Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 10;19(1):63.
doi: 10.1186/s12936-020-3148-5.

Healthcare professionals' perspective can guide post-marketing surveillance of artemisinin-based combination therapy in Uganda

Helen Byomire Ndagije  1 , Ronald Kiguba  2 , Leonard Manirakiza  3 , Elijah Kirabira  3 , Allan Sserwanga  3 , Leah Nabirye  2 , Jackson Mukonzo  2 , Sten Olsson  4 , Anne Spinewine  5 , William D'Hoore  5 , Niko Speybroeck  5
Affiliations

Healthcare professionals' perspective can guide post-marketing surveillance of artemisinin-based combination therapy in Uganda

Helen Byomire Ndagije et al. Malar J. .

Abstract

Background: Efficient testing to identify poor quality artemisinin-based combination therapy (ACT) is important to optimize efforts to control and eliminate malaria. Healthcare professionals interact with both ACT and malaria patients they treat and hence could observe, first-hand, suspect poor quality artemisinin-based combinations linked to poor malaria treatment outcomes and the factors associated with inappropriate use or treatment failure.

Methods: A cross-sectional study of 685 HCP perspectives about the efficacy of ACT between June and July 2018 at selected health facilities in Uganda. Medicine samples were obtained from the seven regions of Uganda and tested for quality using the Germany Pharma Health Fund™ minilabs.

Results: The average age of the 685 respondents was 30 (SD = 7.4) years. There was an almost equal distribution between male and female respondents (51:49), respectively. Seventy percent (n = 480) were diploma holders and the nurses contributed to half (49%, n = 334) of the study population. Sixty-one percent of the HCPs reported having ever encountered ACT failures while treating uncomplicated malaria. Nineteen percent of HCPs thought that dihydroartemisinin/piperaquine gave the most satisfactory patient treatment outcomes, while 80% HCPs thought that artemether/lumefantrine gave the least satisfactory patient treatment outcomes, possibly due to dosing schedule and pill burden. Healthcare professionals from the Central region (OR = 3.0, CI 0.3-1.0; P = 0.0001), Eastern region (OR = 5.4, CI 2.9-9.8; P = 0.0001) and Northern region (OR = 5.3, CI 2.9-9.9; P = 0.0001) had a higher chance of encountering ACT failure in 4 weeks prior to the survey as compared to those from the western region. Healthcare professionals from private health facilities also had higher chances of encountering ACT failures in past 4 weeks as compared to those from public health facilities (OR = 2.7, CI 1.7-3.9; P = 0.0001). All 192 samples passed the quality screening tests. The random sample of 10% of all samples randomly obtained by the laboratory staff also passed the chemical content analysis and dissolution tests.

Conclusion: ACT medicines are widely available over-the-counter to the public and it is very difficult to report and monitor a decrease in efficacy or treatment failure. The perspectives of HCPs on treatment failure or lack of efficacy may potentially guide optimization efforts of sampling methodologies for the quality survey of ACT medicines.

Keywords: Artemisinin-based combination therapy; Healthcare professional perspectives; Perceived treatment failure.

PubMed Disclaimer

Conflict of interest statement

Helen ByomireNdagije, Ronald Kiguba, Leonard Manirakiza, Elijah Kirabira, Allan Serwanga, Leah Nabirye, Sten Olsson, Anne Spinewine, Jackson Mukonzo, Niko Speybroeck have no competing interests that are directly relevant to the content of this study. This publication was supported by an agreement from National Drug Authority (NDA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Drug Authority.

Similar articles

See all similar articles

Cited by

References

    1. WHO. Global Surveillance and Monitoring System for substandard and falsifed medical products. Geneva: World Health Organization; 2017. http://www.who.int/medicines/regulation/ssffc/publications/gsms-report-s.... Accessed 4 Dec 2019.
    1. Ozawa S, Evans DR, Bessias S, Haynie DG, Yemeke TT, Laing SK, et al. Prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries: a systematic review and meta-analysis. JAMA Netw Open. 2018;1:e181662. doi: 10.1001/jamanetworkopen.2018.1662. - DOI - PMC - PubMed
    1. Nayyar GML, Breman JG, Newton PN, Herrington J. Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa. Lancet Infect Dis. 2012;12:488–496. doi: 10.1016/S1473-3099(12)70064-6. - DOI - PubMed
    1. Chikowe I, Osei-Safo D, Harrison JJEK, Konadu DY, Addae-Mensah I. Post-marketing surveillance of anti-malarial medicines used in Malawi. Malar J. 2015;14:127. doi: 10.1186/s12936-015-0637-z. - DOI - PMC - PubMed
    1. Affum AO, Lowor S, Osae SD, Dickson A, Gyan BA, Tulasi D. A pilot study on quality of artesunate and amodiaquine tablets used in the fishing community of Tema, Ghana. Malar J. 2013;12:220. doi: 10.1186/1475-2875-12-220. - DOI - PMC - PubMed

MeSH terms