Anti-malarial prescription practices among outpatients with laboratory-confirmed malaria in the setting of a health facility-based sentinel site surveillance system in Uganda

Sears, David; Kigozi, Ruth; Mpimbaza, Arthur; Kakeeto, Stella; Sserwanga, Asadu; Staedke, Sarah G.; Chang, Michelle; Kapella, Bryan K.; Rubahika, Denis; Kamya, Moses R.; Dorsey, Grant

doi:10.1186/1475-2875-12-252

Cited by 17 publications

(24 citation statements)

References 28 publications

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“…First, testing rates increased by 34% reaching 58% of tested febrile patients at all facilities and 63% tested at facilities with available diagnostics. The testing levels were higher compared to reports from Zambia [18] and Angola [47], similar to those from several Tanzanian studies [9], [48]–[50] but lower compared to what can be achieved under more controlled, smaller scale conditions in Uganda [51]. Notably, at facilities providing both diagnostic services we found significantly higher testing rates (76%), preference for malaria microscopy, and in contrast with our previous findings [40], there was no difference in testing rates between facilities providing solely RDTs (55%) or malaria microscopy (58%).…”

Section: Discussionsupporting

confidence: 77%

Major Improvements in the Quality of Malaria Case-Management under the “Test and Treat” Policy in Kenya

et al. 2014

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BackgroundMonitoring implementation of the “test and treat” case-management policy for malaria is an important component of all malaria control programmes in Africa. Unfortunately, routine information systems are commonly deficient to provide necessary information. Using health facility surveys we monitored health systems readiness and malaria case-management practices prior to and following implementation of the 2010 “test and treat” policy in Kenya.Methods/FindingsBetween 2010 and 2013 six national, cross-sectional, health facility surveys were undertaken. The number of facilities assessed ranged between 172 and 176, health workers interviewed between 216 and 237 and outpatient consultations for febrile patients evaluated between 1,208 and 2,408 across six surveys. Comparing baseline and the last survey results, all readiness indicators showed significant (p<0.005) improvements: availability of parasitological diagnosis (55.2% to 90.7%); RDT availability (7.5% to 69.8%); total artemether-lumefantrine (AL) stock-out (27.2% to 7.0%); stock-out of one or more AL packs (59.5% to 21.6%); training coverage (0 to 50.2%); guidelines access (0 to 58.1%) and supervision (17.9% to 30.8%). Testing increased by 34.0% (23.9% to 57.9%; p<0.001) while testing and treatment according to test result increased by 34.2% (15.7% to 49.9%; p<0.001). Treatment adherence for test positive patients improved from 83.3% to 90.3% (p = 0.138) and for test negative patients from 47.9% to 83.4% (p<0.001). Significant testing and treatment improvements were observed in children and adults. There was no difference in practices with respect to the type and result of malaria test (RDT vs microscopy). Of eight dosing, dispensing and counseling tasks, improvements were observed for four tasks. Overall AL use for febrile patients decreased from 63.5% to 35.6% (p<0.001).ConclusionsMajor improvements in the implementation of “test and treat” policy were observed in Kenya. Some gaps towards universal targets still remained. Other countries facing similar needs and challenges may consider health facility surveys to monitor malaria case-management.

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Section: Discussionsupporting

confidence: 77%

Major Improvements in the Quality of Malaria Case-Management under the “Test and Treat” Policy in Kenya

et al. 2014

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“…The fixed-dose combination Artemeter-Lumefantrine (31.1%) was the most commonly prescribed antimalarial in our study. This is much lower than 97.3% prescription rate for Artemeter-Lumefantrine reported in a recent study in Uganda (22). Availability of various types of Artemisinin-Based Combination Therapy (ACT) in Nigeria without a strict preference for any of the combinations may account for the lower rate of AL prescription in our study.…”

Section: Discussioncontrasting

confidence: 53%

Drug prescribing pattern for under-fives in a paediatric clinic in south-western Nigeria

Fadare¹,

Olatunya²,

Oluwayemi³

et al. 2015

Ethiop J Health Sci

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BACKGROUND: The audit of drug prescribing pattern in under-five children is essential in identifying the various types of non-rational prescribing such as polypharmacy and irrational use of antimicrobials. The primary objective of this study was to determine the drug prescribing pattern for children aged below five years attending the paediatric outpatient clinic of a tertiary hospital in Ado-Ekiti, South-West Nigeria. METHODS: A cross-sectional study was carried out using the medical records of patients who attended the paediatric clinic of the hospital between April 1 and October 30, 2013. The medical records of patients aged below five years were selected monthly for the period of the study using a regular interval ratio. Drug use indicators were assessed using the WHO guidelines on investigation of drug use in health care facilities. RESULTS: There were 293(55.7%) prescriptions collected from male patients and 233(44.3% from female patients with a total of 1369 prescribed drugs (2.6 ± 1.1 drugs per prescription). A total of three hundred and seventy-four (71.1%) patients had at least one antibiotic prescribed with antibiotics accounting for 28.2% of all drugs prescribed, while 13.5% of all encounters had an injection prescribed. Prescribing by generic name was done in 68.9 ± 26.5% of all prescribed medications, and 60.4% of all prescribed medications were from the latest version of the Nigerian Essential Drug List. Three hundred and twelve children (59.3%) had at least one anti-malarial drug prescribed while analgesics drugs accounted for 6.1% of all prescriptions. CONCLUSION: This study showed that over-prescription of antibiotics, significant use of injections and prescribing by generic name are real issues among Nigerian paediatric prescribers.

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“…Such chloroquine use potentially creates various levels of chloroquine selecting pressure in the region, which would be one of the important factors that affects the speed of recovery of susceptible parasites [43]. However, countrywide-antimalarial survey reported no considerable difference of chloroquine use between Tororo and our study area [44][45][46], suggesting that this could not be a main factor for the observed findings.…”

Section: Discussionmentioning

confidence: 64%

Recovery and stable persistence of chloroquine sensitivity in Plasmodium falciparum parasites after its discontinued use in Northern Uganda.

Balikagala

Yatsushiro²,

Tachibana

et al. 2020

Preprint

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Background Usage of chloroquine was discontinued from the treatment of Plasmodium falciparum infection in almost all endemic regions because of global spread of resistant parasites. Since the first report in Malawi, numerous epidemiological studies have demonstrated that the discontinuance led to re-emergence of chloroquine-susceptible P. falciparum parasites, suggesting a possible role in future malaria control. However, most studies were cross-sectional, with few studies looking at the persistence of chloroquine recovery in long term. This study fills the gap by providing, for a period of at least 6 years, proof of persistent re-emergence/stable recovery of susceptible parasite populations using both molecular and phenotypic methods Methods Ex vivo drug-susceptibility assays to chloroquine (n = 319) and lumefantrine (n = 335) were performed from 2013 to 2018 in Gulu, Northern Uganda where chloroquine had been removed from the official malaria treatment regimen since 2006. Genotyping of pfcrt and pfmdr1 was also performed. Results Chloroquine resistance (100 nM) was observed in only 3 (1.3%) samples. Average IC 50 values for chloroquine were persistently low throughout the study period (17.4–24.9 nM). Parasites harboring p fcrt K76 alleles showed significantly lower IC 50 s to chloroquine than the parasites harboring K76T alleles (21.4 nM vs 43.1 nM, p-value= 3.9×10 -8 ). Prevalence of K76 alleles gradually increased from 71% in 2013 to 100% in 2018. Conclusion This study found evidence of stable persistence of chloroquine susceptibility with the fixation of pfcrt K76 in Northern Uganda after discontinuation of chloroquine in the region. Accumulation of similar evidence in other endemic areas in Uganda could open channels for possible future re-use of chloroquine as an option for malaria treatment or prevention.

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Anti-malarial prescription practices among outpatients with laboratory-confirmed malaria in the setting of a health facility-based sentinel site surveillance system in Uganda

Cited by 17 publications

References 28 publications

Major Improvements in the Quality of Malaria Case-Management under the “Test and Treat” Policy in Kenya

Major Improvements in the Quality of Malaria Case-Management under the “Test and Treat” Policy in Kenya

Drug prescribing pattern for under-fives in a paediatric clinic in south-western Nigeria

Recovery and stable persistence of chloroquine sensitivity in Plasmodium falciparum parasites after its discontinued use in Northern Uganda.

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