The Challenges Associated With the Implementation of the Anti-Malaria Drug Policy in the Kwabre District of the Ashanti Region, Ghana

Background: Malaria in Ghana is recognized as the leading public health problem. One essential component of the strategy for malaria control is based on prompt and effective treatment. Over the years, there was a high level of resistance of P. falciparum to mono therapy medicines like chloroquine (CHQ) in most African countries including Ghana. There was therefore the need to change to Artemisinin Combination Therapy (ACT) as recommended by WHO. In January, 2005, a new anti-malaria drug policy (AMDP) was introduced in Ghana with Artesunate-Amodiaquine (AS-AQ) as the first line treatment for uncomplicated malaria. Since its inception, no assessment has been done pertaining to the challenges and successes of the treatment policy and whether it has been accepted by the health staff and the patients in the Kwabre district. These are essential to address the high malaria morbidity in the district. Main Objective: The aim of the study was to determine the factors that influence treatment coverage of artemisinin- based combination therapy (ACTs) with respect to AMDP of Ghana at the district level. Methodology: A descriptive cross-sectional survey was done to elicit information on the knowledge of ACTs dispensed from patients, 16 years and above, who were treated with antimalarials at 12 health facilities in the district. Their ability to recall the name of the drug, the reason for the drug prescription (use of drug), the duration of treatment, and the dosage were assessed. The only two (2) community pharmacies, 24 licensed chemical shops (LCS), and the health facilities were visited to assess the availability of ACTs and their costs. A review of past patient records was also done at the selected health facilities to determine the prescription habit of prescribers with respect to anti-malarials. Health managers/prescribers and members of the District Health Management Team (DHMT) were also interviewed to obtain information on implementation plans put in place to ensure effective implementation of the AMDP. Results: The treatment coverage of ACTs was found to be 76.4%. The two community pharmacies, 19 LCS, 3 private and all the 6 public facilities visited, had stocks of ACTs. The most common ACT available was AS-AQ. There were still mono therapy drugs (Amodiaquine (AQ),Artesunate xiv (AS), Artemos (Artemether), Alaxin (Dihyohoartemisinin)) available at most of the public and private health facilities including the pharmacies and LCS. The cost of ACTs ranged from GH¢1.00- GH¢10.00 with the community pharmacy, having the highest cost (GH¢3.00- GH¢10.00) and the LCS with the lowest (GH¢1.00 –GH¢5.00). For the patient’s knowledge of ACTs dispensed, the name of the drug was recalled in 68.9%, the reason for the drug prescription (use of drug) in 80.6%, the duration of treatment in 26.4%, and the dosage in 84.1%. These values, with the exception of the duration of treatment, are very high and show that the patients had adequate knowledge of ACTs. The patients’ record review showed that 69.0% of records had AS-AQ, 1.2% Artesunate-Sulphadoxine/Pyrimethamine (AS-S/P), and 6.2% Artemether-Lumefantrine (AL) for malaria treatment. There were also 4% with quinine treatment from the hospitals. Mono therapy drugs were still being prescribed, representing 19.6%. The policy makers have implementation plans to ensure the effective implementation of the AMDP. The training of prescribers and other staff, educational campaigns on AMDP and monitoring of drug efficacy to a assess cure rates are being done on a large scale and adequate for effective implementation. The monitoring and supervision by the District Health Management Team (DHMT) and the Sub District Health Management Team (SDHMT), monitoring of adverse drug effects, and organising official staff meeting to assess programmes, are inadequate for effective implementation. To add to that, the generation of monthly returns on ACT consumption and ensuring that drugs are available at all facilities is not encouraging. Conclusion: The treatment coverage of ACTs can be improved if ACTs are made available at all private outlets. The prescription pattern has moved towards the ACTs though there are still some mono therapy drugs being prescribed hence the need to phase them out. The patient knowledge of ACTs is adequate. The implementation plans are in place but need to be enforced. The availability and proper use of ACTs should be monitored and maximized after their introduction in order to have a significant impact on the burden of malaria.

Source: KNUST