Antimalarial prescribing practices: a challenge to malaria control in Ghana.
OBJECTIVE
The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country.


METHODS
The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities.


RESULTS
The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine.


CONCLUSIONS
The findings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections.
Abuaku
B K
BK
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana. babuaku@noguchi.mimcom.net
Koram
K A
KA
Binka
F N
FN
D000655:Amodiaquine / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D037621:Artemisinins / Q000494:pharmacology / Q000627:therapeutic use; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D004351:Drug Resistance; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005869:Ghana; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy* / Q000635:transmission; D008485:Medical Audit; D009313:National Health Programs; D010616:Phenanthrenes / Q000494:pharmacology / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011739:Pyrimethamine / Q000494:pharmacology / Q000627:therapeutic use; D011803:Quinine / Q000494:pharmacology / Q000627:therapeutic use; D019035:Rural Health Services / Q000592:standards; D018571:Sentinel Surveillance; D012717:Sesquiterpenes / Q000494:pharmacology / Q000627:therapeutic use; D013413:Sulfadoxine / Q000494:pharmacology / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D010616:Phenanthrenes; D012717:Sesquiterpenes; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D011803:Quinine; C023768:halofantrine; D011739:Pyrimethamine