies (ACTs). After adoption of this new treatment policy in a country, sufficient care is needed to be taken to prevent occurrence of resistance to the latest drugs. As Cameroon shifted to ACT in 2004, this study aimed to assess knowledge and practices of health workers in government health facilities of the Littoral region regarding mild malaria management in health facilities as well as according to prescription qualities of ACTs in leaflets received in pharmacies. A total of 66 physicians and 16 nurses were questioned in 10 health facilities and 503 medical leaflets with ACTs prescriptions were viewed in 17 pharmacies. All medical workers questioned correctly were defined mild malaria and were aware of the antimalarial policy change in Cameroon. Overall ACTs prescription for mild malaria management in children and adult patients was 72.2% and 87.8% respectively. An important proportion of health workers prescribed antimalarial monotherapies and non recommended antimalarial for uncomplicated malaria treatment. 31.7% of participants did not systematically recommend laboratory diagnostic test before antimalarial prescription. Of leaflets viewed in pharmacies, ACTs were prescribed by physicians, nurses and laboratory technicians. Age was the only criteria for ACTs prescription. Appropriate ACTs quality prescription ranged between 81.2% and 94.4%. Of the ACTs prescribed, blisters had the highest (92.9%) appropriate quality prescription and solutions the lowest (83.3%). According to qualification of prescribers, physicians had the highest score (93.1%) of appropriate quality prescription and laboratory technicians the lowest score (28.1%). For all ACTs containing medical leaflets, concomitant medications were recorded namely antipyretic (73.9%), antibiotic (21.9%), non steroid anti-inflammatory (19.9%) or vitamins (18.1%). Data gathered indicated that although health workers were aware of uncomplicated malaria treatment policy change in Cameroon, mild malaria mismanagement was prevailing in health facilities of the Littoral region and ACTs quality prescription in medical leaflets was not optimal. Therefore, awareness is still needed among prescribers in order to prevent or at least slow the occurrence of Plasmodium resistant strains to ACTs in Cameroon.
Highlights
Malaria is a life threatening parasitic disease leading to an estimate 584,000 deaths in 2013, the World Health Organization (WHO) African Region owing the heaviest burden with an estimated 90% of all malaria deaths worldwide, and children aged under 5 years old accounting for 78% of all deaths [1] [2]
Health facilities used in this study were the 2 reference hospitals of the Littoral region namely the Douala General Hospital and the Douala Laquintinie Hospital, the 2 regional hospitals of the Littoral region namely Edea and Nkongsamba regional hospitals, 3 district hospitals selected in three administrative divisions and 3 government integrated health centres selected in three administrative divisions
A total of 503 medical leaflets with artemisinine-based combination therapies (ACTs) prescriptions were viewed in 17 pharmacies situated in the 5 subdivisions of Douala town
Summary
Malaria is a life threatening parasitic disease leading to an estimate 584,000 deaths in 2013, the WHO African Region owing the heaviest burden with an estimated 90% of all malaria deaths worldwide, and children aged under 5 years old accounting for 78% of all deaths [1] [2]. Plasmodium chemoresistant strains occurred to almost all monotherapeutic antimalarial drugs [3] [4] in Thailand in 1957 increasingly spread from East to West, towards South-Eastern Asia and reached sub-Saharan African countries in the years 1970s [4] [5]. This outbreak of Plasmodium chemoresistant to monotherapies contributed to a worldwide increase in malaria-related mortality, dramatic in sub-Saharan Africa as few affordable alternatives were available. Incorrect uses of drugs probably lead to the selection of resistant parasites which became evident during the Global Malaria Eradication campaign, launched by World Health Organization (WHO) in 1955
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