Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda

Anthony K Mbonye,Pascal Magnussen,Sham Lal,Siân Clarke,Kristian Schultz Hansen,Bonnie Cundill

doi:10.1186/1475-2875-12-131

Abstract

BackgroundSince drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use. As part of a cluster randomized trial to examine impact on appropriate treatment of malaria in drug shops in Uganda and adherence to current malaria treatment policy guidelines, a survey was conducted to estimate baseline prevalence of, and factors associated with, appropriate treatment of malaria to enable effective design and implementation of the cluster randomized trial.MethodsA survey was conducted within 20 geographical clusters of drug shops from May to September 2010 in Mukono district, central Uganda. A cluster was defined as a parish representing a cluster of drug shops. Data was collected using two structured questionnaires: a provider questionnaire to capture data on drug shops (n=65) including provider characteristics, knowledge on treatment of malaria, previous training received, type of drugs stocked, reported drug sales, and record keeping practices; and a patient questionnaire to capture data from febrile patients (n=540) exiting drug shops on presenting symptoms, the consultation process, treatment received, and malaria diagnoses. Malaria diagnosis made by drug shop vendors were confirmed by the study team through microscopy examination of a blood slide to ascertain whether appropriate treatment was received.ResultsAmong febrile patients seen at drug shops, 35% had a positive RDT result and 27% had a positive blood slide. Many patients (55%) had previously sought care from another drug shop prior to this consultation. Three quarters (73%) of all febrile patients seen at drug shops received an anti-malarial, of whom 39% received an ACT and 33% received quinine. The rest received another non-artemisinin monotherapy. Only one third (32%) of patients with a positive blood slide had received treatment with Coartem® while 34% of those with a negative blood slide had not received an anti-malarial. Overall appropriate treatment was 34 (95% CI: 28 – 40) with substantial between-cluster variation, ranging from 1% to 55%.ConclusionIn this setting, the proportion of malaria patients receiving appropriate ACT treatment at drug shops was low. This was due to the practice of presumptive treatment, inadequate training on malaria management and lack of knowledge that Coartem® was the recommended first-line treatment for malaria. There is urgent need for interventions to improve treatment of malaria at these outlets.

Highlights

Since drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use
In Uganda and elsewhere, effective treatment of fever has been hampered by inappropriate treatment practices, in rural areas where there is poor access to formal health facilities and self-treatment is the commonest form of care-seeking [3,4,5,6,7]
Parishes were deemed eligible for inclusion in the trial if they: i) contained a health centre II, the lowest public health facility where early treatment is sought; ii) contained more than 200 households to ensure a sufficient number of patients visiting the drug shops; and iii) contained at least one registered drug shop registered with the District Drug Inspector (DDI)

Summary

Introduction

Since drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use. In Uganda and elsewhere, effective treatment of fever has been hampered by inappropriate treatment practices, in rural areas where there is poor access to formal health facilities and self-treatment is the commonest form of care-seeking [3,4,5,6,7]. Inappropriate treatment practices include, on the one hand, the continuing overdiagnosis of malaria and over-treatment with anti-malarial drugs among patients presenting with a fever [8,9,10], constituting an unnecessary waste of resources. RDTs are affordable, quick, accurate and relatively easy to perform with minimal training [12,13,14,15]

Methods

Results

Conclusion