Physicians' Compliance With Anti-Malarial Treatment Guidelines Among Under Five Children Attending Secondary Health Facilities in Sokoto Metropolis

Abstract

Introduction: Rational use of drugs against most common and life‑threatening tropical diseases such as malaria remains a huge challenge, particularly in sub-Saharan African region. The correct use of antimalarial drugs is the key not only to therapeutic success but also to deterring the spread of drug resistance malaria.
 Aims: To assess the physicians’ compliance with the national anti’-malaria treatment guidelines among Under five (U-5) years children in secondary health facilities in Sokoto metropolis.
 Methods: This was a cross-sectional study conducted as an exit interview among 292 mothers/caregivers of febrile U-5 children with antimalarial prescription, that presented to the out-patient clinics of the selected secondary health facilities in Sokoto metropolis. Simple random sampling technique using balloting option was used to select 2 secondary Health facilities in the metropolis, Proportionate allocation was done to allocate study subjects to the selected Health facilities based on average weekly outpatient attendance. The data was collected using an interviewer-administered questionnaire. Descriptive statistics was used to analysed data using IBM SPSS version 22.
 Results: Of the 292 children, only 115(39.4%) had malaria parasite test requested by the physician, out of which 63(54.8) had microscopy, while 52(45.2) of the children had malaria Rapid Diagnostic Test (mRDT). One hundred and eighty-five (65.1%) of the children were treated presumptively with anti-malarial drugs. Artemisinin based Combination Therapy (ACT) was prescribed in 221(77.8%) of the under-fives. The commonest prescribed ACT was Artemether-Lumefantrine in 113(77.4%) of the children. Majority 263(92.6%) of the prescriptions were in brand names.
 Recommendation: The physicians’ compliance with national malaria treatment guidelines using the proportion of U-5 children was suboptimal. There was over prescription of anti-malarial drugs, as majority of the patients treated for malaria had no laboratory evidence for the treatment. However, compliance with the use of ACT was good. This study shows also suboptimal compliance with WHO prescribing indicators with respect to prescription in generic names. Regular training of the health care providers by the government is recommended to improve adherence to antimalarial treatment guideline.