title: Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? A cross-sectional survey in Gezira State, Sudan.
abstract: BACKGROUND
  In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers' knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan.
  
  
  METHODS
  This cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers' ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each.
  
  
  RESULTS
  All prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers.
  
  
  CONCLUSIONS
  Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers.
authors.affiliation: Al Neelain University, Steen Street, P.O. Box 7294, Code: 11123, Khartoum, Sudan. abeeratta@gmail.com.
authors.forename: Abeer A
authors.initials: AA
authors.lastname: Mannan
authors.affiliation: Federal Ministry of Health, Khartoum, Sudan. khalid.elmardi@gmail.com.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Elmardi
authors.affiliation: Gezira State Ministry of Health, Gezira, Sudan. yassir.idris@gmail.com.
authors.forename: Yassir A
authors.initials: YA
authors.lastname: Idris
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. spectorjm@gmail.com.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spector
authors.affiliation: Federal Ministry of Health, Khartoum, Sudan. nahid100@hotmail.com.
authors.forename: Nahid A
authors.initials: NA
authors.lastname: Ali
authors.affiliation: Gezira State Ministry of Health, Gezira, Sudan. fatihmmalik@gmail.com.
authors.forename: Elfatih M
authors.initials: EM
authors.lastname: Malik
mesh_terms: D037621:Artemisinins / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008288:Malaria / Q000188:drug therapy*; D011320:Primary Health Care; D011361:Professional Competence; D013397:Sudan
chemical_list: D037621:Artemisinins; D007783:Lactones; C075875:artemisin