Abstract
BackgroundMalaria is endemic in Equatorial Guinea with stable transmission, and it remains a major cause of morbidity and mortality in children under 5 years of age. Adherence to artemisinin-based combination therapy (ACT) as a first-line treatment for uncomplicated malaria is critical to malaria control. Six years after the introduction of artesunate-amodiaquine (AS/AQ) therapy in Equatorial Guinea, adherence to the first-line treatment seems to be low in the Bata district. The factors associated with the choice of malaria treatment have not been studied previously in this area; therefore, this study aimed to analyse the preference and use of artemether as malaria treatment and its related factors in the Bata district of Equatorial Guinea.MethodsIn 2013, a cross-sectional study was conducted in the Bata district, which involved 428 households. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical, and behavioural factors that played a role in the preference and use of artemether as malaria treatment.ResultsArtemether was considered the best treatment for malaria by 110 caregivers (26%), and was the antimalarial most administrated in the Bata district. It was prescribed to 117 children (27.34%); while, only 6.78% were administered AS/AQ. Caregivers living ≤ 3 km from the nearest health facility were almost two times more likely to consider artemether as the best treatment than those living farther away (95% CI 0.31–0.86). Caregivers with at least a secondary school education were 2.7 times more likely to consider artemether as the best treatment than those less educated. Children whose caregivers considered artemether the best treatment against malaria were five times more likely to be treated with artemether than children with caregivers who did not consider it the best (OR 5.07, 95% CI 2.93–8.78). In contrast, children that reported weakness as a symptom were less likely to be treated with artemether than those with other symptoms (OR 0.47, 95% CI 0.28–0.78).ConclusionCaregivers, public and private health staff, and drug sellers need to understand the importance of using ACT to treat uncomplicated malaria and the dangers of using artemisinin monotherapy.
Highlights
Malaria is endemic in Equatorial Guinea with stable transmission, and it remains a major cause of mor‐ bidity and mortality in children under 5 years of age
When asked about the treatment prescribed to their child during the last malaria episode, the anti-malarial drugs most administrated were artemether to 117
Treatment with artemether was more expensive than artesu‐ nate-amodiaquine (AS/AQ) (Fig. 1), with a median costs of 10,000 (IQR:6700–18,000) CFA (18.7 USD) and 4000 (IQR:2000–15,750) CFA (7.5 USD), respectively
Summary
Malaria is endemic in Equatorial Guinea with stable transmission, and it remains a major cause of mor‐ bidity and mortality in children under 5 years of age. Adherence to artemisinin-based combination therapy (ACT) as a first-line treatment for uncomplicated malaria is critical to malaria control. Emergence and spread of artemisinin resistance has been detected in Southeast Asia [4] and is threatening global malaria control and elimination efforts, especially in sub-Saharan Africa, where the disease burden is highest and systems for monitoring treatment compliance and containment of resistance are weak [5]. Adherence to this ACT firstline treatment is critical to the success of malaria control
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