Malaria is still a major public health problem caused by plasmodium parasite species transmitted to human through the bite of infected female Anopheles mosquito. There  are  five  parasite  species  that  cause  malaria  in humans, namely Plasmodium falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Two of these species P. falciparum and P. vivax pose the greatest threat. Malaria   is    preventable    and   curable   (World  Health  Organisation, 2019). Although all of the former species may cause significant illness, P. falciparum is responsible for the majority of serious complications and deaths. Drug resistance is an important therapeutic problem, most notably with P. falciparum (Borimas and Nicholas, 2016).

Irrational use of anti-malarial medication is one of the major challenges affecting the prevention, treatment and cure of malaria. This has led to the spread of parasite resistance to most commonly used anti-malarial drugs.

Assessment of drug use patterns with World Health Organization (WHO) drug use indicators is becoming increasingly necessary toward promoting rational drug use in developing countries. Inappropriate drug prescribing is still a global problem (Enwere et al., 2007). Misuse of drugs occurs in all countries and irrational practices are especially common and costly in developing countries (Ghimire et al., 2009). Some studies in Nigeria have revealed that appreciable gaps in knowledge exist with respect to rational drug use among health care professionals (Chukwuani et al., 2002; Okoh, 2012).

Aim of the study

The aim of the study is to assess the antimalarial drug utilization pattern amongst staff of three Health facilities in Rivers State.

Specific objectives

i) To assess the range of antimalarial drugs used by the staffers of the three Health facilities in the study.

ii) To identify the most frequently used anti-malarial drug(s) amongst staff of the three Health facilities.

iii) To find out their level of adherence to national guideline and policy on the diagnosis and treatment of malaria.

iv) To assess the preventive measures used by the study group for malaria control.

Study design

The study adopted a cross sectional design with the use of questionnaire to obtain the desired information. The population for this study included health workers in the General Hospitals of Ahoada and Terabor and that of the Health Centre of Rivers State College of Health Science and Management Technology, Port Harcourt who consented to participating in the study. A total population of 105 respondents was drawn from the Staff of the Health facilities.

Sample size determination

The sample size of  this  research  was  calculated  using  the  Taro Yamane (Yamane, 1973) formula with 95% confidence level.

The calculation formula of Taro Yamane is given as follows:

Where: n = sample size required; N = number of people in the population; e = allowable error (%).

Substituting the numbers into the formula, we have; N = 44, 38 and 33 respectively; e = 5% (0.05). This translates to  n = 40, 35 and 30 respectively for General Hospitals Ahoada and Terabor and College of Health Science and Management Technology Health Centre, Port Harcourt.

Data collection technique

The technique of data collection involves the administration of specially adapted and structured questionnaires adopted in the study. The questionnaire consists of three sections; the first section consists of demographic information of the respondents. The second part consists of knowledge based questions as regards signs and symptoms malaria and antimalarial drug utilization while the third section consists of questions on preventive measures and practices against malaria.

Statistical analysis

Data was compiled, presented and analyzed using Statistical Package for Social Sciences (SPSS) software version 20. Chi Square Test was used to determine correlation between variables, and p-value set at 0.05 significant levels.

A total of 130 questionnaires were distributed and 105 was completed correctly and returned. Of these, 35 was from Terabor, 40 from Ahoada and 30 from College of Health Science and Management Technology Health Centre. The results are presented in Tables 1 to 9.

Choice of malarial prophylaxis

About 32.4% (34) of the respondents reported to have been using malaria preventive medications of which 10 do use Proguanil, 7 do use Pyrimethamine , 14 for Sulphadoxine/Pyrimethamine while 3 reported the use of Chloroquine

Cross tabulation between health facility with preferred choice of antimalarial drug and level of adherence.

As shown in Table 10, there is no statistically significant relationship between the health facility and the preferred choice of antimalarial or the level of adherence to national guidelines on malaria treatment.

Cross tabulation between health facility and choice of antimalarial drug switched to after first treatment

Table 11 reveals that there is no statistical significance between the health facilities and the choice of antimalarial drugs.

Cross tabulation between health facility and reasons for switching antimalarial and medication recommendation

In Table 12, there is no statistical significance between the health facilities and reasons  for switching antimalarial drug. However, there is strong statistical evidence between health facilities and who recommends the medication, as the respondents are more likely to get prescriptions from a doctor or a pharmacist.

Cross tabulation between health facility and characteristics of antimalarial therapy

Table 13 shows that there is no statistical significance between the health facilities and testing before treatment, time duration between drug usage and reasons for second dose. Figure 1 describes  the  malaria  preventive practices among respondents.

ACTs especially Artemeter-Lumefantrine (86.6%) was reported mostly as the drug of first choice for the treatment of malaria infections by the respondents. This is in line with National and WHO Guidelines for the treatment of uncomplicated malarial. From the study generally, 98% utilization was reported as antimalarial drug of first choice. This corresponds with a study carried out by Dodoo et al. (2009) where 90.8% of the respondents used artemisinin-based compound in their treatment regimen. And also that carried out by Ezenduka et al. (2014) where the ACTs recorded 72.7% usage.

On prevalence of malaria, 65.7% of the respondents reportedly develop malaria symptoms within 2 - 6 months. This is quite consistent with a study that revealed that 64.9% of respondents fall ill within 6 months also. 14.3% of the respondents developed symptoms once a year while only 1% rarely develops symptoms. This could be due to a number of reasons such as adequate self-preventive practices amongst others. This is in line with another study conducted in university of Ibadan that concluded that about a third of the volunteers suffered malaria attacks once a year, though a few claimed never to have malaria. This was attributed to the fact that they all had good knowledge of the disease and has developed individual methods of self-management of their malaria attacks (Anumudu et al., 2006). Mosquitoes breed more in the rainy season and hence the prevalence of malaria is always higher in the rainy season (Chigozie et al., 2018).

Health workers in the survey showed good knowledge about the malaria symptoms, demonstrated in their report of high body temperature, headache, fatigue and chills amongst others as symptoms of malaria. This is consistent with other studies that demonstrated knowledge of malaria symptoms such as that carried out by Modupe et al. (2013). Although fever is a symptom of malaria, it is also a symptom of other non-malarial illnesses, hence the need for appropriate diagnosis before treatment as recommended by WHO.

Self-prescribing is still a problem as about 11.4% claim to prescribe drugs for themselves. This is in agreement with the study by Ezenduka et al. (2014) study, who stated that self-medication resulting in the use of monotherapy remains significant  with  increasing  risk  of undermining treatment policy, and suggested that additional measures be put in place to directly target consumers and providers in the sector for improved use of anti-malarial drugs in Nigeria. Self-prescribing could mitigate the effort aimed at ensuring rational antimalarial drug use, and as well may cause recrudescence and contribute to malaria resistance, therefore should be discouraged.

Treatment success does not only depend on the use of recommended treatment guidelines but encompasses the correct use of the drug by the patient. In this study, 94.3% of the respondents reported having always completed the recommended doses  and  their  nature  of work and work environment may be contributory to this. Switching of medication was also reported among the study group with reasons ranging mostly from treatment failure to cost and side effects of medication. However, it would be interesting to note that artesunate-amodiaquine was the drug about 44% of persons switched to,  followed by Dihydroartemisinine/ Piperaquine (31.7%) which are all within WHO antimalarial recommendations. Only about 4.7% still switched to non-ACT monotherapies like Mefloquine, Quinine and Chloroquine which should not be expected from such a study group again.

The use of insecticide treated  nets  constitutes  one  of insecticide treated nets while 27.6% agreed to spraying insecticides. This is closely related to a study carried out in the University of Lagos which showed that more than half of the students possessed long lasting insecticide treated nets (LLIN), but not up to half of the students regularly sleep under the treated nets (Olusegun-Joseph et al., 2016). This also agrees with a study that revealed that more than three-quarter of the students (78.1%) knew that LLIN was an effective form of malaria control; however only 55.3% actually reportedly use LLIN in their homes (Chigozie et al., 2018). Few respondents reported their use of malaria prophylaxis. This may not have been necessary if other preventive measures were adopted; however, it agrees with a study carried out in the University of Ibadan which reported that the most used form of preventive measure were the use of Metakelfin (quinine + sulphalene-pyrimethamine), Daraprim (pyrimethamine) and Fansidar (sulphadoxin-pyrimethamine) in addition to bed nests and insecticides (Anumudu et al., 2006). It should be noted that malaria prophylaxis is generally not necessary in persons living in a malarious area because of the risk of lowering one’s resistance  to   the   disease;   however,  it  is  required  in sickle-cell anaemia patients and non-immune visitors (Federal Ministry of Health, 2005). 95.2% and 96.2% of the respondents reported knowledge of their blood group and genotype respectively. However, of the 101 respondents who reported knowledge of their genotype, 70.3 and 28.7% were respectively AA and AS. Only 1% was SS. Blood group and genotype may be important as it is also related to individual’s malaria susceptibility.

The antimalarial most frequently used among staff of the three health facilities were the ACTs with Artemether-Lumefantrine having the highest frequency. They also had adequate knowledge of malaria symptoms and adherence to WHO recommendations was good. However, strict adherence to National guidelines for the treatment of uncomplicated malaria was poor. Not all the preventive strategies for malaria were thoroughly in practice; however, having their home windows covered with nets, sleeping under insecticide treated nets and wearing clothes  at  night  with  insecticide  spraying were the most utilized methods of malaria prevention among the study group.

1) Concerted efforts should be made towards ensuring strict adherence to National Treatment Guidelines, as well as putting a stop to self-prescribing.

2) Health workers need to take up more responsibilities regarding proper choice of antimalarial medication so that their patients also, can have appropriate recommendations.

3) More campaigns should be channelled towards the adoption of good preventive practices against malaria as this could reduce the incidence rate and consequent drug pressure.

The authors have not declared any conflict of interests.