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 compliance  with  the guideline i.e.  17 out of 75 prescribers treated pregnant women in their first trimester with Quinine or Quinine plus Clindamycin (22.7%). Treatment frequently prescribed was  Artemether-lumefantrine 46 /75 (61. 3%) , Artesunate -amodiaquine 12 /75 (16.0% ) and Quinine  ( 17/75 (22. 7% ). Prescriber’ age , educational status and duration of practice, did not influence compliance with Quinine prescription. Also, prescription drug availability and cost had no significant association with prescribers’ compliance. However, the availability of the  Guideline (p =0.025)=0.025) and side effects of  Quinine (p =0.017)=0.017) =0.017) appeared to influence prescribers’ compliance .

Conclusions

The study showed very low prescriber compliance with Quinine prescription given that the regimen most providers  prescribe for uncomplicated malaria in the first trimester of pregnancy (Artemether-lumefantrine and Artesunate -amodiaquine) have not widely been tested for safety due to limited data means that pregnant women and their foetuses  are probably being put in harm’s way. With majority of prescribers having the treatment guidelines in their offices but not adhering to it calls for intensified effort to educate prescribers .

KEYWORDS: Quinine, Prescriber, compliance, first trimester, pregnancy, uncomplicated malaria.