Health officials working to teach malaria patients how to treat their disease are facing an even greater challenge than a misinformed public. Results of a major drug-use study shows that few drug providers are treating patients with effective medicine, and many others are not treating people at all.
“Community Drug Use Practices in Malaria in Cambodia,” a cross-sectional study of 1,400 villagers and 150 drug providers and health care workers conducted in October 2002 and released this year, indicates that few malaria patients receive the combination drug therapy recommended by the Ministry of Health and World Health Organization.
A combination of anti-malaria drugs is said to be more effective than monotherapies, which are prone to drug resistance, said National Malaria Center Director Dr Duong Socheat.
But 92 percent of those who said they received single artemisinins at both public and private facilities did not receive mefloquine, the study showed. And 87 percent of those who received artemisinins separately at public or NGO health care facilities did not receive mefloquine.
“This could cause resistance very quickly,” Duong Socheat said.
Fifty-eight percent of those who received quinine, the second most popular malaria treatment, at all facilities did not receive tetracycline. Of those who received quinine at public or NGO facilities, 70 percent received it without a form of tetracycline, the study said.
Prescribers widely recommended artemisinins and quinine monotherapy for short durations, a practice that could encourage drug resistance, since the prescribed dosage is ineffective for ensuring treatment, the study said.
“Generally [health care facilities] don’t treat the cases properly because of lack of knowledge. In the remote areas, there are very few qualified staff,” said Dr Ros Seyha, technical adviser to the National Malaria Control Program.
Minimal knowledge about malaria has led many health care workers to provide patients with ineffective treatments before referring them to other clinics, he said. Vitamin injections or a mix of inappropriate drugs can make people more sicker than they were to begin with, he said.
The survey showed that 25 percent of health care providers said they would refer simple cases of malaria to other services.
“This might not be an accurate number, since some providers are afraid to say they have anti-malaria drugs or have offered ineffective therapies,” Ros Seyha said.
Seventy percent of drug providers said they would refer severe cases of malaria to other clinics. Ros Seyha attributed this high number to the fear health workers have of treating the patients.
The US-based Management Sciences for Health, the World Health Organization, and the European Commission Malaria Control Project conducted the survey in Battambang, Pailin, Preah Vihear and Pursat provinces.