TREATMENT PRACTICES FOR UNCOMPLICATED MALARIAL AT TWO PUBLIC HEALTH FACILITIES IN NIGERIA; IMPLICATIONS ON ADHERENCE TO MALARIAL TREATMENT GUIDELINES

Purpose: Adherence to treatment guidelines for uncomplicated malaria by healthcare providers is critical to the success of malaria case management, as poor adherence has implications for increased malaria burden in view of the risk of widespread parasite resistance and treatment failures. The study analyzed the diagnostic and prescription practices for uncomplicated malaria at two levels of public health facilities in south east Nigeria, to assess the current state of malaria treatment practices

Method: Retrospective audit of patients’ records for uncomplicated malaria at a primary/secondary and tertiary health facilities, for a six-month period was carried out. Demographics, diagnostic information, medication and cost data were extracted. Data from the two facilities were compared for similarities and systematic differences, and conformity to malaria treatment policy, in terms of the use of ACT, accuracy of diagnosis, concomitant medication and cost of medication. 

Result:

A total of 4,158 patients’ records, treated for uncomplicated malaria within the six months period were analysed. Over all 38% of cases were subjected to laboratory tests for malaria parasite, using microscopy, while the rest was based on presumptive diagnosis. Over 50% of slide negative results received antimalarial drugs. 93% of prescriptions contained ACT, while monotherapy accounted for 7% of prescriptions, comprising mostly artemisinin products.  97.7% of prescriptions contained at least one concomitant medication, mostly analgesics, (76%), antibiotics (38%) and vitamin preparations (35%) known to interact with artemisinin compound. There were significant differences between the facilities in prescription pattern with primary health facility more likely to prescribe antibiotics (p<0.0001). Children below 5 years are more likely than those above 5 years to be prescribed antibiotics (p<0.0003) 

Conclusion: While evidence suggest high rate of compliance to policy on the use of ACTs as first line treatment for uncomplicated malaria at the facilities, there exists a substantial degree of non-adherence to treatment guidelines in terms of diagnosis and rational use of drugs, with the consequences of increasing risks of parasite resistance and treatment failures. Findings indicate a scope for improved diagnostic practice and rational use of antimalarial drugs, especially at the primary healthcare facility to enhance efficiency of malaria treatment in the area