Antimalarial drug use among caregivers in Ghana

Chloroquine remains the first line antimalarial drug in Ghana. However, the emergence of Plasmodium falciparum resistance to chloroquine is a major obstacle to the national control strategy of case management. This study provides information on some of the reasons underlying chloroquine treatment failure in the country.

Household surveys, using multi-stage sampling, were conducted in 2 sentinel districts, Wassa West and Kassena Nankana, established to monitor chloroquine resistance in the country. Five hundred caregivers were interviewed in each district to determine patterns of antimalarial drug use among caregivers of children under 10 years. Inventory on home-kept drugs was conducted.

Two hundred and four households in the Wassa West district kept a cumulative total of 248 drugs, whereas 228 households in the Kassena Nankana district kept a cumulative total of 410 drugs. One hundred and ninety-nine (80.2%) of the drugs kept in the Wassa West district and 181 (44.2%) of drugs kept in the Kassena Nankana district were antimalarials. The most commonly kept antimalarial drug in homes was chloroquine (88% and 96% in the Wassa West and Kassena Nankana districts respectively). Reasons given for keeping antimalarials were mainly "leftover after previous treatment". Caregivers' descriptions of the amount of chloroquine given to family members suspected to have malaria within the 2-week period preceding the survey were mostly inappropriate in the 2 districts. However, the proportion of appropriateness of doses was significantly lower in the Wassa West district (11.1% vs 36.4%; p < 0.0001).

The significantly higher proportion of inappropriateness of chloroquine use in the Wassa West district could be a factor influencing the lower sensitivity of Plasmodium falciparum to chloroquine in the district compared to the Kassena Nankana district.