Mind the gap: knowledge and practice of providers treating uncomplicated malaria at public and mission health facilities, pharmacies and drug stores in Cameroon and Nigeria

Abstract

Background Artemisinin combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Cameroon since 2004 and Nigeria since 2005, though many febrile patients receive less effective antimalarials. Patients often rely on providers to select treatment, and interventions are needed to improve providers’ practice and encourage them to adhere to clinical guidelines.Methods Providers’ adherence to malaria treatment guidelines was examined using data collected in Cameroon and Nigeria at public and mission facilities, pharmacies and drug stores. Providers’ choice of antimalarial was investigated separately for each country. Multilevel logistic regression was used to determine whether providers were more likely to choose ACT if they knew it was the first-line antimalarial. Multiple imputation was used to impute missing data that arose when linking exit survey responses to details of the provider responsible for selecting treatment.Results There was a gap between providers’ knowledge and their practice in both countries, as providers’ decision to supply ACT was not significantly associated with knowledge of the first-line antimalarial. Providers were, however, more likely to supply ACT if it was the type of antimalarial they prefer. Other factors were country-specific, and indicated providers can be influenced by what they perceived their patients prefer or could afford, as well as information about their symptoms, previous treatment, the type of outlet and availability of ACT.Conclusions Public health interventions to improve the treatment of uncomplicated malaria should strive to change what providers prefer, rather than focus on what they know. Interventions to improve adherence to malaria treatment guidelines should emphasize that ACT is the recommended antimalarial, and it should be used for all patients with uncomplicated malaria. Interventions should also be tailored to the local setting, as there were differences between the two countries in providers’ choice of antimalarial, and who or what influenced their practice.

Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence

“…Information on pre-existing antimalarial preferences was gathered from baseline and preintervention surveys, 32 49 interview transcripts Tanz1 and unpublished reports, 54 although no data were available for five studies Afgh1,Ghan1,Tanz3,Uga1,Uga2 . The data suggest an association between the use of ACTs for positive mRDTs and baseline preferences for, or use of, ACTs rather than other antimalarials.…”

Stocking pattern for anti-malarial medications among proprietary patent medicine vendors in Akinyele Local Government Area, Ibadan, Nigeria

“…Hence there is still the need for the PPMVs to be trained periodically on the recommended guideline for diagnosis and treatment of uncomplicated malaria. There was a report on PPMVs having poor access to the recommended treatment guideline as similarly documented in a study conducted by Mangham-Jefferies et al [28] among drug stores owners in Nigeria and Cameroon but at variance with findings of Adibe et al in a study conducted among PPMVs in Enugu State, Nigeria which reported 75.6% had access to the recommended treatment guideline [17].…”

Anti-malarial landscape in Myanmar: results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016

“…Increasing provider knowledge may be a first step towards ensuring the delivery of first-line treatments. That said, some studies have found no evidence of a relationship between providers’ knowledge and practice, and have suggested that provider preference is a stronger predictor of appropriate case management practices [ 40 ]. As such, simply increasing knowledge of the first-line treatment may have a limited effect, as supported by other studies [ 41 – 43 ].…”