Gap Still Remains Between Malaria Knowledge, Treatment

When the sting of a mosquito bite turns into the hot fever of malaria, ailing patients need treatment, and they need it fast.

But a gap between government guidelines for malaria treatment and health care staff recommendations results in the mistreatment of many malaria pa­tients, according to a study of drug-use behavior and treatment released earlier this year.

Eighty percent of public-sector medical staff surveyed in October 2002 for the “Community Drug Use Practices in Malaria in Cambodia” study said they knew how to treat malaria patients, but only 20 percent of patients actually benefited from that knowledge.

“Though they know the first-line treatment, they don’t prescribe the first-line,” said the World Health Organization’s Dr Kim Yadany on Wednesday. A combination of anti-malaria drugs currently is accepted by the Health Ministry as the most effective “first-line” treatment for malaria in Cambodia.

Yadany said health care pro­viders may not be practicing what they preach because the first-line treatment was only recently introduced in 2000. A large stock of quinine and tetracycline also prompted the National Malaria Center to push doctors to prescribe those drugs rather than the preferred combination of artesunate and mefloquine.

The survey was conducted in Pursat, Battambang, Pailin and Preah Vihear provinces, where malaria transmission is a high risk. Approximately 5,060 families living along the Thai border received questionnaires to define the illnesses from which they suffered and what treatments were used to remedy their ills.

Approximately 160 health care providers also faced a series of questions to test their knowledge of recommended combination drug therapy for malaria.

For children younger than 6 years old, recommendations were either not given or not followed: No child in this age bracket received the recommended treatment of rectal artesunate. Oral artesunate was distributed with greater frequency, landing in the mouths of 44 percent of children younger than 6 years old. Twelve percent of the children received chloroquine treatments.

Ninety-three percent of patients combating fever sought treatment within three days of the onset of their symptoms, the majority of whom found medical assistance from private providers. Since only 11 percent of those patients received the recommended pre-packaged treatment for malaria, patients sought help from the private sector.

But once there, village and market health care providers—60 percent—did not offer blood tests to patients suffering from fever. Only 11 percent of patients received the recommended pre-packaged treatments.

Most patients who patronized village providers relied on health workers’ recommendations to determine which drug treatment was appropriate, with only 25 percent practicing self-medication.

The number of patients who requested specific drugs from private providers was evenly divided with those who self-medicated, according to the survey conducted by the Ministry of Health and WHO, with support from international donors.

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