Knowledge level and pattern of anti-malarial drugs use in Manyatta-B
In order to assess the knowledge level on drug used, the pattern of anti-malarial use (symptoms for use, dosage, duration/frequency and available anti-malarials) was evaluated. Table
1 presents data on the pattern of anti-malarial drugs used in Manyatta-B. Results revealed that most of the respondents who had taken anti-malarial drugs reported high temperatures (48.4%), headache (39.4%), vomiting (7.6%) and shivering (4.0%) as symptoms for anti-malarial drug use, while the rest (0.6%) reported other symptoms (coughs, pregnancy-related and acute respiratory infections).
Table 1
Anti-malarial drugs taken and the doses and duration with which they were used in Manyatta B.
ACT
| 42 (33.0%) | 85 (67.0%) | 37 (29.4%) | 90 (70.6%) |
SP
| 120(82.0%) | 27 (18.0%) | 125 (85.0%) | 22 (15.0%) |
Quinine
| 27 (96.4%) | 1 (3.6%) | * | * |
Chloroquine
| 10 (34.5%) | 19 (65.5%) | 15 (51.7%) | 14 (48.3%) |
Amodiaquine
| * | * | * | * |
Consumers' knowledge on the dosage and duration/frequency was further assessed on respondents who reported using the anti-malarial drugs. Most of SP consumers used the correct dosage (85.0%) and within the correct duration (82.0%) (Table
1). Only 29.4% of the consumers who reported having used ACT could identify the correct daily adult dose of 8 tablets (ACT-artemether/lumefantrine, commonly available in 20/120-mg tablet size) (Table
1). All other ACT users (70.6%) reported taking fewer than eight tablets a day. Similarly, of those who responded to the question of duration of ACT therapy, the majority (67.0%) responded incorrectly, mostly identifying shorter treatment duration (less than 3 days) (Table
1). Most respondents who used quinine could identify the correct duration of use (96.4%) since its administration was entirely done in health facilities (Table
1). All of the consumers that used amodiaquine either could not remember or declined to respond to questions on dosage and duration (Table
1).
Behaviours in anti-malarial drug use
In this study, behaviour was defined as habitual practices, actions or deeds an individual or households carry out with an anti-malarial drug. In order to assess behaviours during the use of anti-malarial drugs, respondents were first stratified into those who took drugs with prescription (39.4%) and without prescription (61.6%). For those who had no prescription, the reasons given were as follows; 39.0% said procedure of acquisition was less costly, 23.0% took same drug for similar symptoms, 15.5% were not satisfied with health services/institutions, 12.5% had neighbour/friend/relative previously taking the same drug and 10% said health institution was far from their location.
In addition, there were notable differences between proportions of those who bought full dosage of drugs (39.1%) versus those who did not (60.9%). For those who did not buy full drug dosage, they gave the following reasons; 67.3% could not afford, 16.8% got better after taking few tablets, 14.4% said symptoms were mild and so there was no need of buying full dosage, while 1.4% gave other reasons not listed in the questionnaire. When asked about how drugs were taken, 63.9% reported to have taken drugs according to advice given at the source while 36.1% reportedly did not take drugs according to advice given. Reasons for not taking drugs according to advice were mainly; 41.4% kept drugs for future episodes of the same illness, 33.0% got better hence discontinued, and 16.2% shared the dosage with another person while the rest gave other actions not listed on the questionnaire.
When asked about the drug used, 34.6% of the respondents reported the drugs used for treatment was always available at source, 20.9% said the drug of has a faster action, 18.8% reported that they have been using the same drug for the same ailment/symptoms, 12.0% reported that the drug used had no side effects, 9.4% reported that the drug had fewer number of dosages per treatment course and 4.3% included other reasons. In terms of day of first use of drugs after the symptoms started, 34.3% took drugs the same day (within 12 hours of illness), 38.5% took drugs the next day (within 24 hours of illness), 17.6% took drugs two days after (within 48 hours of illness), 9.1% took drugs three or more days (60 hours or more), while 0.5% could not remember.
Finally, when asked about what the respondents would do if they missed their morning dose during treatment course, 32.7% said they would ignore their missed dose, 25.9% indicated they would take it immediately they remember, 21.2% said they would double the next dose, 15.6% said they would extend day of therapy, 2.8% said they would narrow the dosing interval, while 1.8% gave other actions.
Association between knowledge factors and anti-malarial drug use patterns
In order to determine knowledge factors associated with patterns of use of anti-malarial drugs in this peri-urban population, a logistic regression analysis was performed. The independent variables included knowledge on symptoms for use, knowledge on dosage, knowledge on duration, and knowledge on available anti-malarials. The above factors were regressed against the outcome variables (i.e. drugs taken, duration of use and dosage/frequency of use) (Table
2).
Table 2
Knowledge factors and the use of anti-malarial drugs in Manyatta-B
Constants
| 2.021 | 1.231 | 1.778 |
Knowledge variables
| |
Symptoms for use |
β = 0.063,
P
= 0.001
| β = 0.016, P = 0.849 | β = 0.079, P = 0.150 |
Anti-malarial(s) availability |
β = 0.013,
P
= 0.020
|
β = 0.121,
P
= 0.027
| β = 0.018, P = 0.722 |
Dosage | β = 0.101, P = 0.341 | β = 0.115, P = 0.279 | β = 0.105, P = 0.322 |
Duration | β = 0.192, P = 0.089 | β = 0.039, P = 0.706 |
β = 0.018,
P
= 0.022
|
Knowledge on symptoms of malaria was a significant factor in determining the type of anti-malarial drug taken since many respondents took ACT (94.5%) and SP (93.2%) against the presence or mixed symptoms of headache, high temperature, shivering and vomiting as compared to other symptoms mentioned (β = 0.063,
P = 0.001) (Table
2).
Furthermore, knowledge on the anti-malarial drugs available in the market significantly influenced the drug taken (β = 0.013,
P = 0.020) and dosages used (β = 0.121,
P = 0.027) (Table
2), primarily due to the fact that significantly higher proportions of respondents with knowledge on availability of SP (78.5%) took SP against symptoms of malaria and further took correct dosages as opposed to individuals with knowledge on other drugs (
P = 0.002). Further analysis revealed that knowledge on duration of use significantly influenced the duration for which drugs were taken (β = 0.018,
P = 0.022) since many individuals who used ACT took it for shorter (incorrect) duration as compared to the individuals who used other anti-malarials (Table
2).