Prescribing Practices for Uncomplicated Malaria in a Rural District in Ghana, 2012

Background: The use of Artemisinin–based Combination Therapies (ACTs) for laboratory confirmed malaria, in conformity to recommended guidelines, remains critical to halting the emergence of drug resistance. We reviewed prescribing practices for malaria in Kwahu South District (KSD) and determined factors influencing conformity to guidelines.
Methods: We conducted a cross-sectional survey in seven health facilities from three randomly selected sub-districts in KSD. We reviewed patients’ records with a diagnosis of malaria from January to December 2012. Patients’ records were selected by systematic random sampling. Variables reviewed were demographics, clinical presentation and prescription patterns. Prescriptions were considered to conform to recommended guidelines if ACT was prescribed for confirmed uncomplicated malaria and not prescribed for test negative or presumptive malaria. Frequencies, relative frequencies, mean and median were calculated. Unadjusted odds ratios were used to determine associations at 5% significance level. Predictors of conformity were determined by logistic regression model, adjusting for potential confounders.
Results: Four hundred and four records were reviewed of which 247(61.1%) were females. Median age was 23 years (interquartile range 12-38). Overall, 202(50%) of prescriptions conformed to guidelines: 132 (65.3%) being Artesunate-Amodiaquine (AA). Temperature of ≥37.5°C [adjusted odds ratio (AOR)=1.8, (CI:1.11-2.92)] and being managed at the district hospital [AOR=8.7, (CI:5.41-14.12)] were independent predictors of conformity.
Conclusion: Conformity of prescribing practices to recommended guidelines was suboptimal. Determinants of conformity were fever and being managed at the hospital. We recommended targeted interventions to improve conformity of case management practices to guidelines.