Abstract

ADHERENCE OF MEDICAL PRACTITIONERS TO THE NATIONAL MALARIA PROTOCOL AMONG PRIMARY HEALTH CARE CENTERS IN KHARTOUM LOCALITY

Al-Husein Mohammed Chyad*, Chahinez Houacine, Hind Mahmood and Hassan Mohammed Ali

ABSTRACT

Introduction: Very few studies have dealt with the issue of compliance and adherence to the National Malaria Protocol (NMP) in Khartoum locality. Irrational use of anti-malarial drugs by medical practitioners (MPs) and pharmacists was shown in various practices e.g. over prescribing and Over-The-Counter (OTC) dispensing. Methods: A cross-sectional study was conducted on 33 MPs employing a closed questionnaire. Results and Discussion: A 87.9% adherence to the NMP was shown by the MPs for the 1st line treatment of uncomplicated malaria (UM) prescribing Artesunate plus Sulfadoxine-Pyrimethamine tablets, 21.2% for the 2nd line treatment of UM as Artemether plus Lumefantrine, 48.5% for the 3rd line treatment of UM as quinine tabs, 48.5% for the 1st line treatment of severe malaria (SM) as quinine injections, 15.2% for the 2nd line treatment of SM as Artemether injections, 90.9% for the 1st line treatment of UM in children as Artesunate plus Sulfadoxine-Pyrimethamine tabs, 15.2% for the 2nd line treatment of UM in children as artemether plus Lumefantrine, 90.9% for SM in children as quinine injections or artemether injections. 48% of MPs were aware of the NMP by protocol posters. The adherence to the NMP by MPs of different ages and gender showed only significant inter subject differences for the 1st line treatment of UM in children (p-value 0.010 and 0.022) respectively. Doctors with different academic qualifications post MBBS showed only significant differences for the adherences to the 2nd line treatment of SM (p-value 0.023) and 1st line treatment of UM (p-value 0.013). Doctors with different professional medical status showed a significant difference for the adherence to the 1st line treatment of UM in children (p-value 0.038). Conclusion: MPs are only showing adherence towards the 1st line treatment of NMP in UM in adults and children and SM in children, but not the 2nd and 3rd line treatment of UM in adults, 1st and 2nd line treatments of SM and 2nd line treatment of UM in children. Rational antimalarial therapy could be attained via promotion of an administrative and/or managerial and /or educational intervention(s).

Keywords: Adherence, Malaria, National Malaria Protocol, Medical practitioners.