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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

Research on the economics of ACT (REACT): patient and provider surveys to inform the design of interventions to support improved use of ACT in Cameroon.

LSHTM investigators:
Virginia Wiseman, Lindsay Mangham & Bonnie Cundill
External collaborators:
Wilfred Mbacham, Olivia Achonduh, Joel Ambebila, Albertine Lele, Theresia Metoh, Sarah Ndive, Ignatius Ndong, Rachel Nguela, Akindeh Nji, Barnabas Orang-Ojong & Joelle Pamen- Ngako (University of Yaoundé I, Cameroon).
Funding body:
Bill & Melinda Gates Foundation through the ACT Consortium.

The objective of the provider and patient surveys was to investigate the quality of malaria case management in Cameroon 5 years after artemisinin-based combination therapy (ACT) was adopted as the first-line antimalarial.

Patterns of treatment were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated.

A cross-sectional cluster survey was conducted among individuals of all ages who reported seeking treatment for a fever as they exit public and private health facilities and medicine retailers. Prevalence of malaria was determined using rapid diagnostic tests (RDTs) in consenting patients.

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 facility type: 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. The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT, were physically examined by the health worker, had not previously sought an antimalarial for the illness and sought treatment at a public or private facility. Malaria was confirmed in 29% of patients, and 70% of patients with a negative malaria test result 70% were prescribed or received an antimalarial.

The results of these surveys showed that malaria case management could be improved, and symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. As the Cameroon Government plans to extend malaria testing it will be important to promote the rational use of ACT. The REACT study is working with the National Malaria Control Programme to develop and evaluate provider training interventions that can support the roll out of RDTs.