Availability of Antimalarial Drugs and Evaluation of the Attitude and Practices for the Treatment of Uncomplicated Malaria in Bangui, Central African Republic
National malaria management policy is based upon the availability of effective and affordable antimalarial drugs. This study was undertaken to evaluate the quality of the treatment of uncomplicated malaria cases in Bangui, an area with multidrug-resistant parasites, at a time preceding implementation of a new therapeutic policy relying on the artemisinin derivative combined treatment artemether-lumefantrine. A cross-sectional study was carried out in Bangui city to assess availability of antimalarial drugs and the performances of health workers in the management of uncomplicated malaria. Availability of drugs was recorded in all drugs wholesalers ( ), all pharmacies in health facilities ( ), private drugstores ( ), and in 60 non-official drug shops randomly chosen in the city. Despite a limited efficacy at the time of the survey, chloroquine remained widely available in the official and nonofficial markets. Artemisinin derivatives used in monotherapy or in combination were commonly sold. In health care facilities, 93% of the uncomplicated malaria cases were treated in the absence of any laboratory confirmation and the officially recommended treatment, amodiaquine-sulfadoxine/pyrimethamine, was seldom prescribed. Thus, the national guidelines for the treatment of uncomplicated malaria are not followed by health professionals in Bangui. Its use should be implemented while a control of importation of drug has to be reinforced. 1. Background The aim of malaria management policy is to provide therapeutic guidelines to health workers and efficacious and affordable drugs to health facilities for patients to buy. This policy must be based on proper laboratory diagnosis and treatment of malarial episodes. Given the rapid evolution of parasite resistance to chloroquine and sulfadoxine-pyrimethamine (SP), several countries have modified their national policy and adopted the artemisinin derivative combined treatments (ACT’s) as recommended by WHO [1]. Access to drugs is widely available for the urban population through private drugstores and an illicit market [2]. The consequence is an increase of “drugs pressure” on the parasite strains, thus increasing the risk of development of multidrug resistance [3]. Moreover, urban malaria has its own epidemiological characteristics requiring appropriate fighting methods [4]. In Bangui, capital of Central African Republic (CAR), chloroquine is no longer recommended by the National Malaria Control Program (NMCP) because the resistance rate was of 40.9% in 2004 [5], while, in rural areas, this rate has been estimated to be
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