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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

Research on the cconomics of ACT (REACT): Provider and patient surveys to inform the design of interventions to support improved use of ACT in Nigeria.

LSHTM investigators:
Virginia Wiseman, Lindsay Mangham & Bonnie Cundill.
External collaborators:
Obinna Onwujekwe, Benjamin Uzochukwu, Ogochukwu Ezeoke & Emma Nwala (University of Nigeria, Nigeria).
Funding body:
The Bill & Melinda Gates Foundation through the ACT Consortium.

In Nigeria, treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT) at primary health facilities.

Research was undertaken to determine the extent to which patients seeking treatment at primary care facilities and medicine retailers receive the recommended treatment and what factors influence the choice of treatment. A cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria.

The results of these surveys showed that although 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001).

The results identified major problems in the choice of treatment for malaria, and the need for interventions that target consumer preferences as well as seek to improve health service provision. The REACT study is working with the Malaria Control Programme in Enugu State to develop and evaluate innovative demand and supply-side interventions that aim to improve access to a confirmed malaria diagnosis, raise awareness about the recommended antimalarials and promote appropriate treatment for malaria