Abstract
BackgroundAt primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received.MethodsA cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria.ResultsAlthough 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001).ConclusionFew febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision.
Highlights
At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT)
Patient characteristics Data were collected from 100 health facilities and the analysis is based on exit data collected from 1,642 febrile patients attending public facilities and medicine retailers and 149 health workers (Figure 1)
More than half (57%) of the patients treated at public health facilities were children, while 80% of the cases presenting at pharmacies and patent medicine dealers (PMDs) were adults
Summary
At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. ACT became the recommended treatment for uncomplicated malaria, as resistance emerged to conventional monotherapies, including sulphadoxine-pyrimethamine (SP), chloroquine and amodiaquine, thereby reducing their therapeutic efficacy. Countries have revised their national malaria treatment policies to adopt ACT as the first-line recommended treatment for Evidence from several settings on malaria case management report problems with the choice of treatment, showing that ACT is often underused and many patients continue to receive less effective anti-malarials, such as SP [2,3,4]. Problems with the dispensing of malaria treatment have been observed, with patients frequently receiving inadequate doses and without advice on how the medicines should be taken [2,7]. Ensuring accuracy of drug dispensing is challenging for pharmacies and other drug retailers which typically stock a multitude of different types of ACT and the accurate dosage depends on the patient’s age or weight but varies by brand depending on the formulation and composition of the active ingredients [8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
