Antimalarial Prescribing Practices: A Challenge to Malaria Control in Ghana

Abstract

Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects andMethods: The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. Results: The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. Conclusion: Thefindings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections.

Prescribing trend of antimalarial drugs at the Ghana Police Hospital

“…The average number per encounter obtained in this study is comparable to that of a study conducted in Tanzania, where the average number of drugs per encounter was 2.4 [24]. The average number obtained in this study suggests minimal polypharmacy and a specific malaria treatment regimen [23]. However, since this study did not examine whether there was laboratory or rapid diagnostic testing to support treatment with antimalarial drugs, we cannot confirm the latter suggestion.…”

“…Also, drugs prescribed per encounter were significantly lower than those observed in a similar study within two districts in Ghana, Wassa West and Kassena Nankana. Drugs prescribed per encounter in the latter study were 4.3 and 3.0, respectively, in the two districts [23], and it is worth noting that the studies conducted were undertaken before the introduction of the ACT policy. The average number per encounter obtained in this study is comparable to that of a study conducted in Tanzania, where the average number of drugs per encounter was 2.4 [24].…”

Why Don’t Medical Practitioners Treat Malaria Rationally? A Qualitative Study from Pakistan

“…Irrational prescribing practices, unavailability of drugs, lack of awareness and adherence of prescribers regarding standard treatment guidelines, self medication and overuse of antibiotics were highlighted as the major factors contributing towards irrational drug use in malaria in Pakistan by the respondents. Similar patterns of irrational drug use in other countries have been reported [16][17].…”

A qualitative study exploring perspectives towards rational use of medicines in Pakistan's Malaria Control Program (MCP)

“…Several studies conducted in Pakistan have reported a more prevalent resistance of falciparum malaria to chloroquine; the use of artimisinin derivatives is more effective but too costly for a developing country to be used on large scale (Shah et al, 1997, Rana, 2004#257, Fox et al, 1985, Ejaz et al, 2007. Similar patterns of irrational drug use have been reported in Ghana and Cambodia (Chareonkul et al, 2002;Abuakua et al, 2005).…”