title: Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the 'test and treat' policy of malaria case management.
abstract: OBJECTIVE
  Adherence to treatment guidelines for uncomplicated malaria is critical to the success of malaria case management. Poor adherence has implications for increased malaria burden, in view of the risk of widespread parasite resistance and treatment failures. This study analyzed the diagnostic and prescription pattern for uncomplicated malaria at two public health facilities, south east Nigeria, to assess the current state of compliance to policy guidelines on the use of artemisinin-based combination therapy (ACT).
  
  
  METHODS
  Retrospective audit of patients' records, treated for uncomplicated malaria, between the months of January and March 2013, was undertaken at two public health facilities. Demographics, diagnostic information, medication and cost data were extracted. Questionnaires were distributed to providers to assess their malaria treatment intent. Data from the facilities were analyzed and compared for similarities and systematic differences, and conformity to malaria treatment policy, in terms of laboratory diagnosis, use of ACT, co-medication and cost of medication.
  
  
  RESULTS
  A total of 2,171 records of patients who had been treated for uncomplicated malaria were analyzed. Of these, 1066 (49%) were sent for laboratory confirmation of malaria using mostly microscopy, out of which 480 (45%) tested positive. 51% (1105) of the prescriptions was on the basis of presumptive treatment. 58% of slide negative results received antimalarial drugs. 93% of patients received ACT, with artemether-lumefantrin, AL (50.5%) as the most prescribed antimalarial drug. Monotherapy accounted for 7% of prescriptions, comprising mostly sulphadoxine + pyrimethamine, SP (46.5%) and monotherapy artemisinin, AS (29.2%). 97% of the prescriptions received at least one co-medication. Antibiotics were prescribed to 50% of patients. Overall, median cost of medication was N1160.00 (US$7.48 (US$0.19 - 267.87) per case, higher in tertiary than the secondary facility. There were significant variations in treatment practices between the two facilities.
  
  
  CONCLUSIONS
  Evidence suggests good compliance to policy on the use of ACT as first line treatment for uncomplicated malaria. However, there exists significant scope for improved diagnosis and rational drug use, to enhance accuracy of treatment, reduced wastages and risks of adverse drug reactions, in line with the goals of 'test and treat' policy of malaria case management.
authors.affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University Awka Agulu campus, Agulu, Nigeria.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Ezenduka
authors.affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nigeria.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Okonta
authors.affiliation: Department of Pharmaceutical Microbiology & Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University Awka, Agulu campus, Agulu, Nigeria.
authors.forename: Charles O
authors.initials: CO
authors.lastname: Esimone
keywords: Antimalarial drugs; Health facility; Nigeria; Policy adherence; Prescription practices; Treatment guidelines; Uncomplicated malaria
references.citation: Ann Trop Med Parasitol. 2005 Jul;99(5):473-81
references.pmid: 16004706
references.citation: Malar J. 2009 Oct 28;8:246
references.pmid: 19863803
references.citation: BMJ. 2005 Oct 1;331(7519):734
references.pmid: 16195289
references.citation: Malar J. 2013 Jul 19;12:252
references.pmid: 23870515
references.citation: PLoS One. 2014 Mar 24;9(3):e92782
references.pmid: 24663961
references.citation: BMC Public Health. 2010 Aug 16;10:486
references.pmid: 20712876
references.citation: Afr Health. 1998 Jan;20(2):2, 5
references.pmid: 12321390
references.citation: Am J Trop Med Hyg. 2003 Apr;68(4 Suppl):44-9
references.pmid: 12749485
references.citation: Malar J. 2006 Jan 20;5:4
references.pmid: 16423307
references.citation: Malar J. 2014 Jun 24;13:243
references.pmid: 24961280
references.citation: Malar J. 2009 Oct 28;8:243
references.pmid: 19863788
references.citation: Parasitol Today. 1996 Oct;12(10):399-401
references.pmid: 15275291
references.citation: Malar J. 2009 Jan 05;8:2
references.pmid: 19123926
references.citation: Malar J. 2009 Dec 30;8:313
references.pmid: 20042098
references.citation: Malar J. 2011 Aug 03;10:218
references.pmid: 21812948
references.citation: Malar J. 2007 May 04;6:55
references.pmid: 17480216
references.citation: BMJ. 2004 Nov 20;329(7476):1212
references.pmid: 15542534
references.citation: Trop Med Int Health. 2011 Mar;16(3):272-9
references.pmid: 21226795
references.citation: Malar J. 2011 Oct 06;10:290
references.pmid: 21978238
references.citation: Malar J. 2011 Jun 08;10:155
references.pmid: 21651787