Assessment of Prescribers’ Knowledge, Diagnostic Decision-Making, and Rational Antimalarial Drug Use in the Management of Uncomplicated Malaria in the Buea Health District, Cameroon

Abstract

Malaria remains a leading cause of morbidity and mortality in Cameroon. The national policy, aligned with WHO guidelines, mandates parasitological confirmation via microscopy or Rapid Diagnostic Tests (RDTs) before treatment with Artemisinin-based Combination Therapy (ACT) for uncomplicated malaria. However, the adherence to these guidelines at the point of care is often suboptimal. This study assessed the critical determinants of malaria case management by evaluating prescriber knowledge, diagnostic decision-making, and antimalarial drug use patterns in the Buea Health District. A descriptive cross-sectional study was conducted over four months (February to June 2017) in 31 public and private health facilities. Data were collected from 63 healthcare prescribers and a calculated sample of 323 patients using pre-tested, structured questionnaires. Data analysis was performed using SPSS, employing descriptive statistics and multivariate logistic regression, with a statistical significance level set at p < 0.05. The findings reveal a significant gap between policy awareness and implementation. While all prescribers demonstrated universal awareness of ACTs, knowledge depth was uneven; a significantly higher proportion of physicians knew three or more ACTs (51.6%) compared to nurses and midwives (0%, p < 0.001), highlighting a cadre-specific training deficit. Fever was the predominant diagnostic cue (23.1%). Despite a high stated preference for confirmatory testing (85.7% for RDTs, 79.4% for microscopy), persistent barriers like ACT stockouts (31.7%) and absence of trained personnel (15%) compromised this practice. Artemether-Lumefantrine was the preferred first-line treatment (68.3% of first-line prescriptions), yet its prescription adequacy was alarmingly low for children under five (53.7% for correct posology, 58.9% for correct duration), pointing to a major challenge in pediatric dosing. The reliance on clinical symptoms and the use of non-ACTs due to stockouts or patient refusal not only leads to mismanagement of non-malarial fevers but also exerts unnecessary selective pressure for drug resistance. This study underscores that effective malaria control requires moving beyond policy dissemination to address systemic barriers. Strengthening supply chains for diagnostics and ACTs, implementing targeted, continuous training for all prescriber cadres—with emphasis on pediatric dosing—and enhancing community sensitization are essential strategies to bridge the gap between policy and practice in the Buea Health District.