Use of pre-packaged chloroquine for the home management of presumed malaria in Malagasy children

Objective: The main objective of this study was to assess the quality of home malaria management with pre- packaged chloroquine in two areas in the Moramanga district of Madagascar. The knowledge, attitude and practices of care providers in terms of home treatment options were evaluated and compared. The availability of treatment options by studying retailers and community-based service providers was also investigated. Methods: A cross- sectional investigation in two communities, in the hamlets and villages located close to carers, retailers, community- based service providers and primary health centres was carried out. Results: Carers in the two districts were equally well aware of the use of pre- packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory ( 100%) with pre- packaged chloroquine and rarely satisfactory ( 1.6% to 4.5%) with non pre- packaged chloroquine. In cases of treatment failure, the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre- packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests ( P = 0.01) was significantly higher in children treated with non pre- packaged chloroquine ( 38%) than in children treated with pre- packaged chloroquine ( 1.3%). Conclusion: Home malaria management should be improved in Madagascar. Efforts should focus on communication, the training of community- based service providers, access to pre- packaged drugs and the gradual withdrawal of pre- packaged chloroquine and its replacement by prepackaged artemisinin- based combination therapies.