title: Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study.
abstract: OBJECTIVE
  To evaluate treatment practices for uncomplicated malaria after the policy change from chloroquine to sulfadoxine-pyrimethamine and to artemether-lumefantrine in Zambia.
  
  
  METHODS
  Cross sectional survey.
  
  
  METHODS
  Outpatient departments of all government and mission facilities in four districts in Zambia.
  
  
  METHODS
  944 children with uncomplicated malaria seen by 103 health workers at 94 health facilities.
  
  
  METHODS
  Antimalarial prescriptions in accordance with national guidelines and influence of factors on health workers' decision to prescribe artemether-lumefantrine.
  
  
  RESULTS
  Artemether-lumefantrine, sulfadoxine-pyrimethamine, and chloroquine were available, respectively, at 48 (51%), 94 (100%), and 71 (76%) of the 94 facilities. Of 944 children with uncomplicated malaria, only one child (0.1%) received chloroquine. Among children weighing less than 10 kg, sulfadoxine-pyrimethamine was commonly prescribed in accordance with guidelines (439/550, 79.8%). Among the children weighing 10 kg or more, sulfadoxine-pyrimethamine was commonly prescribed (266/394, 68%), whereas recommended artemether-lumefantrine was prescribed for only 42/394 (11%) children. Among children weighing 10 kg or more seen at facilities where artemether-lumefantrine was available, the same pattern was observed: artemether-lumefantrine was prescribed for only 42/192 (22%) children and sulfadoxine-pyrimethamine remained the drug of choice (103/192, 54%). Programmatic activities such as in-service training and provision of job aids did not seem to influence the prescribing of artemether with lumefantrine.
  
  
  CONCLUSIONS
  Although the use of chloroquine for uncomplicated malaria was successfully discontinued in Zambia, the change of drug policy towards artemether-lumefantrine does not necessarily translate into adequate use of this drug at the point of care.
authors.affiliation: Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI/Wellcome Trust Collaborative Programme, PO box 43640, 00100 GPO, Nairobi, Kenya. dzurovac@wtnairobi.mimcom.net
authors.forename: Dejan
authors.initials: D
authors.lastname: Zurovac
authors.forename: Mickey
authors.initials: M
authors.lastname: Ndhlovu
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Rowe
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004983:Ethanolamines; D005449:Fluorenes / Q000627:therapeutic use*; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D011739:Pyrimethamine / Q000627:therapeutic use*; D012717:Sesquiterpenes / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D015024:Zambia
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine