Healthcare Professional Preferences for Prescribing Artemisinins and Quinine for Malaria in Burundi

Overview

Journal East Afr Health Res J

Date 2022 Jan 17

PMID 35036845

Authors

Aine-Ernest Niyonkuru

Eric McLaughlin

Gregory Heath

Sonia Inamuco

Hillary Topazian

Mike Davis

Affiliations

Soon will be listed here.

Abstract

Background: Malaria is a significant cause of morbidity and mortality throughout the world and particularly sub-Saharan Africa. The World Health Organization and many national bodies, including Burundi, recommend artemisinin-based therapy as first-line treatment for uncomplicated and severe malaria. Implementing this recommendation requires healthcare professionals' acceptance of this treatment as the optimal choice.

Methods: A survey was conducted among Burundian healthcare professionals from June to September 2017 to assess prescribing preferences regarding artemisinins versus quinine for treating malaria. Healthcare professionals were surveyed from 32 health facilities in 10 provinces. Respondents included both physicians and nurses who provided responses about their antimalarial treatment preferences for a variety of clinical scenarios. Comparisons among healthcare professionals, their level of training, work setting, and length of work experience were examined using a series of stratified analyses, where the Pearson Chi-square statistic and odds ratios with 95% confidence intervals were calculated.

Results: Respondents included 101 doctors and 196 nurses. Seventy-nine percent of respondents worked in hospitals, while 58% had more than 5 years of work experience. Although 94% of respondents correctly identified artemisinin-based treatment as first-line therapy according to the national protocol, 24-40% of respondents preferred the use of quinine in various hypothetical clinical scenarios. Overall, nurses were at greater odds of preferring quinine versus artemisinins compared with physicians. Availability of artemisinins was associated positively with artemisinin preference. These results did not vary by duration of work experience.

Conclusions: Though knowledge of artemisinin-based therapy was recognised by the majority of respondents as the recommended antimalarial treatment, a high proportion of Burundian healthcare professionals, especially nurses, prefer using oral and IV quinine in a number of clinical scenarios. These findings identify a significant barrier to the satisfactory implementation of a life-saving treatment in accordance with national and international recommendations.

References

Ouedraogo L, Drabo K, Zongo P . [An evaluation of the implementation of the national treatment protocol for uncomplicated malaria in rural areas of Burkina Faso]. Sante Publique. 2012; 24(4):353-63. View

Noubiap J . Shifting from quinine to artesunate as first-line treatment of severe malaria in children and adults: saving more lives. J Infect Public Health. 2014; 7(5):407-12. DOI: 10.1016/j.jiph.2014.04.007. View

Nzayirambaho M, Freund R, Millet P, Lombrail P, Malvy D, Potel G . [Assessing the application of Rwanda's national protocol for uncomplicated malaria treatment in healthcare institutions in Kigali City, Rwanda]. Med Mal Infect. 2007; 38(3):119-24. DOI: 10.1016/j.medmal.2007.08.003. View

Yameogo T, Tapsoba S, Sombie I, Guiguemde T . [Evaluation of application of national guidelines for the management of malaria in Bobo-Dioulasso university hospital]. Sante Publique. 2015; 27(2):265-73. View

Sinclair D, Donegan S, Isba R, Lalloo D . Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012; (6):CD005967. PMC: 6532684. DOI: 10.1002/14651858.CD005967.pub4. View

Pulford J, Smith I, Mueller I, Siba P, Hetzel M . Health Worker Compliance with a 'Test And Treat' Malaria Case Management Protocol in Papua New Guinea. PLoS One. 2016; 11(7):e0158780. PMC: 4938505. DOI: 10.1371/journal.pone.0158780. View

Selemani M, Masanja I, Kajungu D, Amuri M, Njozi M, Khatib R . Health worker factors associated with prescribing of artemisinin combination therapy for uncomplicated malaria in rural Tanzania. Malar J. 2013; 12:334. PMC: 3848943. DOI: 10.1186/1475-2875-12-334. View

Ndayiragije A, Niyungeko D, Karenzo J, Niyungeko E, Barutwanayo M, Ciza A . [Efficacy of therapeutic combinations with artemisinin derivatives in the treatment of non complicated malaria in Burundi]. Trop Med Int Health. 2004; 9(6):673-9. DOI: 10.1111/j.1365-3156.2004.01255.x. View

Ferrari G, Ntuku H, Burri C, Tshefu A, Duparc S, Hugo P . An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study. Malar J. 2015; 14:226. PMC: 4455055. DOI: 10.1186/s12936-015-0732-1. View

10.

Sayang C, Gausseres M, Vernazza-Licht N, Malvy D, Bley D, Millet P . Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in urban health facilities in Yaoundé, central province, Cameroon. Malar J. 2009; 8:176. PMC: 2726182. DOI: 10.1186/1475-2875-8-176. View

11.

Zurovac D, Githinji S, Memusi D, Kigen S, Machini B, Muturi A . Major improvements in the quality of malaria case-management under the "test and treat" policy in Kenya. PLoS One. 2014; 9(3):e92782. PMC: 3963939. DOI: 10.1371/journal.pone.0092782. View

12.

Sayang C, Gausseres M, Vernazza-Licht N, Malvy D, Bley D, Millet P . Treatment of malaria from monotherapy to artemisinin-based combination therapy by health professionals in rural health facilities in southern Cameroon. Malar J. 2009; 8:174. PMC: 2726181. DOI: 10.1186/1475-2875-8-174. View

13.

Dondorp A, Fanello C, Hendriksen I, Gomes E, Seni A, Chhaganlal K . Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010; 376(9753):1647-57. PMC: 3033534. DOI: 10.1016/S0140-6736(10)61924-1. View

14.

Masanja I, Lutambi A, Khatib R . Do health workers' preferences influence their practices? Assessment of providers' attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania. BMC Public Health. 2012; 12:956. PMC: 3530431. DOI: 10.1186/1471-2458-12-956. View

15.

Amuasi J, Diap G, Blay-Nguah S, Boakye I, Karikari P, Dismas B . Access to artesunate-amodiaquine, quinine and other anti-malarials: policy and markets in Burundi. Malar J. 2011; 10:34. PMC: 3050774. DOI: 10.1186/1475-2875-10-34. View

16.

Bilal J, Gasim G, Abdien M, Elmardi K, Malik E, Adam I . Poor adherence to the malaria management protocol among health workers attending under-five year old febrile children at Omdurman Hospital, Sudan. Malar J. 2015; 14:34. PMC: 4318364. DOI: 10.1186/s12936-015-0575-9. View

17.

Dondorp A, Nosten F, Stepniewska K, Day N, White N . Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet. 2005; 366(9487):717-25. DOI: 10.1016/S0140-6736(05)67176-0. View