Good Prescribing Interventions, made an Impact in Reduced Coartem Usage – a Retrospective Study at the Copperbelt University Health Facility

Abstract

According to the WHO malaria report, 2017, it was reported in 2016 that, 91 countries had a total of 216 million cases of malaria of which malaria deaths globally reached 445,000 [1]. Malaria is the commonest presentation illness in Sub-Sahara Africa, and over diagnosis of malaria in patients presenting with fever in Zambia is a major public health problem [1-3]. Malaria remains an important cause of illness and death in adults and children. It requires an integrated approach, including prevention and prompt treatment with effective antimalarial agents [1-3]. The recommended first line treatment of malaria in Zambia is artemisin based combination (ABC) therapy that is Artemether 20mg+Lumefantrine 120mg (coartem) tablets [2]. Over the past years, the introduction of the relatively expensive artemether plus lumefantrine (Coartem) drug and the subsequent appearance of malaria resistance in our country have driven the need to rationalize the overuse of antimalarial drugs at the Copperbelt University (CBU) health facility [3]. Furthermore, the recent decline in malaria transmission in many areas of Zambia has led to increasing awareness that is often associated with neglect of non-malarial causes of fever [46]. The availability of rapid diagnostic tests for malaria (RDTs) as well as parasitological test (microscopy) has provided a potentially important instrument to address these problems. All suspected cases of fever should have malaria tests to confirm the diagnosis by using both microscopy and RDTs and supported by a quality assurance programme. In 2015 the ‘WHO Guidelines for Malaria Diagnosis and Treatment’ recommended parasitological confirmation in all patients with suspected malaria before treatment and restricting antimalarial treatment to parasite-positive patients [7,8]. This was one of the managerial interventions that were implemented at CBU health facility. The idea was to limit the over use of valuable drug to patients who may not need them but due to the presenting fever, physicians tend to prescribe even when the microscopic examination Abstract