Improving quality of malaria treatment services: Assessing inequities in consumers' perceptions and providers' behaviour in Nigeria

Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria. .
International Journal for Equity in Health (Impact Factor: 1.71). 10/2010; 9(1):22. DOI: 10.1186/1475-9276-9-22
Source: PubMed


Information about quality of malaria treatment services of different healthcare providers is needed to know how to improve the treatment of malaria since inappropriate service provision leads to increased burden of malaria. Hence, the study determined the technical and perceived quality of malaria treatment services of different types of providers in three urban and three rural areas in southeast Nigeria.
Questionnaire was used to interview randomly selected healthcare providers about the technical quality of their malaria treatment services. Exit polls were used to obtain information about perceived quality from consumers. A socio-economic status (SES) index and comparison of data between urban and rural areas was used to examine socio-economic status and geographic differences in quality of services.
The lowest technical quality of services was found from patent medicine dealers. Conversely, public and private hospitals as well as primary healthcare centres had the highest quality of services. Householders were least satisfied with quality of services of patent medicine dealers and pharmacy shops and were mostly satisfied with services rendered by public and private hospitals. The urbanites were more satisfied with the overall quality of services than the rural dwellers.
These findings provide areas for interventions to equitably improve the quality of malaria treatment services, especially for patent medicine dealers and pharmacy shops, that are two of the most common providers of malaria treatment especially with the current change of first line drugs from the relatively inexpensive drugs to the expensive artemisinin-based combination therapy, so as to decrease inappropriate drug prescribing, use, costs and resistance to artemisinin-based combination therapy.

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    • "Surveys in Senegal and Madagascar showed that poor-quality medicines were not limited to any particular type of distributor. In Uganda, the public sector performed best, while in Nigeria, a country with weak drug regulations, oral AMT accounted for 10% of prescriptions in the public sector [30,32]. There was no significant difference in stocking ineffective medicines between the regulated and the informal private sector in those countries. "
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    ABSTRACT: Background Despite great progress towards malaria control, the disease continues to be a major public health problem in many developing countries, especially for poor women and children in remote areas. Resistance to artemisinin combination therapy (ACT) emerged in East Asia. Its spread would threaten the only effective malaria treatment currently available. Improvement in availability of diagnosis as part of malaria control has highlighted the fact that many fevers are not due to malaria. These fevers also need to be promptly diagnosed and adequately treated in order to improve public health outcomes in developing countries. Methods This review looked for evidence for the most effective approach to deliver malaria treatment in developing countries, by public sector, formal and informal private sector, and community health workers (CHWs). The authors analysed 31 studies to assess providers based on six parameters: knowledge and practice of provider, diagnosis, referral practices, price of medicine, availability of ACT, and treatment coverage and impact on morbidity and mortality. Results The public sector has made progress in prevention and treatment in many countries, but facilities are inaccessible to some communities, and the sector suffers shortages of health workers and stock-outs of medicines. Despite wide outreach, the private sector, especially informal facilities, presents public health risks. This is due to an inability to diagnose and treat non-malarial fevers, and an innate motive to over-prescribe malaria treatment. The need to pay for treatment is a major factor in deterring poor women and children from accessing the medicines they need. A system that depends on ability to pay risks a repeat of the chloroquine story, where an effective and cheap anti-malarial drug was rendered useless partly due to under-treatment. CHWs have proved to be effective agents in providing correct diagnosis and treatment of malaria and other common fevers, even in remote areas. Conclusions The evidence shows that there is no short-cut to investing in training and supervision of providers, or in treating malaria within a public health context rather than as a separate disease. The studies highlighted that all outlets face challenges in delivering their services, but that CHWs scored highly in almost all parameters. CHWs have proved to be effective agents in providing correct diagnosis and treatment of malaria and other common fevers, even in remote areas. Their role should be recognized and expanded.
    Full-text · Article · Dec 2012 · Malaria Journal
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    ABSTRACT: Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. We searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually through references of retrieved articles. Our search included studies of all designs that described characteristics, knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist. Finally, we conducted a structured narrative synthesis of the main findings. We obtained 61 studies, mostly from Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested, with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is known on the link between regulatory enforcement and practices of specialized drug shops. Evidence suggests that characteristics and practices of specialized drug shops differ across rural and urban locations, and that these providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the governance of the retail pharmaceutical sector.
    Full-text · Article · Jul 2012 · BMC Health Services Research
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    ABSTRACT: Introduction: Patent Medicine vendors (PMVs) can provide an opportunity for effective scaling up of artemsinin based combination therapy (ACT). However, there are serious concerns about their malaria treatment practices. Inadequate medicine sellers’ knowledge will likely jeopardise the objective of this combination therapy. It is therefore relevant to assess the knowledge and utilization of ACTs by the PMVs in communities in Nigeria. Objective: This study was conducted to evaluate the knowledge and utilization of artemisinin based combination therapy (ACT) by PMVs. Methodology: The study was conducted among PMVs in six (6) communities in Anambra state, South-east Nigeria. A minimal sample size of 237 was determined using the formula for descriptive studies and 270 PMVs were used for the study. An interviewer administered questionnaire was used for the data collection and the data analysed using Statistical Program for Social Sciences (SPSS) version 18. Results: Only 8 % of the respondents correctly mentioned the vector organism responsible for malaria transmission. However, while 78 % of the PMVs were conversant with the term ACT and 71 % stock ACT in their shops, only 13.3 % knew the Federal Ministry of Health (FMOH) recommended first line drug for treatment of uncomplicated malaria and also, only 23 % knew the distinction between mono- and combination therapies. Meanwhile, only 38.9 % of the interviewed group indicated paticipating in malaria trainings organised by different organisations in the past three years. Furthermore, 16.7 %, 20 % and 25.6 % respectively knew the dosage regimen, side effects and contra indications to a stated ACT.
    Full-text · Article · Jan 2013
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