“Waiting for chloroquine”: A community understanding of changes in 1 st -line treatment for uncomplicated malaria, and the need for effective policy communication. Vincent Okungu. Background.
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“Waiting for chloroquine”: A community understanding of changes in 1st-line treatment for uncomplicated malaria, and the need for effective policy communication
Kenya rolled out artemether-lumefantrine (AL) in 2006 to replace sulfadoxine-pyrethamine (SP)
How treatment policy change from SP to AL was communicated to the study community:
Print & electronic media
From through To
[Implications for uptake and universal access to malaria drugs]
“We don’t know that drugs have changed, only that there are seasons for each malaria drug. It is now the season for malara-tab [AQ] and the other one... [AL]. We are waiting for CQ season, then we will have no problems treating malaria…” (Male, FGD)
“I have no information about any changes in malaria drugs, but if there are indeed changes, then the new drugs have not yet reached this village.” (Female patient, 24)
“We keep asking why AL and not any other ACT? This question has not been answered and sometimes we believe that the change was motivated by non-health reasons... may be someone just wanted to make money.” (District health worker)
“Recently, I asked my wife why she was given fewer drugs than those given to everyone who goes to the dispensary. She responded that the other drug [AL] cannot be given to pregnant women. This confirms that the new drug is harmful.” (Male, FGD).
“We heard that malaria drugs currently available are not good. We hoped for a new and better drug, but the new drug has 24 tablets instead of just a few. Why are the tablets so many if it is a good drug?”
“…one type of drug cannot treat people suffering from different types of malaria. I suggest that each type of malaria should have its own drug….” (Male, 39- FGD)
“...all we see are graphics and pictures, which we often take for decorations in the dispensary.” (Female, 33)
From through To
[Public health officers, local authority, teachers, (radio)]
“There is a lot of information coming through radios and posters regarding different types of malaria drugs, but with no one to differentiate for the ordinary people and show them that AL is the best and recommended drug, they get confused by the adverts....” (Health worker).
“…the dispensary gave my wife what it said were the latest malaria drugs, but the shopkeeper also had the latest drugs different from the dispensary’s… this is confusing.” (Male 27, FGD)
“I wanted to know why I was given [malaria] drugs different from the ones I have known all along but the nurse asked me whether I came to be treated or to know what drugs I would take….”
4. Perception among some health workers that SP is still effective
“SP is one of the best malaria drugs I have ever come across- fast acting and easy to use- sometimes we wonder why the replacement occurred too soon.”
“…I prefer the older drugs... I do not like the new one because of many tablets and the fact that patients who use it never recover. I think there should be a warning on the [AL] package that it may not cure malaria the same way it is done to warn smokers against cigarette consumption.” (Female, 46- ID)