Artemisinin-based antimalarial combination therapy amongst healthcare professionals in a tertiary facility in south-south Nigeria: preferences, tolerability, and cost considerations

Background: Nigeria adopted the Artemisinin-Based Combination Therapy (ACT) as the mainstay of treating uncomplicated malaria in February 2005. However, the individual preferences for the use of these medicines by health care professionals (HCP) as distinct from their observed prescribing practices is largely unknown. This study determined the preferences, tolerability and cost of the ACTs among HCP in Benin-City. Methods: This descriptive cross-sectional study was conducted in the University of Benin Teaching Hospital, Benin-City, Nigeria. Consenting HCPs were recruited consecutively for the study. Semi structured questionnaires were administered to doctors, nurses and pharmacists in the hospital. Information obtained included demographics, treatment of malaria in the previous year, antimalarial medication preferences and tolerability as well as cost of ACT. Results: A total of 556 HCPs, 295 doctors (54.1%), nurses 200 (36.0%), pharmacists 61(11.0%) completed the questionnaire. In the previous year, 224 (75.9%) doctors, 153 (79.1%) nurses, and 48 (70.5%) pharmacists had treatment for malaria and self-medication was highest among doctors (228,77.3%). Artemether-Lumenfantrine was the most preferred antimalarial used, 294 (52.8%); however, 1.6% used chloroquine sulphate and ACTs were perceived to be ineffective by 25.4%. Adverse effects were experienced by 167 (29.1%) resulting in 50 (9.0%) discontinuing their medication. Between 500 and 1500 Naira (~US$1-4) was expended on ACT by 66.3% of the staff, while 21.4% were concerned about the high cost of medications. Conclusion: This study highlights the use and preferences, self-medication practices, perceived lack of effectiveness and high cost of ACTs from a HCP perspective. There is an urgent need to address these concerns in view of adverse consequences as well as the likely possibility of its the impact on prescribing practices.

Access to Subsidized Artemether-Lumefantrine from the Private Sector among Febrile Children in Rural Setting in Kilosa; Tanzania

Abstract:The World Health Organization aims at universal access to effective antimalarial treatment by the year 2015. Consequently; an enormous financial resource has been invested on Artemisinin Combination Therapy (ACT))) subsidy. In Tanzania; strategies to increase access of artemether-lumufantrine (ALu) rural areas; where the burden is highest; includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria access ALu from the private sector in rural areas. A total of 1;235 under fives randomly selected from 12 rural villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured questionnaire; caretakers were interviewed about the child's history of fever in the past 7 days; type of treatment given and the source. Baseline data were obtained on demographic characteristics; caretakers' knowledge about malaria and social economic indicators of the household. Of the 1;235 children followed-up; 740 care-seeking visits were recorded; of which; 264 (35.7) were made at government health facilities and nearly a quarter (24.1; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22 of the caretakers sought care from FBO and ADDOs. While 686 (86.6) of the episodes were treated with antimalarials; only 319 (43) received ALu; the recommended antimalarial. Majority (83) of the visits made at government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0) and ADDOs (25.0). In conclusion; this study has shown that less than a quarter of fever episodes suspected to be malaria in rural areas were made at FBO facilities and ADDOs; of which; less than half were treated with ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas; where the malaria burden is highest. This cast some doubts if the target of universal access to effective antimalarial; by 2015; will be reached. There is need to consider enlisting the services of community health workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers' / dispensers' preference for non-recommended antimalarials in the private sector and caretakers' preference for ordinary