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Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the 'test and treat' policy of malaria case management.

Ezenduka CC, Okonta MJ, Esimone CO - J Pharm Policy Pract (2014)

Bottom Line: Overall, median cost of medication was N1160.00 (US$7.48 (US$0.19 - 267.87) per case, higher in tertiary than the secondary facility.There were significant variations in treatment practices between the two facilities.However, there exists significant scope for improved diagnosis and rational drug use, to enhance accuracy of treatment, reduced wastages and risks of adverse drug reactions, in line with the goals of 'test and treat' policy of malaria case management.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University Awka Agulu campus, Agulu, Nigeria.

ABSTRACT

Objectives: Adherence to treatment guidelines for uncomplicated malaria is critical to the success of malaria case management. Poor adherence has implications for increased malaria burden, in view of the risk of widespread parasite resistance and treatment failures. This study analyzed the diagnostic and prescription pattern for uncomplicated malaria at two public health facilities, south east Nigeria, to assess the current state of compliance to policy guidelines on the use of artemisinin-based combination therapy (ACT).

Methods: Retrospective audit of patients' records, treated for uncomplicated malaria, between the months of January and March 2013, was undertaken at two public health facilities. Demographics, diagnostic information, medication and cost data were extracted. Questionnaires were distributed to providers to assess their malaria treatment intent. Data from the facilities were analyzed and compared for similarities and systematic differences, and conformity to malaria treatment policy, in terms of laboratory diagnosis, use of ACT, co-medication and cost of medication.

Results: A total of 2,171 records of patients who had been treated for uncomplicated malaria were analyzed. Of these, 1066 (49%) were sent for laboratory confirmation of malaria using mostly microscopy, out of which 480 (45%) tested positive. 51% (1105) of the prescriptions was on the basis of presumptive treatment. 58% of slide negative results received antimalarial drugs. 93% of patients received ACT, with artemether-lumefantrin, AL (50.5%) as the most prescribed antimalarial drug. Monotherapy accounted for 7% of prescriptions, comprising mostly sulphadoxine + pyrimethamine, SP (46.5%) and monotherapy artemisinin, AS (29.2%). 97% of the prescriptions received at least one co-medication. Antibiotics were prescribed to 50% of patients. Overall, median cost of medication was N1160.00 (US$7.48 (US$0.19 - 267.87) per case, higher in tertiary than the secondary facility. There were significant variations in treatment practices between the two facilities.

Conclusion: Evidence suggests good compliance to policy on the use of ACT as first line treatment for uncomplicated malaria. However, there exists significant scope for improved diagnosis and rational drug use, to enhance accuracy of treatment, reduced wastages and risks of adverse drug reactions, in line with the goals of 'test and treat' policy of malaria case management.

No MeSH data available.


Related in: MedlinePlus

Schematic summary of selected malaria cases included in the study.
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Fig1: Schematic summary of selected malaria cases included in the study.

Mentions: A total of 7949 outpatient visits were identified, out of which 2171(27.3%) cases were treated for uncomplicated malaria. Ninety-four (4%) records were excluded due to either severe malaria or incomplete/missing information on variables of interest. 49% (1066) of those treated for malaria was sent for laboratory examination while the rest, 51% (1105) was based on presumptive diagnosis. 48% of laboratory diagnosis tested slide positive while 52% tested negative. Only the tertiary health facility reported the use of RDT. Figure 1 shows the graphic presentation of selection process. The proportion of uncomplicated malaria cases was higher at the medical center, 47% (1261/2674) compared to the teaching hospital, 17% (910/5252).Figure 1


Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the 'test and treat' policy of malaria case management.

Ezenduka CC, Okonta MJ, Esimone CO - J Pharm Policy Pract (2014)

Schematic summary of selected malaria cases included in the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363460&req=5

Fig1: Schematic summary of selected malaria cases included in the study.
Mentions: A total of 7949 outpatient visits were identified, out of which 2171(27.3%) cases were treated for uncomplicated malaria. Ninety-four (4%) records were excluded due to either severe malaria or incomplete/missing information on variables of interest. 49% (1066) of those treated for malaria was sent for laboratory examination while the rest, 51% (1105) was based on presumptive diagnosis. 48% of laboratory diagnosis tested slide positive while 52% tested negative. Only the tertiary health facility reported the use of RDT. Figure 1 shows the graphic presentation of selection process. The proportion of uncomplicated malaria cases was higher at the medical center, 47% (1261/2674) compared to the teaching hospital, 17% (910/5252).Figure 1

Bottom Line: Overall, median cost of medication was N1160.00 (US$7.48 (US$0.19 - 267.87) per case, higher in tertiary than the secondary facility.There were significant variations in treatment practices between the two facilities.However, there exists significant scope for improved diagnosis and rational drug use, to enhance accuracy of treatment, reduced wastages and risks of adverse drug reactions, in line with the goals of 'test and treat' policy of malaria case management.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University Awka Agulu campus, Agulu, Nigeria.

ABSTRACT

Objectives: Adherence to treatment guidelines for uncomplicated malaria is critical to the success of malaria case management. Poor adherence has implications for increased malaria burden, in view of the risk of widespread parasite resistance and treatment failures. This study analyzed the diagnostic and prescription pattern for uncomplicated malaria at two public health facilities, south east Nigeria, to assess the current state of compliance to policy guidelines on the use of artemisinin-based combination therapy (ACT).

Methods: Retrospective audit of patients' records, treated for uncomplicated malaria, between the months of January and March 2013, was undertaken at two public health facilities. Demographics, diagnostic information, medication and cost data were extracted. Questionnaires were distributed to providers to assess their malaria treatment intent. Data from the facilities were analyzed and compared for similarities and systematic differences, and conformity to malaria treatment policy, in terms of laboratory diagnosis, use of ACT, co-medication and cost of medication.

Results: A total of 2,171 records of patients who had been treated for uncomplicated malaria were analyzed. Of these, 1066 (49%) were sent for laboratory confirmation of malaria using mostly microscopy, out of which 480 (45%) tested positive. 51% (1105) of the prescriptions was on the basis of presumptive treatment. 58% of slide negative results received antimalarial drugs. 93% of patients received ACT, with artemether-lumefantrin, AL (50.5%) as the most prescribed antimalarial drug. Monotherapy accounted for 7% of prescriptions, comprising mostly sulphadoxine + pyrimethamine, SP (46.5%) and monotherapy artemisinin, AS (29.2%). 97% of the prescriptions received at least one co-medication. Antibiotics were prescribed to 50% of patients. Overall, median cost of medication was N1160.00 (US$7.48 (US$0.19 - 267.87) per case, higher in tertiary than the secondary facility. There were significant variations in treatment practices between the two facilities.

Conclusion: Evidence suggests good compliance to policy on the use of ACT as first line treatment for uncomplicated malaria. However, there exists significant scope for improved diagnosis and rational drug use, to enhance accuracy of treatment, reduced wastages and risks of adverse drug reactions, in line with the goals of 'test and treat' policy of malaria case management.

No MeSH data available.


Related in: MedlinePlus