Artemisinin-based combination therapy amongst medical students in the University of Benin, South-South Nigeria: A cross-sectional study

Submitted: 21 May 2022
Accepted: 4 August 2022
Published: 16 September 2022
Abstract Views: 195
PDF: 109
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Since 2005, the recommended first-line therapy for uncomplicated malaria in Nigeria has been Artemisinin-based Combination Therapy (ACT). Previous research indicates that these therapies are widely accepted by health care providers and other end users. Nonetheless, few studies have examined the preferences of clinical students who will be future prescribers of these medications. This was a descriptive cross-sectional survey of medical students undergoing clinical placements at the University of Benin Teaching Hospital in Benin City, Edo State, South-South Nigeria, to assess ACT preferences, tolerability, and cost considerations. Consenting clinical medical students who were recruited sequentially were given a semi-structured questionnaire. The questionnaire collected information about the students’ demographics, previous episodes of malaria symptoms, diagnosis, and treatment. Their preferred antimalarial, tolerability to ACTs, and ACT cost. The information was presented descriptively. There were 475 registered clinical students, but only 416 agreed to participate in the survey, yielding an 87.6% response rate. The students’ mean (standard deviation) age was 24.3 (3.8) years, with a male preponderance of 250 (60.1%). The majority, 154 (37.0%), were in the 600 level, while the 500 and 400 levels were 130 (31.3%) and 132 (31.7%), respectively. The majority of students, 272 (65.5%), treated malaria presumptively, and the majority of students, 344 (82.7%), had treated one to five episodes of malaria in the previous 12 months. The ACTs were known to nearly all of the final year clinical students (97.4%). The majority, 289 (69.5%), had no adverse drug reactions with the ACTs. Among those who experienced adverse drug reactions, 23 (39.7%) discontinued their medication, while 2 (3.4%) required hospitalization. The mean cost of the ACT was ₦1263.4 (SD ± 529.6) (₦=Naira) (3.0 USD), with a range of ₦ 300- ₦3000 (0.72- 7.2 USD). This study demonstrates a high level of acceptance for ACTs, particularly artemether-lumefantrine. However, the adverse effects of ACTs, particularly other recommended ACTs, must be evaluated on a regular basis because they may have an impact on their continued use.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

WHO. World Malaria report 2019. Accessed 29th September 2020. Available from: https://apps.who.int/iris/rest/bitstreams/1262394/retrieve
Federal Ministry of Health, National Malaria Control Programme, Abuja, Nigeria. Strategic Plan 2009-2013. Accessed 10th march 2022. Available from: https://extranet.who.int/countryplanningcycles/sites/default/files/country_docs/Nigeria/nigeria_draft_malaria_strategic_plan_2009-2013.pdf
Malaria: Current status in Nigeria. Accessed 8th March 2022. Available from: https://healththink.org/malaria-in-nigeria-where-are-we-now
Korenromp EL, Williams BG, Gouws E, et al. Measurement of trends in childhood malaria mortality in Africa: an assessment of progress toward targets based on verbal autopsy. Lancet Infect Dis 2003;3:349–58. DOI: https://doi.org/10.1016/S1473-3099(03)00657-1
Marsh K. Malaria disaster in Africa. Lancet 1998;352:924–5. DOI: https://doi.org/10.1016/S0140-6736(05)61510-3
WHO. Antimalarial drug combination therapy. Report of a technical consultation 2001. WHO. Geneva, Switzerland. Available from: https://apps.who.int/iris/handle/10665/66952
Federal Ministry of Health (FMOH). National antimalarial treatment policy, 2014. Abuja, Nigeria. Available from: https://www.health.gov.ng/doc/NATIONAL-MALARIA-POLICY_2014_28022014.pdf
WHO. World Malaria Report 2016. Geneva, Switzerland. Accessed 9th March 2022. Available from: https://apps.who.int/iris/bitstream/handle/10665/252038/9789241511711-eng.pdf
Severe malaria observatory: Nigeria 2020. Accessed 17th march 2021. Available from: https://www.severemalaria.org/countries/nigeria
WHO. Malaria Report 2021. Geneva, Switzerland. Accessed 17 March 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria
Agbaje EO, Aphia DO. Knowledge and management of malaria among non-medical Nigerian undergraduates. Niger Postgrad Med J 2007;14:221-5.
Anene-okeke CG, Isah A, Oyine Aluh D, Ezeme AL. Knowledge and practice of malaria prevention and management among non-medical students of university of Nigeria, Nsukka. Int J Community Med Public Health 2018;5:461-5. DOI: https://doi.org/10.18203/2394-6040.ijcmph20180220
Welle SC, Ajumobi O, Dairo M, et al. Preference for Artemisinin-based combination therapy among healthcare providers, Lokoja, North-Central Nigeria. Glob Health Res Policy 2019;4:1. DOI: https://doi.org/10.1186/s41256-018-0092-9
WHO. World Malaria Report 2014. Geneva, Switzerland. Available from: http://apps.who.int/iris/bitstream/handle/10665/144852/9789241564830_eng.pdf?sequence=2
Murray CJL, Rosenfeld LC, Lim SS, et al. Global malaria mortality between 1980 and 2010: a systematic analysis. Lancet 2012;379:413–31. DOI: https://doi.org/10.1016/S0140-6736(12)60034-8
Akoria OA, Arhuidese IJ. Progress toward elimination of malaria in Nigeria: uptake of artemisinin-based combination therapies for the treatment of malaria in households in Benin City. Ann Afr Med 2014;13:104-13. DOI: https://doi.org/10.4103/1596-3519.134383
World Health Organization The WHO prequalification project. Accessed 30th july 2022. Available from: http://www.who.int/mediacentre/factsheets/fs278/en/index.html
Iwuafor AA, Udoh UA, Ita OI, et al. Awareness of the National Antimalarial Treatment Policy and Malaria Self-care Practices among Medical Students and the Staff of the University of Calabar, Nigeria. Saudi J Pathol Microbiol 2019;4:803-12. DOI: https://doi.org/10.36348/sjpm.2019.v04i11.005
WHO. World Malaria Report 2018. Geneva, Switzerland. Available form: http://apps.who.int/iris/bitstream/handle/10665/275867/9789241565653-eng.pdf
Isiguzo C, Anyanti J, Ujuju C, et al. Presumptive treatment of malaria from formal and informal drug vendors in Nigeria. PLoS ONE 2014;9:e110361. DOI: https://doi.org/10.1371/journal.pone.0110361
Uzochukwu BSC, Onwujekwe E, Ezuma NN, et al. Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria. PLOS One 2011;6:e14627. DOI: https://doi.org/10.1371/journal.pone.0014627
James H, Handu SS, Al Khaja KAJ, Sequeira RP. Influence of medical training on self-medication by students. Int J Clin Pharmacol Therapeutics 2008;46:23–9. DOI: https://doi.org/10.5414/CPP46023
Esan DT, Fasoro AA, Odesanya OE, et al. Assessment of self-medication practices and its associated factors among undergraduates of a private university in Nigeria. J Environ Public Health 2018;2018:5439079. DOI: https://doi.org/10.1155/2018/5439079
Daanish AF, Mushkani EA. Influence of medical education on medicine use and self-medication among medical students: a cross-sectional study from Kabul. Drug Healthc Patient Saf 2022;14:79-85 DOI: https://doi.org/10.2147/DHPS.S360072
Ashley EA, Dhorda M, Fairhurst RM, et al. Tracking Resistance to Artemisinin Collaboration (TRAC). Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 2014;371:411-23. DOI: https://doi.org/10.1056/NEJMx140047
Amaratunga C, Lim P, Suon S, et al. Dihydroartemisinin-piperaquine resistance in Plasmodium falciparum malaria in Cambodia: a multisite prospective cohort study. Lancet Infect Dis 2016;16:357-65. DOI: https://doi.org/10.1016/S1473-3099(15)00487-9
Maude RJ, Woodrow CJ, White LJ. Artemisinin Antimalarials: Preserving the "Magic Bullet". Drug Dev Res 2010;71:12-19. DOI: https://doi.org/10.1002/ddr.20344
Adegbite BR, Edoa JR, Honkpehedji YJ, et al. Monitoring of efficacy, tolerability and safety of artemether–lumefantrine and artesunate–amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Lambaréné, Gabon: an open-label clinical trial. Malar J 2019;18:424. DOI: https://doi.org/10.1186/s12936-019-3015-4
Lula Ntamba Y, Muhindo Mavoko H, Kalabuanga M, et al. Safety and tolerability of artesunate-amodiaquine, artemether-lumefantrine and quinine plus clindamycin in the treatment of uncomplicated Plasmodium falciparum malaria in Kinshasa, the Democratic Republic of the Congo. PLoS ONE 2019;14:e0222379. DOI: https://doi.org/10.1371/journal.pone.0222379
Fanello CI, Karema C, Van Doren W, et al. A randomized trial to access the safety and efficacy of AL (coartem®) for the treatment of uncomplicated P. falciparum malaria in Rwanda. Trans R Soc Trop Med Hyg 2007;101:344-350. DOI: https://doi.org/10.1016/j.trstmh.2006.06.010
Thiam S, Ndiaye JL, Diallo I, et al. Safety monitoring of artemisinin combination therapy through a national pharmacovigilance system in an endemic malaria setting. Malar J 2013;12:54. DOI: https://doi.org/10.1186/1475-2875-12-54
Ayinbuomwan AS, Isah AO. Safety and Tolerability Profile of Artemisinin-based Combination Therapy in Adult patients in Benin City, Nigeria. West Afr J Pharmacol Drug Res 2014;29:25-9.
Yakasai AM, Hamza M, Dalhat MM, , et al. Adherence to artemisinin-based combination therapy for the treatment of uncomplicated malaria: a systematic review and meta-analysis. J Trop Med 2015;2015:189232. DOI: https://doi.org/10.1155/2015/189232
World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva: World Health Organization. Available from: https://apps.who.int/iris/bitstream/handle/10665/162441/9789241549127_eng.pdf
Shillcutt S, Morel C, Goodman C, et al. Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull World Health Organ 2008;86:101-10. DOI: https://doi.org/10.2471/BLT.07.042259

How to Cite

Ayinbuomwan, S., Opadeyi, A., & Isah, A. (2022). Artemisinin-based combination therapy amongst medical students in the University of Benin, South-South Nigeria: A cross-sectional study. Annals of Clinical and Biomedical Research, 3(2). https://doi.org/10.4081/acbr.2022.209