Perceived treatment failure of artemisinin combination therapy among healthcare providers in Kampala District and associated factors

Abstract

The integrity of artemisinin-based combination therapies (ACTs) is critical in successfully combating malaria in endemic countries. However, ACT use has been linked to treatment failure which can be heightened by overuse, non-compliance by patients to treatment and dosage regimes and proliferation of substandard and falsified medicines among others. This results in high rates of re-infection and changes in artemisinin sensitivity patterns. Perceived ACT treatment failure among healthcare providers may influence their decision-making during health service delivery, and also provide clues on what happens to the health system when there is a failing drug. Objective: To determine the healthcare provider-perceived ACT treatment failure and associated factors in Kampala district. Methods: A cross-sectional study among 297 eligible healthcare providers in Kampala, recruited using a multistage sampling. Data was collected using self-administered questionnaires and then entered into EPIDATA 3.1 and analyzed using STATA V 13 with logistic regression analysis. Responses to the open-ended questions were coded and analyzed. Results: Between June 2018 and July 2018, 297 healthcare providers were recruited. Of these, 165(56) were males and 132(44) were females with ages ranging between 21 and 51 years. Those that reported having ever encountered treatment failure were 62%. The factors that were associated with health worker perceived ACT treatment failure include Age (P<0.001). Professional experience (P<0.001), color of ACT tablets (P=0.001) and previous patient complaints about ACTs (P<0.001). Six in every ten healthcare providers had ever perceived ACT treatment failure of healthcare providers during treatment of uncomplicated malaria. This was high when compared to a similar study done among nurses in Nigeria, where about four in every ten nurses had ever perceived ACT treatment failure. The perception of most of the healthcare providers interviewed in this study was that risk of ACT failure has been associated with overuse. In addition, factors which could lead to perceived treatment failure identified included poor patient adherence. Healthcare providers reported patient concerns on color, size, and number of tablets prescribed. Since healthcare providers, during patient care, always interact with medicines, their perceptions about ACTs will influence their decision-making during service delivery. It is important for the MOH to empower healthcare providers with information to make more informed decisions at the point of care.