Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in rural health facilities in southern Cameroon.
BACKGROUND
One year after the adoption of artesunate-amodiaquine (AS/AQ) as first-line therapy for the treatment of uncomplicated malaria, this study was designed to assess the treatment practices regarding anti-malarial drugs at health facilities in four rural areas in southern Cameroon.


METHODS
Between April and August 2005, information was collected by interviewing fifty-two health professionals from twelve rural health facilities, using a structured questionnaire.


RESULTS
In 2005, only three anti-malarial drugs were used in rural health facilities, including: amodiaquine, quinine and sulphadoxine-pyrimethamine. Only 2.0% of the health professionals prescribed the recommended AS/AQ combination. After reading the treatment guidelines, 75.0% were in favour of the treatment protocol with the following limitations: lack of paediatric formulations, high cost and large number of tablets per day. Up to 21.0% of professionals did not prescribe AS/AQ because of the level of adverse events attributed to the use of amodiaquine as monotherapy.


CONCLUSIONS
The present study indicates that AS/AQ was not available in the public health facilities at the time of the study, and health practitioners were not informed about the new treatment guidelines. Results of qualitative analysis suggest that prescribers should be involved as soon as possible in projects related to the optimization of treatment guidelines and comply with new drugs. Adapted formulations should be made available at the international level and implemented locally before new drugs and treatments are proposed through a national control programme. This baseline information will be useful to monitor progresses in the implementation of artemisinin-based combination therapy in Cameroon.
Sayang
Collins
C
Department of Tropical Medicine, Centre René Labusquière, University of Bordeaux 2, Bordeaux, France. sayangcollins@yahoo.fr
Gausseres
Mathieu
M
Vernazza-Licht
Nicole
N
Malvy
Denis
D
Bley
Daniel
D
Millet
Pascal
P
D000328:Adult; D000368:Aged; D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002163:Cameroon; D002675:Child, Preschool; D004338:Drug Combinations; D006282:Health Personnel; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011739:Pyrimethamine / Q000627:therapeutic use*; D011803:Quinine / Q000627:therapeutic use*; D012423:Rural Health; D013413:Sulfadoxine / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D055815:Young Adult
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011803:Quinine; D011739:Pyrimethamine