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Antimalarial Drugs Utilization, Adherence to Malaria Treatment Guideline and Awareness of the Guideline among the Health Providers

Ebere Emilia Ayogu*, Chinwe Victoria Ukwe, Nneka Uchenna Igboeli and Maxwel Ogochukwu Adibe

Background: Prompt and appropriate administration of effective antimalarial drug is paramount in the prognosis and treatment of severe malaria. Artesunate injection has been chosen over quinine injection as first line drug for severe malaria treatment following evidences of lower mortality, proven efficacy, ease of use and safety profile. Adherence to this policy will lead to more effective treatments.

Objective: The aims of this study were to audit antimalarial drug utilization in management of severe malaria, assess the adherence to severe malaria treatment guidelines and assess the levels of awareness of the 2015 severe malaria guidelines among health practitioners.

Methods: The study was carried out in two secondary hospitals in two phases using two methods. The first method is a retrospective survey using a structured data collection form to collect data on drug use from severe malaria patients ’ folders. Second method was a cross sectional prospective study, using validated questionnaires to assess the medical practitioners’ drug of choice for severe malaria treatment and their awareness of the new treatment guidelines.

Results: A total of 563 folders of participants were audited, almost half of the patients (48.5%) were 1-5 years, 33 doctors and 17 hospital pharmacists participated. The prevalence of severe malaria was 0.8%, the most prescribed initial and follow up treatment was injection artesunate (84.2%) and oral artemetherlumefantrine (73.7%) respectively. The most common antibiotic and infusion used were ceftriaxone (74.2%) and dextrose saline (65.5%) respectively. About 78.8% of the doctors possessed and implemented the new treatment guideline (NTG) while 72.7% of the doctors were aware of the NTG, 70.6% of the pharmacists were not aware. Age (P-value=0.0004) and facility (P-value=0.0001) of the prescribers were significantly associated with the doctors’ choice of medication for each patient.

Conclusion: Parenteral artesunate is the most prescribed medication for severe malaria treatment. The healthcare providers in these facilities were adherent to the new treatment guideline for severe malaria with doctors being more aware of the guideline than the pharmacist.