Abstract
Background: Prompt and effective case detection and treatment are vital components of the malaria case management
strategy as malaria-endemic countries implement the testing, treating and tracking policy. The implementation of this
policy in public and formal private sectors continue to receive great attention while the informal private retail sector
(mostly the patent and propriety medicine vendors [PPMVs]) where about 60% of patients with fever in Nigeria seek
treatment is yet to be fully integrated. The PPMVs sell artemisinin combination therapies (ACTs) without prior testing
and are highly patronized. Without prior testing, malaria is likely to be over-treated. The need to expand access to
diagnosis in the huge informal private health sector among PPMVs is currently being explored to ensure that clients that
patronize retail drug stores are tested before sales of ACTs.
Methods: A cross-sectional multistage study was conducted among 1279 adult clients, 20 years and above, who purchased
malaria medicines from 119 selected PPMVs in five administrative areas (States) of Nigeria, namely: Adamawa, Cross
River, Enugu, Lagos and Kaduna, as well as the Federal Capital Territory, Abuja. Exit interviews using a standard case
report questionnaire was conducted after the purchase of the antimalarial medicine and thick/thin blood smears from
the clients’ finger-prick were prepared to confirm malaria by expert microscopy.
Results: Of the 1279 clients who purchased malaria medicines from the PPMV outlets, 107 (8.4%) were confirmed to
have malaria parasites. The malaria prevalence in the various study areas ranged from 3.5% to 16%. A high proportion of
clients in the various study sites who had no need for malaria medicines (84%-96.5%) purchased and used antimalarial
medicines from the PPMVs. This indicated a high level of over-treatment and misuse of antimalarials. Common
symptoms that are widely used as indicators for malaria such as, fever, headache, and tiredness were not significantly
associated with malaria. Nausea/vomiting, poor appetite, chills, bitter taste in the mouth and dark urine were symptoms
that were significantly associated with malaria among the adult clients (P<.05) but not fever (P=.06).
Conclusion: Misuse of ACTs following overtreatment of malaria based on clinical diagnosis occurs when suspected cases
of malaria are not prior confirmed with a test. Non-testing before sales of malaria medicines by PPMVs will perpetuate
ACT misuse with the patients not benefiting due to poor treatment outcomes, waste of medicines and financial loss from
out-of-pocket payment for unneeded medicines.