Knowledge and behaviour as determinants of anti-malarial drug use in a peri-urban population from malaria holoendemic region of western Kenya

Abstract

BackgroundThe appropriate use of anti-malarial drugs determines therapeutic efficacy and the emergence and spread of drug-resistant malaria. Strategies for improving drug compliance require accurate information about current practices at the consumer level. This is to ascertain that the currently applied new combination therapy to malaria treatment will achieve sustained cure rates and protection against parasite resistance. Therefore, this cross-sectional study was designed to determine knowledge and behaviour of the consumers in households (n = 397) in peri-urban location in a malaria holoendemic region of western Kenya.MethodsThe knowledge and behaviour associated with anti-malarial use were evaluated. Using clusters, a questionnaire was administered to a particular household member who had the most recent malaria episode (within <2 weeks) and used an anti-malarial for cure. Mothers/caretakers provided information for children aged <13 years.ResultsConsumers' knowledge on dosage and duration/frequency demonstrated that only 29.4% used the correct artemisinin-based combination therapy (ACT) dosage. Most respondents who used quinine identified the correct duration of use (96.4%) since its administration was entirely at health facilities. To assess behaviours during use of anti-malarial drugs, respondents were stratified into those who took drugs with prescription (39.4%) and without prescription (61.6%). For those without prescription, the reasons given were; procedure of acquisition less costly (39.0%), took same drug for similar symptoms (23.0%), not satisfied with health services (15.5%), neighbour/friend/relative previously taken the same drug (12.5%) and health institution was far from their location (10%).ConclusionMajority of consumers in the study area were knowledgeable on the symptoms of malaria. In addition, majority acquired ineffective anti-malarial drugs for treatment and reported sub-optimal treatment regimens with the currently recommended drugs. Furthermore, behaviours which constrain the successful up-scaling of ACT were common, creating a challenge in the desire to turn efficacy to effectiveness of the combination therapy programme. It will be important to direct and focus interventions in creating awareness on the importance of using recommended drugs to lessen the use of less efficacious anti-malarials. In addition, the consumers need to be educated on the importance of drug adherence in such areas to reduce the emergence and spread of drug-resistant malaria.

Socioeconomic Determinants of Antimalarial Drug Use Behaviours: A Systematic Review

“…Four studies [14,20,27,32] reported on the association between income level and antimalarial drug use behaviours of non-adherence to the treatment dosage [20,27,31] and non-compliance to treatment guideline in the form of self-medication [15,23,30]. All of these studies were conducted in Africa.…”

“…Of these, 62.7% used the patent medicine dealers [30] Self-diagnosis was the most common diagnostic method in both rural and urban for adult and child diagnosis [16] Reasons for selfmedication 39.0% said less expensive than consultation; 10% said health institution was far away; 12.5% said neighbour/friend/relative previously took the same drug [23] [15,23] For those who had no prescription, the reasons given were as follows: 39.0% said procedure of acquisition (without prescription) was less costly; 23.0% took same drug for similar symptoms; 10% said health institution was far from their location; 12.5% said neighbour/friend/relative previously took the same drug [15]. Household size significantly influenced the types of anti-malarial drugs used (b=0.092, P=0.049).…”

“…At the end of the assessment and appraisal exercise, seventeen (17) studies [14][15][16][17][18][19][20][21][23][24][25][26][27][28][29][30][31] that were of good quality based on the PCAqs assessment were included in this systematic review.…”

“…Nevertheless, the contributions of socioeconomic factors to antimalarial drug use behaviours have only been sparsely reported in studies; with most of the studies not primarily designed to identify or assess the association of these variables [15,17,19,21,[23][24][25]. In addition there is no existing systematic review of studies on the socioeconomic determinants of antimalarial drug use.…”

“…Socioeconomic factors like income level can be key determining factor in treatment seeking and drug use behaviours of individuals and households. Relative to the level of poverty in malaria endemic countries, the high cost of antimalarial drugs -like the ACTs class of drugs -leads to drug use behaviours such as not using the recommended class of drugs [12], use of monotherapies, nonadherence to treatment regimen [13], presumptive and self-treatment [14][15][16] amongst others.…”