Prescribers’ Compliance with Quinine Use for Treating Uncomplicated Malaria in the First Trimester of Pregnancy in Polyclinics in Accra

Abstract

Background Malaria is a public health problem affecting vulnerable populations in sub-Saharan Africa. It is has deleterious effects during pregnancy on foetal and neonatal health. The WHO recommended regimen for treating uncomplicated Plasmodium falciparum malaria in the first trimester of pregnancy, and adopted by the Ghana Health service, is 10 mg/kg body weight of oral Quinine given three times daily for 7 days or 10 mg/kg body weight of Quinine plus clindamycin to be taken orally 3 times daily for 3 days. However, little is known about the proportion of prescribers who comply with this guideline in health facilities in Ghana. Objectives This study sought to find out whether prescribers in polyclinics in the Accra Metropolis comply with the use of Quinine in the treatment of uncomplicated malaria in the first trimester of pregnancy and also assess factors that influence prescribers’ compliance with the Standard Treatment Guidelines (STG). Methods Structured questionnaire was used to collect data from 75 prescribers interviewed from polyclinics in Accra (Adabraka, Dansoman, Kaneshie, Madina, Mamprobi and Ussher polyclinics). Univariate analyses of categorical variables were expressed as frequencies and proportions. Cross tabulations and bivariate analysis were used to show associations between independent variables and compliance with Quinine prescription. Factors predictive of Quinine compliance were determined by multivariate analysis. Statistical analyses were performed on STATA version 13.0. Results The results showed low level of prescriber compliancecompliance compliance compliance with th with th e guideline i.e. e guideline i.e. e guideline i.e. e guideline i.e. e guideline i.e. e guideline i.e. e guideline i.e. 17 out of 75 prescribers treated pregnant women in their first trimester with Quinine or Quinine plus Clindamycin (22.7%). Treatment reatment reatment reatment reatment frequently frequently frequently frequently frequently frequently frequently prescribed prescribed prescribed prescribed prescribed waswaswas Artemether ArtemetherArtemetherArtemether Artemether-lumefantrine lumefantrinelumefantrine lumefantrine lumefantrine 46 /75 (61. 3%) , ArtesunateArtesunate Artesunate ArtesunateArtesunate -amodiaquineamodiaquine amodiaquineamodiaquine 12 /75 (16.0% ) andand Quinine 17/75 (17/75 ( 17/75 (22. 7% ). PrescriberPrescriber Prescriber Prescriber Prescribers’ age s’ age s’ age s’ age s’ age , educational status and duration of practice, educational status and duration of practice, educational status and duration of practice, educational status and duration of practice , educational status and duration of practice, educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice, educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice , educational status and duration of practice, educational status and duration of practice , educational status and duration of practice, educational status and duration of practice, educational status and duration of practice , educational status and duration of practice, educational status and duration of practice did not influence did not influence did not influence did not influence did not influence did not influence did not influence compliance compliance compliance compliance compliance compliance wit h Quinine prescription. Also, prescription. Also, prescription. Also, prescription. Also, prescription. Also, prescription. Also, drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant drug availability and cost had no significant association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. association with prescribers’ compliance. However, However, However, However, However, the ava the avathe avathe availability of the ilability of theilability of the ilability of the ilability of theilability of theilability of the ilability of theilability of the Guideline Guideline Guideline Guideline (p =0.025)=0.025) and side effecand side effec and side effec and side effecand side effecand side effecand side effec and side effects of of Quinine (p =0.017)=0.017) =0.017) appeared to appeared to appeared to appeared to appeared to appeared to influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ influence prescribers’ compcomp liance lianceliance liance. Conclusions The study showed very low prescriber compliance with Quinine prescription prescriber compliance with Quinine prescriptionprescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescriptionprescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescriptionprescriber compliance with Quinine prescriptionprescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescriptionprescriber compliance with Quinine prescription prescriber compliance with Quinine prescription prescriber compliance with Quinine prescription. Given that iven that iven that the regimen regimen regimen regimen regimen most providers prescri most providers prescrimost providers prescri most providers prescri most providers prescri most providers prescri most providers prescrimost providers prescrimost providers prescrimost providers prescri be for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in for uncomplicated malaria in the first first trimester of trimester of trimester of trimester of pregnanc pregnancpregnancpregnanc pregnanc y (ArtemetherArtemether Artemether Artemether-lumefantrine umefantrineumefantrine andand also Artesunatealso Artesunate also Artesunate also Artesunatealso Artesunatealso Artesunate -amodiaquineamodiaquine amodiaquineamodiaquine ) have not widely have not widely have not widely have not widely have not widely have not widely have not widely have not widely have not widely been been been tested tested for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to for safety due to limited limited limited data data means tha means tha means thameans tha t pregnant women and their foetus t pregnant women and their foetus t pregnant women and their foetust pregnant women and their foetust pregnant women and their foetus t pregnant women and their foetus t pregnant women and their foetus t pregnant women and their foetus t pregnant women and their foetust pregnant women and their foetus t pregnant women and their foetust pregnant women and their foetus t pregnant women and their foetus t pregnant women and their foetus es are are are probably being probably being probably being probably being probably being probably being probably being probably being probably being put in put in har harm’s m’s way way. With mWith m With m With majority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers ajority of prescribers having having having having the treatment the treatment the treatment the treatment the treatment the treatment guidelines in their officesguidelines in their offices guidelines in their offices guidelines in their officesguidelines in their offices guidelines in their officesguidelines in their officesguidelines in their offices guidelines in their officesguidelines in their offices but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for but not adhering to it calls for intensified intensified intensified effort to effort to effort to effort to effort to educateducat educateducateducate prescribers prescribersprescribers prescribers prescribers KEYWORDS: Quinine, Prescriber, compliance, first trimester, pregnancy, uncomplicated malaria.