Awareness of anti-malarial policy and malaria treatment practices of patent medicine vendors in three Nigerian states

Abstract

Introduction: This paper assesses Patent Medicine Vendors' (PMVs) practices, awareness of new Nigerian Artemisinin Combination Therapy (ACT) policy, the anti-malarial drugs in stock and how the PMVs identify fake drugs. Methodology: PMV s and medicine shops were selected through a multi-stage random sampling process, beginning with the purposive selection of three states that reflect major geographic and ethnolinguistic areas of Nigeria: Oyo (Southwest-Yoruba), Kaduna (Northcentral-Hausa), and Enugu (Southeast-Igbo). Local Government Areas (LGAs) in selected states were stratified into urban and rural strata, with two LGAs randomly sampled from each stratum in each state, and one ward (urban LGAs) or community (rural LGAs) randomly sampled from a list in each LGA. A complete listing of PMVs and drug shops was constructed at each site, yielding 111 PMVs and 106 medicine shops. Out of this number, a total of 110 PMVs consented to be interviewed. Results: Some PMVs (43.1 %) were aware of the 2005 government policy that changed the recommended first-line treatment for malaria from chloroquine (CQ) to ACT, but significant differences were found between states (p<0.001). PM V shops stocked many brands of anti-malarial drugs (average 5.5 brands), with ACTs stocked in only 8.5% of the stores at a mean price of N504 ($4) per treatment, compared to sulfadoxine-pyrimethamine (92% of shops, mean price of N90 ($0.7) and even monotherapy artesunates (32% of shops, mean price of N39 ($0.3). The PMVs identify a drug not bearing the National Agency for Food & Drug Administration and Control (NAFDAC) identification number as being fake or counterfeit. Conclusion: PMVs need to be a part of the strategy to change treatment to ACTs if there are to be meaningful changes in the anti-malarial drugs that Nigerians receive.