Antimalarial Prescribing Practices: A Challenge to Malaria Control in Ghana
Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects andMet...
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| Published in | Medical principles and practice Vol. 14; no. 5; pp. 332 - 337 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
Basel, Switzerland
01.09.2005
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1011-7571 1423-0151 |
| DOI | 10.1159/000086931 |
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| Abstract | Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects andMethods: The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. Results: The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. Conclusion: Thefindings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections. |
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| AbstractList | Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects andMethods: The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. Results: The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. Conclusion: Thefindings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections. The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country.OBJECTIVEThe study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country.The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities.SUBJECTS AND METHODSThe study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities.The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine.RESULTSThe overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine.The findings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections.CONCLUSIONThe findings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections. The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. The findings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections. |
| Author | Koram, K.A. Abuaku, B.K. Binka, F.N. |
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| Keywords | Antimalarial practices Ghana Prescribing practices Malaria control |
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| References | Massele AY, Ofori-Adjei D, Laing RO: A study of prescribing patterns with special reference to drug use indicators in Dar es Salaam region, Tanzania. Trop Doct 1993;23:104-107.8356735 Siddiqi S, Hamid S, Rafique G, Chaudhry SA, Ali N, Shahab S, Sauerborn R: Prescription practices of public and private health care providers in Attock District of Pakistan. Int J Health Plann Management 2002;17:23-40.1196344110.1002%2Fhpm.650 Binka FN, Maude GH, Gyapong M, Ross DA, Smith PG: Risk factors for child mortality in northern Ghana: a case-control study.Int J Epidemiol1995;24:127-135. Massele AY, Nsimba SE, Rimoy G: Prescribing habits in church-owned primary health care facilities in Dar es Salaam and other Tanzanian coast regions. East Afr Med J 2001;78:510-514.11921592 Neequaye J: In vivo chloroquine-resistant falciparum in western Africa. Lancet 1986;i:153.10.1016%2FS0140-6736%2886%2992286-5 Landgraf B, Kollaritsch H, Wiedermann G, Wernsdorfer H: Plasmodium falciparum: susceptibility in vitro and in vivo to chloroquine and sulfadoxine-pyrimethamine in Ghanaian school children. Trans R Soc Trop Med Hyg 1994;88:440-442. Desta Z, Abula T, Beyene L, Fantahun M, Yohannes AG, Ayalew S: Assessment of rational drug use and prescribing in primary health care facilities in northwest Ethiopia. East Afr Med J 1997;74:758-763.9557418 World Health Organization: The World Health Report 1999: Making a Difference. Geneva, World Health Organization, 1999, p 49. Trap B, Hansen EH, Hogerzeil HV: Prescription habits of dispensing and non-dispensing doctors in Zimbabwe. Health Policy Plann 2002;17:288-295.1213599510.1093%2Fheapol%2F17.3.288 Bosu WK, Ofori-Adjei D: An audit of prescribing in health care facilities of the Wassa West district of Ghana. West Afr J Med 2000;19:298-303.11391845 Ghana Ministry of Health: Baseline study on the pharmaceutical sector in Ghana: Rational use, procurement and financing of drugs. Final Report 1999, p 22. Kitua AY: Antimalarial drug policy: making systematic change. Lancet 1999;354(suppl):SIV32. Afari EA, Akanmori BD, Nankano T, Ofori-Adjei D: Plasmodium falciparum: sensitivity to chloroquine in-vivo in three ecological zones in Ghana. Trans R Soc Trop Med Hyg1992;86:231-232. Koram KA: Mapping response of Plasmodium falciparum to chloroquine and other antimalarial drugs in Ghana, Project ID 980034. Final report submitted to MIM/TDR, 2003. Ghana Ministry of Health: Draft, Rollback Malaria Strategic Plan for Ghana: 2000-2010. Accra, Ministry of Health, 1999. Simon N, Hakkou F, Minani M, Jasson M, Diquet B: Drug prescription and utilization in Morocco. Therapie 1998;53:113-120.9773110 Quick JD, Laing RO, Ross-Degnan D: Intervention research to promote clinically effective and economically efficient use of pharmaceuticals: the international network for rational use of drugs. J Clin Epidemiol 1991;44(suppl 2):57S-65S.10.1016%2F0895-4356%2891%2990114-O Binka FN, Morris SS, Ross DA, Arthur P, Aryeetey ME: Patterns of malaria morbidity and mortality in northern Ghana. Trans R Soc Trop Med Hyg 1994;88:381-385. Massele AY, Mwaluko GM: A study of prescribing patterns at different health care facilities in Dar es Salaam, Tanzania. East Afr Med J 1994;71:314-316.7925064 Akabzaa T, Darimani A: Impact of Mining Sector Investment in Ghana: A Study of the Tarkwa Mining Region, 2001. White N: Antimalarial drug resistance and combination chemotherapy. Philos Trans R Soc Lond B 1999;354:739-749. Håkansson A, Andersson H, Cars H, Melander A: Pharmacoepidemiology and prescription: prescribing. Prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care. Eur J Clin Pharmacol 2001;57:65-70.1137259510.1007%2Fs002280100271 ref2 ref1 ref4 ref3 ref5 |
| References_xml | – reference: White N: Antimalarial drug resistance and combination chemotherapy. Philos Trans R Soc Lond B 1999;354:739-749. – reference: Ghana Ministry of Health: Baseline study on the pharmaceutical sector in Ghana: Rational use, procurement and financing of drugs. Final Report 1999, p 22. – reference: Neequaye J: In vivo chloroquine-resistant falciparum in western Africa. Lancet 1986;i:153.10.1016%2FS0140-6736%2886%2992286-5 – reference: Landgraf B, Kollaritsch H, Wiedermann G, Wernsdorfer H: Plasmodium falciparum: susceptibility in vitro and in vivo to chloroquine and sulfadoxine-pyrimethamine in Ghanaian school children. Trans R Soc Trop Med Hyg 1994;88:440-442. – reference: Desta Z, Abula T, Beyene L, Fantahun M, Yohannes AG, Ayalew S: Assessment of rational drug use and prescribing in primary health care facilities in northwest Ethiopia. East Afr Med J 1997;74:758-763.9557418 – reference: Afari EA, Akanmori BD, Nankano T, Ofori-Adjei D: Plasmodium falciparum: sensitivity to chloroquine in-vivo in three ecological zones in Ghana. Trans R Soc Trop Med Hyg1992;86:231-232. – reference: Binka FN, Morris SS, Ross DA, Arthur P, Aryeetey ME: Patterns of malaria morbidity and mortality in northern Ghana. Trans R Soc Trop Med Hyg 1994;88:381-385. – reference: Håkansson A, Andersson H, Cars H, Melander A: Pharmacoepidemiology and prescription: prescribing. Prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care. Eur J Clin Pharmacol 2001;57:65-70.1137259510.1007%2Fs002280100271 – reference: Kitua AY: Antimalarial drug policy: making systematic change. Lancet 1999;354(suppl):SIV32. – reference: Koram KA: Mapping response of Plasmodium falciparum to chloroquine and other antimalarial drugs in Ghana, Project ID 980034. Final report submitted to MIM/TDR, 2003. – reference: World Health Organization: The World Health Report 1999: Making a Difference. Geneva, World Health Organization, 1999, p 49. – reference: Simon N, Hakkou F, Minani M, Jasson M, Diquet B: Drug prescription and utilization in Morocco. Therapie 1998;53:113-120.9773110 – reference: Quick JD, Laing RO, Ross-Degnan D: Intervention research to promote clinically effective and economically efficient use of pharmaceuticals: the international network for rational use of drugs. J Clin Epidemiol 1991;44(suppl 2):57S-65S.10.1016%2F0895-4356%2891%2990114-O – reference: Massele AY, Mwaluko GM: A study of prescribing patterns at different health care facilities in Dar es Salaam, Tanzania. East Afr Med J 1994;71:314-316.7925064 – reference: Bosu WK, Ofori-Adjei D: An audit of prescribing in health care facilities of the Wassa West district of Ghana. West Afr J Med 2000;19:298-303.11391845 – reference: Ghana Ministry of Health: Draft, Rollback Malaria Strategic Plan for Ghana: 2000-2010. Accra, Ministry of Health, 1999. – reference: Massele AY, Nsimba SE, Rimoy G: Prescribing habits in church-owned primary health care facilities in Dar es Salaam and other Tanzanian coast regions. East Afr Med J 2001;78:510-514.11921592 – reference: Siddiqi S, Hamid S, Rafique G, Chaudhry SA, Ali N, Shahab S, Sauerborn R: Prescription practices of public and private health care providers in Attock District of Pakistan. Int J Health Plann Management 2002;17:23-40.1196344110.1002%2Fhpm.650 – reference: Akabzaa T, Darimani A: Impact of Mining Sector Investment in Ghana: A Study of the Tarkwa Mining Region, 2001. – reference: Massele AY, Ofori-Adjei D, Laing RO: A study of prescribing patterns with special reference to drug use indicators in Dar es Salaam region, Tanzania. Trop Doct 1993;23:104-107.8356735 – reference: Binka FN, Maude GH, Gyapong M, Ross DA, Smith PG: Risk factors for child mortality in northern Ghana: a case-control study.Int J Epidemiol1995;24:127-135. – reference: Trap B, Hansen EH, Hogerzeil HV: Prescription habits of dispensing and non-dispensing doctors in Zimbabwe. Health Policy Plann 2002;17:288-295.1213599510.1093%2Fheapol%2F17.3.288 – ident: ref4 doi: 10.1007%2Fs002280100271 – ident: ref5 doi: 10.1093%2Fheapol%2F17.3.288 – ident: ref2 doi: 10.1016%2F0895-4356%2891%2990114-O – ident: ref3 doi: 10.1002%2Fhpm.650 – ident: ref1 doi: 10.1016%2FS0140-6736%2886%2992286-5 |
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| SubjectTerms | Amodiaquine - pharmacology Amodiaquine - therapeutic use Animals Anti-Infective Agents - therapeutic use Antimalarials - classification Antimalarials - pharmacology Antimalarials - therapeutic use Artemisinins - pharmacology Artemisinins - therapeutic use Chloroquine - pharmacology Chloroquine - therapeutic use Drug Combinations Drug Resistance Drug Utilization - statistics & numerical data Ghana Humans Interviews as Topic Malaria - drug therapy Malaria - transmission Medical Audit National Health Programs Original Paper Phenanthrenes - pharmacology Phenanthrenes - therapeutic use Plasmodium falciparum - drug effects Practice Patterns, Physicians' - statistics & numerical data Pyrimethamine - pharmacology Pyrimethamine - therapeutic use Quinine - pharmacology Quinine - therapeutic use Rural Health Services - standards Sentinel Surveillance Sesquiterpenes - pharmacology Sesquiterpenes - therapeutic use Sulfadoxine - pharmacology Sulfadoxine - therapeutic use |
| Title | Antimalarial Prescribing Practices: A Challenge to Malaria Control in Ghana |
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