ABSTRACT
National malaria management policy is based upon the availability of effective and affordable antimalarial drugs. This study was undertaken to evaluate the quality of the treatment of uncomplicated malaria cases in Bangui; an area with multidrug-resistant parasites; at a time preceding implementation of a new therapeutic policy relying on the artemisinin derivative combined treatment artemether-lumefantrine. A cross-sectional study was carried out in Bangui city to assess availability of antimalarial drugs and the performances of health workers in the management of uncomplicated malaria. Availability of drugs was recorded in all drugs wholesalers (n=3); all pharmacies in health facilities (n=14); private drugstores (n=15); and in 60 non-official drug shops randomly chosen in the city. Despite a limited efficacy at the time of the survey; chloroquine remained widely available in the official and nonofficial markets. Artemisinin derivatives used in monotherapy or in combination were commonly sold. In health care facilities; 93of the uncomplicated malaria cases were treated in the absence of any laboratory confirmation and the officially recommended treatment; amodiaquine-sulfadoxine/pyrimethamine; was seldom prescribed. Thus; the national guidelines for the treatment of uncomplicated malaria are not followed by health professionals in Bangui. Its use should be implemented while a control of importation of drug has to be reinforced
Subject(s)
Antimalarials/therapeutic use , Attitude , Drug Evaluation , Malaria/therapyABSTRACT
Objective: The main objective of this study was to assess the quality of home malaria management with pre-packaged chloroquine in two areas in the Moramanga district of Madagascar. The knowledge; attitude and practices of care providers in terms of home treatment options were evaluated and compared. The availability of treatment options by studying retailers and community-based service providers was also investigated. Methods: A cross-sectional investigation in two communities; in the hamlets and villages located close to carers; retailers; community-based service providers and primary health centres was carried out. Results :Carers in the two districts were equally well aware of the use of pre-packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory (100) with pre-packaged chloroquine and rarely satisfactory (1.6to 4.5) with non pre-packaged chloroquine. In cases of treatment failure; the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre-packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests (P=0.01) was significantly higher in children treated with non pre-packaged chloroquine (38) than in children treated with pre-packaged chloroquine (1.3). Conclusions: Home malaria management should be improved in Madagascar. Efforts should focus on communication; the training of community-based service providers; access to pre-packaged drugs and the gradual withdrawal of pre-packaged chloroquine and its replacement by pre-packaged artemisinin-based combination therapies