International Journal of Health Policy and Management

International Journal of Health Policy and Management

Misuse of Artemisinin Combination Therapies by Clients of Medicine Retailers Suspected to Have Malaria Without Prior Parasitological Confirmation in Nigeria

Document Type : Original Article

Authors
Earnest Nwokolo 1
Chinazo Ujuju 1
Jennifer Anyanti 1
Chinwoke Isiguzo 1
Ifeanyi Udoye 1
Elamei Bongos-Ikwue 1
Onoriode Ezire 1
Mopelola Raji 1
Wellington A. Oyibo 2
1 Society for Family Health, Abuja, Nigeria
2 ANDI Centre of Excellence for Malaria Diagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
10.15171/ijhpm.2017.122
Abstract
Background
Prompt and effective case detection and treatment are vital components of the malaria case management strategy as malaria-endemic countries implement the testing, treating and tracking policy. The implementation of this policy in public and formal private sectors continue to receive great attention while the informal private retail sector (mostly the patent and propriety medicine vendors [PPMVs]) where about 60% of patients with fever in Nigeria seek treatment is yet to be fully integrated. The PPMVs sell artemisinin combination therapies (ACTs) without prior testing and are highly patronized. Without prior testing, malaria is likely to be over-treated. The need to expand access to diagnosis in the huge informal private health sector among PPMVs is currently being explored to ensure that clients that patronize retail drug stores are tested before sales of ACTs.

 
Methods
A cross-sectional multistage study was conducted among 1279 adult clients, 20 years and above, who purchased malaria medicines from 119 selected PPMVs in five administrative areas (States) of Nigeria, namely: Adamawa, Cross River, Enugu, Lagos and Kaduna, as well as the Federal Capital Territory, Abuja. Exit interviews using a standard case report questionnaire was conducted after the purchase of the antimalarial medicine and thick/thin blood smears from the clients’ finger-prick were prepared to confirm malaria by expert microscopy.

 
Results
Of the 1279 clients who purchased malaria medicines from the PPMV outlets, 107 (8.4%) were confirmed to have malaria parasites. The malaria prevalence in the various study areas ranged from 3.5% to 16%. A high proportion of clients in the various study sites who had no need for malaria medicines (84%-96.5%) purchased and used antimalarial medicines from the PPMVs. This indicated a high level of over-treatment and misuse of antimalarials. Common symptoms that are widely used as indicators for malaria such as, fever, headache, and tiredness were not significantly associated with malaria. Nausea/vomiting, poor appetite, chills, bitter taste in the mouth and dark urine were symptoms that were significantly associated with malaria among the adult clients (P < .05) but not fever (P = .06).

 
Conclusion
Misuse of ACTs following overtreatment of malaria based on clinical diagnosis occurs when suspected cases of malaria are not prior confirmed with a test. Non-testing before sales of malaria medicines by PPMVs will perpetuate ACT misuse with the patients not benefiting due to poor treatment outcomes, waste of medicines and financial loss from out-of-pocket payment for unneeded medicines.
Keywords
ACT Misuse
Malaria Case Management in Africa
Test Before Treatment
Private Medicine Vendors
Presumptive Malaria Treatment
Subjects
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International Journal of Health Policy and Management
Volume 7, Issue 6
2018
Pages 542-548

  • Received Date 27 March 2016
  • Revised Date 20 September 2017
  • Accepted Date 06 October 2017
  • First Published Date 01 June 2018
  • Published Date 01 June 2018