title: Factors influencing adverse events reporting within the health care system: the case of artemisinin-based combination treatments in northern Ghana.
abstract: BACKGROUND
  The use of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria was a policy recommended by World Health Organization. In 2004, Ghana changed her first-line anti-malarial drug policy to use ACT. This study examined factors affecting adverse events reporting in northern Ghana after the introduction of ACT.
  
  
  METHODS
  This was a qualitative study based on sixty in-depth interviews with health workers, chemical shop owners and patients with malaria who were given ACT at the health facilities. Purposive sampling method was used to select study participants. The interviews were transcribed, coded into themes using Nvivo 9 software. The thematic analysis framework was used to analyse the data.
  
  
  RESULTS
  Study respondents reported body weakness and dizziness as the most frequent side effects they had experienced from the used of ACT. Other side effects they reported were swollen testes, abdominal pain and shivering. These side effects were mostly associated with the use of artesunate-amodiaquine compared to other artemisinin-based combinations. Patients were not provided information about the side effects of the drugs and so did not report when they experienced them. Also long queues at health facilities and unfriendly health worker attitude were the main factors affecting adverse events reporting. Other factors such as wrong use of ACT at home, farming and commercial activities also affected effective adverse events reporting in the study area.
  
  
  CONCLUSIONS
  Patients' lack of knowledge and health sector drawbacks affected side effect reporting on ACT. Intensive health education on likely side effects of ACT should be provided to patients by health workers. Also, improving health worker attitude toward clients will encourage patients to visit the health facilities when they react negatively to ACT and, subsequently, will improve on adverse events reporting.
authors.affiliation: Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana. schatio@yahoo.co.uk.
authors.forename: Samuel
authors.initials: S
authors.lastname: Chatio
authors.affiliation: Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana. rayaborigo@yahoo.com.
authors.forename: Raymond
authors.initials: R
authors.lastname: Aborigo
authors.affiliation: School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana. adongophilip@yahoo.com.
authors.forename: Philip Baba
authors.initials: PB
authors.lastname: Adongo
authors.affiliation: Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana. Thomas.anyorigiya@navrongo-hrc.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Anyorigiya
authors.affiliation: Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana. padalinjong@yahoo.com.
authors.forename: Philip Ayizem
authors.initials: PA
authors.lastname: Dalinjong
authors.affiliation: School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana. akweongo@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana. Abraham.oduro@navrongo-hrc.org.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oduro
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D037621:Artemisinins / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D036301:Qualitative Research
chemical_list: D000962:Antimalarials; D037621:Artemisinins