A Survey of the Rational use of Artemisinin Based Combination Therapies (ACTs) for the Treatment of Malaria among Health Practitioners in Ogun State, South West Nigeria

Abstract

This study was carried out in health institutions in Ogun State to evaluate the rational use of artemisinin based combination therapies (ACTs) for the treatment of malaria. Data was collected using structured questionnaires. A total of 200 questionnaires were administered and returned. One hundred and eight (108) (54%) doctors and 92 (46%) pharmacists were interviewed. Eighty six (86) (79.6%) doctors and 82 (89.1%) pharmacists agreed that the ACTs were more effective than monotherapy for the treatment of malaria. Twenty (20) (18.5%) doctors still thought that monotherapy was more effective and 2 (1.9%) doctors were indifferent. Forty nine (49) (45.4%) doctors and 70 (76.1%) pharmacists use ACTs as first line antimalarial. Out of the 200 respondents, 173 (86.5%) were not aware that taking antioxidants such as vitamin C concurrently with the ACTs caused an inhibition of antimalarial effect. One hundred and sixty two (162) (81%) of total respondents took precautions while administering the ACTs and 38 (19%) took no precautions such as: “avoid alcohol and cigarettes” (83.5%), “take with fatty meals” (98.5%), “report any side effect immediately” (63.5%) and “don’t combine with any drug or herbal mixture for the first 24 hours” (12.5%). Ninety two (92) (85.2%) doctors and 72 (78.3%) pharmacists always order for a laboratory investigation before prescribing the ACTs. Twenty two (22) (20.4%) doctors and 12 (13.0%) pharmacists monitor patient’s compliance with medication by getting feedback from the patients. Fifty five (55) (53.9%) doctors and 82 (89.1%) pharmacists never documented adverse effect of ACTs experienced by the patients. ACTs were prescribed by 100% of the respondents in the second and third trimester of pregnancy because of their safety during these periods of pregnancy. Using statistical package for social sciences (SPSS), awareness that the ACTs taken with antioxidants such as ascorbic acid, antimalarial effect increases with practitioners’ years of practice. Most of the practitioners’ stocks of ACTs are from medical representatives, therefore pharmaceutical companies will play a pivotal role in providing these drug information in literatures distributed to the health practitioners with comprehensive information on the proper use of the ACTs.

Keywords: pharmacists, doctors, artemisinin, malaria, rational use, combination therapy

Nigerian Journal of Pharmaceutical Research, Vol. 8 No 1 pp. 84 - 91 (September 2010)