Research article

A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria

Ikeoluwapo O Ajayi¹ , Catherine O Falade² , Benjamin O Olley¹ , Bidemi Yusuf¹ , Sola Gbotosho¹ , Toyin Iyiola³ , Omobola Olaniyan⁴ , Christian Happi¹ , Kaendi Munguti⁵ and Franco Pagnoni⁶

¹Malaria Research Laboratories, Institute of Medical Research and Training, College of Medicine, University of Ibadan, Nigeria

²Department of Pharmacology & Therapeutics, College of Medicine, University of Medicine, University of Ibadan, Ibadan, Nigeria

³Ministry of Health, Oyo State, Nigeria

⁴Primary Health Care Unit, Ona-Ara Local Government, Oyo State, Nigeria

⁵Institute for Development Studies, College of Humanities and Social Studies, University of Nairobi, Nairobi, Kenya

⁶Implementation Research & Methods Unit, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland

author email corresponding author email

BMC Health Services Research 2008, 8:119doi:10.1186/1472-6963-8-119

Published:	1 June 2008

Abstract

Background

In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use.

Methods

A before and after qualitative study using key informant interviews (KII) and focus group discussions (FGDs) was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs) were trained in each village to dispense artemeter-lumenfantrine (AL) to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers.

Results

None of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised.

Conclusion

Our findings showed that the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.