Prescribing practices for malaria in a rural Ugandan hospital: evaluation of a new malaria treatment policy

Abstract

Background: Increasing resistance to first line antimalarial drugs led to a change in the antimalarial policy of Uganda in 2005. Successful implementation of this policy depends on changing prescribing patterns of health workers. Objectives: To describe prescribing patterns for malaria and associated factors in a rural Ugandan hospital following a change in antimalarial treatment policy from chloroquine plus sulphadoxine-pyrimethamine to artemisinin-based combination therapies. Methods: From the outpatients register, 715 prescriptions for malaria were reviewed. Data was collected on patient demographics, prescriber factors and prescription patterns. Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. Results:The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine (n=564, 88.5%) and quinine (n=66, 84.6%) respectively. The proportion of prescriptions conforming to the new antimalarial treatment policy was 88.1% (n=630). Predictors of conformity were: duration in service of less than 6 years (OR=3.40. CI=1.24-9.33), prescriber's profession (OR=97.51, CI=27.29-348.34) and diagnosis of uncomplicated malaria (OR=10.13, CI=3.37-30.42). Conclusions: Adequate training and provision of information relevant to the needs of different cadres of health workers is needed to promote effective uptake of new treatment policies.

Use of proscribed chloroquine is associated with an increased risk of pfcrt T76 mutation in some parts of Ghana

“…The differences in the distribution of pfcrt T76 resistance gene among the four study sites were constantly related to the different pattern of CQ stocking and usage in each area. This suggests that complete withdrawal of CQ from the country could lead to re-emergences of CQ sensitive P. falciparum similar to the findings from other endemic countries [ 35 , 36 , 49 , 50 ].…”

“…The observed high prevalence of the pfcrt T76 mutation is similar to the Uganda study where CQ was substituted with artemether-lumefantrine (AL) as the first-line anti-malarial drug [ 35 , 36 ]. After seven years of AL usage, CQ resistance was still high, ranging from 98.7 to 100% [ 35 , 36 ]. The increase in the observed resistance in those reports was attributed to continuous use of CQ, the same reason adduced by this study.…”

Strengthening health policy development and management systems in low- and middle- income countries: South Africa's approach

“…[ 7 , 28 , 29 , 31 , 33 , 35 , 36 , 38 , 39 , 41 , 42 , 51 , 54 , 58 , 59 , 61 , 62 , 64 , 68 , 70 , 72 , 74 , 95 , 102. , 103. , 104.…”

“…The literature emphasized the need to monitor the availability of policy inputs, such as medical supplies and medicines [ 33 , 35 , 55 , 60 , 63 , 64 , 67 , 68 , 79 , 95 , 101 , 103 ]. Various supply chain management systems have been established to monitor health system input availability and access.…”

“…An evaluation should be conducted when required by the policy [ 27 , 28 , 33 , 52 , 54 , 64 , 80 , 81 , 85 , 103 , 106 , 115 ]. Many policies include a requirement that a policy evaluation be conducted a certain number of years after implementation.…”