Prescribing practices for malaria in a rural Ugandan hospital: Evaluation of a new malaria treatment policy
Department of Pharmacy, College of Health Sciences, Makerere University, P.O.Box 7062, Kampala University Road, Kampala, Uganda; Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, P.O.Box 7062, Kampala University Road, Kampala, Uganda; Clinical Epidemiology Unit, College of Health Sciences, Makerere University, P.O.Box 7062, Kampala University Road, Kampala, Uganda
Background: Increasing resistance to first line antimalarial drugs led to a change in the antimalarial policy of Uganda in 2005. Successful implementation of this policy depends on changing prescribing patterns of health workers. Objectives: To describe prescribing patterns for malaria and associated factors in a rural Ugandan hospital following a change in antimalarial treatment policy from chloroquine plus sulphadoxine-pyrimethamine to artemisinin-based combination therapies. Methods: From the outpatients register, 715 prescriptions for malaria were reviewed. Data was collected on patient demographics, prescriber factors and prescription patterns. Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. Results: The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine (n=564, 88.5%) and quinine (n=66, 84.6%) respectively. The proportion of prescriptions conforming to the new antimalarial treatment policy was 88.1% (n=630). Predictors of conformity were: duration in service of less than 6 years (OR=3.40. CI=1.24-9.33), prescriber's profession (OR=97.51, CI=27.29-348.34) and diagnosis of uncomplicated malaria (OR=10.13, CI=3.37-30.42). Conclusions: Adequate training and provision of information relevant to the needs of different cadres of health workers is needed to promote effective uptake of new treatment policies.
artemether plus benflumetol; chloroquine; pyrimethamine plus sulfadoxine; quinine; article; child; controlled study; cross-sectional study; drug choice; female; health care need; health care policy; human; malaria; male; medical decision making; practice guideline; prescription; professional competence; professional standard; rural population; school child; treatment planning; Uganda; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Female; Health Policy; Hospitals, Rural; Humans; Infant; Malaria; Male; Middle Aged; Physician's Practice Patterns; Prescriptions; Registries; Uganda; Young Adult