Prescribing patterns and availability of Artemisinin based combination therapy anti-malarials compared to monotheraphy in Kirinyaga district, central province, Kenya

Abstract

Malaria, a protozoan infection with high mortality and morbidity, remains a major health concern in Kenya and the world. New therapeutic agents and combinations continue to be developed and researched on the treatment of malaria. The Ministry of Health in the Republic of Kenya has developed guidelines on the management of Malaria. However, no ., study has been done to assess the progress of this new initiative. The aim of this study was to examine the prescriptions generated over a three months period for those suffering from malaria and the availability of the various anti-malarials, The study involved district hospitals, sub-district hospitals, dispensaries, health centres private clinics, nursing homes and pharmacies. A total of 482 prescriptions were examined from 50 health facilities. The centres were chosen randomly from a set of 102 facilities in Kirinyaga District of Central Province Kenya. The results showed that Artemisin-Based Combination Therapy is the most commonly prescribed and dispensed anti-malarial (45.2%) followed by amodiaquine and quinine, in that order. The younger children were however more likely to get amodiaquine preparations while in adults preference tilted towards Sulfadoxine- Pyrimethamine and Quinine. The results indicated that the ACT uptake has gone up from a previous study at 10.2% and is consistent with the reports of a baseline study undertaken by the Ministry of Health, WHO and Pharmacy and Poisons Board. Nevertheless, the results indicate that SP, chloroquine, amodiaquine and artemeter monotherapy are still available in our drug outlets to a significant extent. Challenges revealed by the study included stock out in the Public Sector and quality of available anti-malarials. Emerging resistance to ACT anti-malarials will continue to pose a serious threat to the Ministry of Health and the drug regulatory authority. Again, the public sector is totally reliant on donor funding to sustain the ACT availability. A donor pull out would spell doom to our country from a disease that is responsible for 30% all of outpatient attendances and 19% of admissions to our public health facilities. It is expected that results from this study represent what is likely to be the situation in other parts of Kenya. Suggestions have been made on solutions or interventions to this killer disease.