Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon

Trop Med Int Health. 2012 Mar;17(3):330-42. doi: 10.1111/j.1365-3156.2011.02918.x. Epub 2011 Nov 21.

Abstract

Objective: To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated.

Methods: A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers.

Results: Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial.

Conclusions: Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antimalarials / therapeutic use*
  • Artemisinins / therapeutic use*
  • Cameroon / epidemiology
  • Child
  • Child, Preschool
  • Commerce
  • Cross-Sectional Studies
  • Female
  • Fever / drug therapy*
  • Fever / etiology
  • Health Facilities* / economics
  • Humans
  • Infant
  • Malaria / drug therapy*
  • Malaria / epidemiology
  • Male
  • Odds Ratio
  • Patient Acceptance of Health Care*
  • Pharmacies
  • Physical Examination
  • Plant Extracts / therapeutic use*
  • Prescriptions
  • Prevalence
  • Private Sector
  • Public Sector
  • Young Adult

Substances

  • Antimalarials
  • Artemisinins
  • Plant Extracts
  • artemisinine