title: Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria.
abstract: BACKGROUND
  At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received.
  
  
  METHODS
  A cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria.
  
  
  RESULTS
  Although 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001).
  
  
  CONCLUSIONS
  Few febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. lindsay.mangham@lshtm.ac.uk
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Mangham
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cundill
authors.forename: Ogochukwu
authors.initials: O
authors.lastname: Ezeoke
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nwala
authors.forename: Benjamin S C
authors.initials: BS
authors.lastname: Uzochukwu
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.forename: Obinna
authors.initials: O
authors.lastname: Onwujekwe
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination / Q000379:methods; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D009549:Nigeria; D011247:Pregnancy; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin