Journal Article•
Choice and Sources of Antimalarial Drugs Used for Self-medication in Kisumu, Western Kenya
TL;DR: Self-medication for perceived malaria is prevalent in Kisumu city, Western Kenya, and Artemisinin-based combination therapies (ACT) is the drug of choice for self-medicated.
Abstract: Background : The choice and sources of antimalarial drugs used for self-medication has important implication to the current malaria treatment policies in Kenya. However, data on the choice of antimalarial drugs used for self-medication and their sources remains scanty. Objectives : The objectives of this study were to determine the prevalence of self-medication, the choice and sources of antimalarial drugs used for malaria self-medication in Kisumu city, Western Kenya. Methodology: This was a cross-sectional community based study, in which semi-structured questionnaires were randomly administered to 338 participants, in five administrative wards of Kisumu city. Results: Overall, 250 (74%) of the participants reported self-medication for perceived malaria illness. Of the 250 participants, 219 (87.6%) had used an antimalarial drug(s), while 31 (12.4%) took other drugs (antipyretics and herbs), which they perceived to have antimalarial effect. Artemisinin-based combination therapies (ACT), was the drug of choice for majority 154 (70.3%) of those who had self-medicated. The other antimalarials used were sulphadoxine/sulphalene-pyrimethamine 25 (11.4%), amodiaquine 11 (5%), chloroquine 5 (2.3%), quinine 2 (0.9%), dihydroartemisinin 1 (0.5%), halofantrene 1 (0.5%) and 20 (9%) of participants had used two different antimalarials. The antimalarial drugs were sourced from private pharmacies/chemists (78.4%), general retail shops (29.2%), left over drugs at home (1.6%), or friends, relatives and neighbors (2.8%). Conclusion: Self-medication for perceived malaria is prevalent in Kisumu city. ACT is the drug of choice for self-medication. However, a substantial proportion of individuals use currently ineffective antimalarials or other drugs, for example antipyretics, with no known antimalarial efficacy. Pharmacies/chemists and general retail shops are the major sources for self-prescribed drugs. Key words: Self-medication, antimalarial drugs, choices, sources
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TL;DR: It is demonstrated that self-medication practice is common among rural communities in the study area and the need for community awareness is emphasized for correct and comprehensive information about drawbacks associated with self-Medication practices.
Abstract: Self-medication has been widely practiced worldwide particularly in developing countries including Tanzania. In sub-Saharan Africa high incidences of malaria have contributed to self-medication with anti-malarial drugs. In recent years, there has been a gain in malaria control, which has led to decreased malaria transmission, morbidity and mortality. Therefore, understanding the patterns of self-medication during this period when most instances of fever are presumed to be due to non-malaria febrile illnesses is important. In this study, self-medication practice was assessed among community members and information on the habit of self-medication was gathered from health workers. Twelve focus group discussions (FGD) with members of communities and 14 in-depth interviews (IDI) with health workers were conducted in Kilosa district, Tanzania. The transcripts were coded into different categories by MaxQDA software and then analysed through thematic content analysis. The study revealed that self-medication was a common practice among FGD participants. Anti-malarial drugs including sulphadoxine-pyrimethamine and quinine were frequently used by the participants for treatment of fever. Study participants reported that they visited health facilities following failure of self-medication or if there was no significant improvement after self-medication. The common reported reasons for self-medication were shortages of drugs at health facilities, long waiting time at health facilities, long distance to health facilities, inability to pay for health care charges and the freedom to choose the preferred drugs. This study demonstrated that self-medication practice is common among rural communities in the study area. The need for community awareness is emphasized for correct and comprehensive information about drawbacks associated with self-medication practices. Deliberate efforts by the government and other stakeholders to improve health care services, particularly at primary health care facilities will help to reduce self-medication practices.
76 citations
Cites result from "Choice and Sources of Antimalarial ..."
...Afolabi BM, Brieger WR, Salako LA: Management of childhood febrile illness prior to clinic attendance in urban Nigeria....
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...Osemene KP, Lamikanra A: A study of the prevalence of self-medication practice among university students in Southwestern Nigeria....
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...The findings from this study revealed that in most cases antipyretics were applied with anti-malarials, which agrees with findings from Nigeria where fever was associated with anti-malarial drugs and antipyretics [46]....
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...This finding agrees with studies done in Kenya, Sudan and Mali [37,38,50] and suggests that provision of affordable medical services will assist in reducing self-medication practices....
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...With regards to sources of drugs, the majority obtained drugs from pharmacies/drug shops whereas other participants used left over medicines at home or from neighbours, relatives or friends which is in agreement with studies conducted in Kenya and Nigeria [38,39]....
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TL;DR: A deterministic model involving the transmission dynamics of malaria/visceral leishmaniasis co-infection is presented and the results show that the implementation of the strategy combining all the time dependent control variables is the most cost-effective control strategy.
Abstract: In this paper, a deterministic model involving the transmission dynamics of malaria/visceral leishmaniasis co-infection is presented and studied. Optimal control theory is then applied to investigate the optimal strategies for curtailing the spread of the diseases using the use of personal protection, indoor residual spraying and culling of infected reservoirs as the system control variables. Various combination strategies were examined so as to investigate the impact of the controls on the spread of the disease. And we investigated the most cost-effective strategy of all the control strategies using three approaches, the infection averted ratio (IAR), the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER). Our results show that the implementation of the strategy combining all the time dependent control variables is the most cost-effective control strategy. This result is further emphasized by using the results obtained from the cost objective functional, the ACER, and the ICER.
54 citations
Journal Article•
TL;DR: Self-medication with antibiotics exists among patients seeking treatment at Gatundu Sub-County Hospital and the source of antibiotic was from community pharmacy, and amoxicillin was the most used drug in self-medicated with antibiotics.
Abstract: Self-medication encompasses the use of the medicines by the users for self-perceived health problems or the continuing use of medications formally prescribed earlier. The study compares the prevalence of self-medication with antibiotics among patients in Gatundu Sub County with the results of other studies done elsewhere. The main objective of the study was to establish the extent of self-medication with antibiotics among patients seeking treatment at Gatundu Sub-County Hospital. The study was cross sectional. The sample size was 382 patients identified through stratified sampling, simple random and systematic random sampling technique drawn from the outpatient department. Data was collected from the outpatient department using an interview guide. Data was analyzed using SPSS (statistical package for social sciences). Descriptive statistics such as frequencies and percentages were used to analyze categorical data. Statistical significance level was set at 0.05. The prevalence of self- medication with antibiotics was 48%. Self-medication with antibiotics was significantly associated with age (p=0.0005) and lack of medical insurance cover (p=0.0198). Only 20% of the respondents had a medical insurance cover. Sixty percent of the respondents gave the reason for self-medication as cost cutting measure. The source of antibiotic was from community pharmacy (81%). Amoxicillin (36%) was the most used drug in self-medication with antibiotics. In conclusion self-medication with antibiotics exists. Common source of antibiotics used in self-medication with antibiotics was community pharmacy. Respondents knew antibiotics dosage from pharmacy attendants.
15 citations
TL;DR: There is no clear cut trajectory for management of uncomplicated malaria in the study area and there is need for community education to influence behaviour on the management of malaria to achieve real gains from ACT use.
Abstract: Malaria accounts for many deaths and illnesses, mostly among young children and pregnant women in sub-Saharan Africa. An integrated approach is recommended to ensure effective malaria control. Socio-cultural factors continue to serve as determinants of malaria health-seeking behaviour. An INDEPTH effectiveness and safety study platform was established to unearth issues around the use of licensed and nationally recommended anti-malarials in real life settings. This study reports on treatment-seeking behaviour for uncomplicated malaria among community members. A qualitative study was conducted in the dry and rainy seasons in purposively selected communities in Kintampo north and south districts. This was based on distances to a health facility, ethnicity and availability of medicines at the sale outlets. Twenty-four focus group discussions were conducted among adult men, women care-takers of children less than 5 years and pregnant women. Ten INDEPTH interviews were also conducted among operators of medicine sale outlets and managers of health facilities. Fifty-one illnesses narrative interviews were conducted among adult men, women, women caretakers of children less than 5 years and pregnant women. Transcripts were transferred into Nvivo 8 software for data management and analysis. The artemisinin-based combinations that were commonly known and used were artesunate–amodiaquine and artemether–lumefantrine. Use of herbal preparation to treat diseases including uncomplicated malaria is rife in the communities. Drug stores were not the main source of artemisinin-based combination sales at time of the study. Monotherapies, pain killers and other medicines were purchased from these shops for malaria treatment. Dizziness, general body weakness and sleepiness were noted among respondents who used artemisinin-based combination therapy (ACT) in the past. There is no clear cut trajectory for management of uncomplicated malaria in the study area. Different approaches are adopted when treating malaria. There is need for community education to influence behaviour on the management of malaria to achieve real gains from ACT use.
13 citations
TL;DR: Self-medications practice is very common among community members in Kasulu district and the main reasons identified for self-medication was long time taken to get treatment in health facilities.
Abstract: Background: Anti- malarial self-medication practice in Africa is very common. It is considered as an alternative way for people who cannot afford the cost of health care services. This study was conducted to assess the magnitude and factors associated with anti-malarial self-medication practice among residents of Kasulu Town Council. Materials and methods: The study was a descriptive cross sectional study. Two hundred and eighty consenting respondents were selected by systematic random sampling and interviewed with the aid of a semi structured questionnaire to assess anti-malarial self- medication practice. A p value of less than 0.05 was considered statistically significant, at 95% confidence interval. Results: Prevalence of anti-malarial self-medication was (69.6%). Majority of the respondents (83.1%) reported that, they did not get better after self- medication. About 36% of the respondents metioned time taken in health facilities as the main factor for self- medication. Conclusion: This study revealed that, self-medication practice is very common among community members in Kasulu district. The main reasons identified for self-medication was long time taken to get treatment in health facilities. Keywords: Anti-malarial, Self- medication, Practice, Kasulu, Tanzania.
7 citations
References
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TL;DR: The overall median clearance times were 84 hours (interquartile range, 60 to 96) in Pailin and 48 hours in Wang Pha (P<0.001) in each of the two locations as discussed by the authors.
Abstract: We studied 40 patients in each of the two locations. The overall median parasite clearance times were 84 hours (interquartile range, 60 to 96) in Pailin and 48 hours (interquartile range, 36 to 66) in Wang Pha (P<0.001). Recrudescence confirmed by means of polymerase-chain-reaction assay occurred in 6 of 20 patients (30%) receiving artesunate monotherapy and 1 of 20 (5%) receiving artesunate–mefloquine therapy in Pailin, as compared with 2 of 20 (10%) and 1 of 20 (5%), respectively, in Wang Pha (P = 0. 31). These markedly different parasitologic responses were not explained by differences in age, artesunate or dihydroartemisinin pharmacokinetics, results of isotopic in vitro sensitivity tests, or putative molecular correlates of P. falciparum drug resistance (mutations or amplifications of the gene encoding a multidrug resistance protein [PfMDR1] or mutations in the gene encoding sarco–endoplasmic reticulum calcium ATPase6 [PfSERCA]). Adverse events were mild and did not differ significantly between the two treatment groups. CONCLUSIONS P. falciparum has reduced in vivo susceptibility to artesunate in western Cambodia as compared with northwestern Thailand. Resistance is characterized by slow parasite clearance in vivo without corresponding reductions on conventional in vitro susceptibility testing. Containment measures are urgently needed. (ClinicalTrials.gov number, NCT00493363, and Current Controlled Trials number, ISRCTN64835265.)
3,010 citations
TL;DR: Artemisinins are potent and rapidly acting antimalarial drugs, and their widespread use for treating patients with Plasmodium falciparum malaria raises the question of emerging drug resistance.
Abstract: To the Editor: Although artemisinins are potent and rapidly acting antimalarial drugs, their widespread use for treating patients with Plasmodium falciparum malaria raises the question of emerging drug resistance.1,2 Artemisinin monotherapy should not be used in areas where malaria is endemic; it requires an extended administration period and may lead to treatment failure, most frequently because of problems with compliance. Recent reports of high failure rates associated with artemisinin-based combination therapy, as well as in vitro drug-susceptibility data, suggest the possibility of clinical artemisinin resistance along the Thai–Cambodian border.3,4 We studied the potential emergence of artemisinin resistance using . . .
1,593 citations
TL;DR: Genetically determined artemisinin resistance in P falciparum emerged along the Thailand–Myanmar border at least 8 years ago and has since increased substantially, with experts predicting resistance will reach rates reported in western Cambodia in 2–6 years.
889 citations
TL;DR: A review of literature on treatment seeking for malaria was undertaken to identify patterns of care seeking, and to assess what is known about the adequacy of the treatments used.
431 citations