Prescribers� compliance with quinine use for treating uncomplicated malaria in the first trimester of pregnancy in polyclinics in Accra

Abstract

Introduction : malaria is a public health problem affecting vulnerable populations in sub-Saharan Africa. The recommended regimen for treating uncomplicated Plasmodium falciparum malaria in the first trimester of pregnancy is 10 mg/kg body weight of oral Quinine given three times daily for 7 days or 10 mg/kg body weight of Quinine plus clindamycin to be taken orally 3 times daily for 3 days. However, little is known about the proportion of prescribers who comply with this guideline in health facilities in Ghana.This study sought to find out whether prescribers in polyclinics in the Accra Metropolis comply with the use of Quinine in the treatment of uncomplicated malaria in the first trimester of pregnancy and also assess factors that influence prescriber’s compliance with the Standard Treatment Guidelines (STG). Methods : a descriptive cross-sectional study approach involving the use of a structured questionnaire to collect data from 75 prescribers at polyclinics in Accra. Bivariate analysis was used to show associations between independent variables and compliance with Quinine prescription. Factors predictive of Quinine compliance were determined by multivariate analysis. Results : the results showed low level of prescriber compliance with regards to the treatment guidelines i.e. 17/75 (22.7%) prescribers treated pregnant women in their first trimester with Quinine or Quinine plus Clindamycin. Treatment frequently prescribed was Artemether-lumefantrine 46/75 (61.3%), Artesunate-amodiaquine 12/75 (16.0%) and Quinine 17/75 (22.7%). Prescriber’s age, educational status and duration of practice did not influence compliance with Quinine prescription. However, the availability of the guideline (p = 0.025) and side effects of Quinine (p = 0.017) influenced prescribers compliance. Conclusion : low level of compliance with regards to Quinine prescription may have serious clinical implications as pregnant women in their first trimester who have malaria may not be receiving the right treatment. Furthermore, because the ACTs have not widely been tested for safety due to limited data means that pregnant women and their fetuses are probably being put in harm’s way. This therefore calls for intensified effort to educate prescribers.