Knowledge and malaria treatment practices using artemisinin combination therapy (ACT) in Malawi: survey of health professionals

Abstract

Background: Malaria still remains a life-threatening disease worldwide with between 190 and 311 million cases in 2008. Due to increased resistance to sulfadoxine-pyrimethamine (SP), the Ministry of Health in Malawi, as in many sub-Saharan African countries, changed the malaria treatment policy to use artemisinin-based combination therapy (ACT). In order to optimize the correct use of this drug, and protect against the development of resistance by the parasite, it is important to assess the knowledge and practices of medical practitioners with regard to the use of ACT and its impact on adherence to new treatment policy guidelines. Methods: A cross-sectional survey was conducted to assess the knowledge and perceptions of Malawian medical doctors and pharmacists on the use of ACT and the drivers of treatment choice and clinical treatment decisions. Medical doctors and pharmacists who are involved in managing malaria patients in Malawi were recruited and a self-administered questionnaire was used to obtain information on socio-demographic characteristics of the study participants, knowledge on ACT, source of information on ACT and methods used to decide on the treatment of patients with malaria. Results: Most of the participants (95.7%) know at least one form of ACT, 67.4% reported that different forms of ACT have different characteristics, and 77.3% reported that there are special formulations for children. The most commonly mentioned ACT was artemether-lumefantrine (AL), by 94.6% of the participants; 75.0% of the participants indicated that they preferred to prescribe AL. 73.9% of participants had ever received information on ACT. However, only 31.5% had received training on management of malaria using ACT. 71.7% of respondents had heard of ACT causing side effects. Only 25.0% of the participants had received training on how to report serious adverse events. Conclusion: It was found that most of the participants knew about ACT and treatment guidelines for malaria. However, most of the participants had not received any training on how to use ACT or how to report adverse effects arising from the use of ACT. There is a need for more training of health care professionals to ensure correct and effective use of ACT