Abstract
BackgroundPolicymakers have recognized that proprietary patent medicine vendors (PPMVs) can provide an opportunity for effective scaling up of artemisinin-based combination therapy (ACT) since they constitute a major source of malaria treatment in Nigeria. This study was designed to determine the stocking pattern for anti-malarial medications, knowledge of the recommended anti-malarial medicine among PPMVs in Akinyele Local Government Area (LGA) of Oyo State, Nigeria and their perception on ways to improve PPMV adherence to stocking ACT medicines.MethodsA cross-sectional survey was conducted among 320 PPMVs using a mixed method of data collection. Survey respondents were consecutively selected as a complete listing of all the PPMVs was not available. A pretested interviewer-administered questionnaire was used to collect quantitative data and two focus group discussions (FGD) were conducted among PPMVs using a pretested FGD guide.ResultsMost PPMVs stocked artemether-lumefantrine (90.9%), dihydroartemisinin-piperaquine (5.3%) and artesunate-amodiaquine (2.8%). Drugs contrary to the policy, which included sulfadoxine-pyrimethamine, chloroquine, quinine, halofantrine, artesunate, and artemether were stocked by 93.8, 22.8, 0.6, 1.3, 6.6, and 7.8% of the PPMVs, respectively. Most PPMVs (96.3%) had good knowledge of artemether-lumefantrine as the first-line treatment for malaria and 2.8% had good knowledge of artesunate-amodiaquine as the alternate treatment for malaria. The major factors influencing stocking decision were government recommendations (41.3%) and consumer demand (40.30%).ConclusionStocking of artemisinin-based combinations was high among PPMVs, although they also stocked and dispensed other anti-malarial drugs and this has serious implications for drug resistance development. The PPMVs had considerable knowledge of the recommended treatment for uncomplicated malaria and stocking decisions were overwhelmingly driven by consumer demand. However, there is a need for more enlightenment on discontinuation of government-banned anti-malarial drugs.
Highlights
Policymakers have recognized that proprietary patent medicine vendors (PPMVs) can provide an opportunity for effective scaling up of artemisinin-based combination therapy (ACT) since they constitute a major source of malaria treatment in Nigeria
Akinyele Local Government Area (LGA) is endemic for malaria, to other parts of Oyo State, and home management of malaria using drugs bought from PPMVs is a common practice among caregivers in Nigeria including those in this study LGA (Fig. 1)
This study revealed that a high proportion of the PPMVs stored anti-malarial medications in acceptable storage conditions as documented by ACT watch Group in an outlet survey conducted in Nigeria [23]
Summary
Policymakers have recognized that proprietary patent medicine vendors (PPMVs) can provide an opportunity for effective scaling up of artemisinin-based combination therapy (ACT) since they constitute a major source of malaria treatment in Nigeria. Many people with malaria do not attend health facilities and choose self-medication, using drugs bought from private sectors such as proprietary patent medicine vendors (PPMVs) because they are readily accessible [2]. Artemisinin-based combination therapy (ACT) has been adopted for first-line treatment of uncomplicated malaria since 2005 in Nigeria, 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 [6]. Inadequate and poor knowledge and practices in the use of artemisinin-based combinations, which is the government-recommended anti-malarial medicine, increases morbidity and mortality, undermines therapeutic efficacy and promotes the emergence and spread of drug-resistant malaria parasites
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