There have been several studies on the knowledge of ACT among communities and health workers in sub-Saharan Africa [12–16] and their use can be successfully integrated into the malaria home management programme [13]. However a study in Nigeria [14] revealed that a significant number of community members have no knowledge of ACT, though they could have been treated with ACT. This study adequately demonstrates some level of knowledge of ACT among community members that were involved in this study. The challenge about knowledge is the ability of discussants/respondents to mention the name of the actual ACT that they mean. This call for the need for national malaria programme managers to come out with short names or abbreviated versions of names of ACT. Community members should be adequately educated on this abbreviated versions or short names to enhance its usage. Disposition related to medicine use vary among communities. They are either negative or positive. Whilst a study in Malawi recorded positive disposition about use of artemether–lumefantrine [15], this study recorded some negative experiences by community members who used Ghana’s first-line malaria treatment, artesunate–amodiaquine. Some of the negative experiences were dizziness, drowsiness, “body weaknessâ€. These experiences could create perceptions that may have negative consequence for the successful implementation of health programmes, as happened in Nigeria during a polio immunization campaign [16], if not properly managed.
Experiences of patients and community level interpretation of the use of medication has the tendency to foster continuous use of such medicines or rejection. In a study to assess the barriers to malaria mass drug administration [17], it was revealed that fears of perceived side effects such as dizziness, stomach ache and the quantity of medicines that needed to be taken contributed to poor adherence. Women who intended to get pregnant refused and the state of their pregnancy also contributed to the refusals. This study recorded similar findings. Respondents indicated that they feel dizzy when they take ACT. A minority group of respondents cited specific group of people such as pregnant women children and diabetics as people who should not take ACT. This position was not corroborated by Dial et al. [17]. Though this perception was held by a minority group, it is likely that women and children who are at risk may be discouraged from taking ACT. This could lead to poor treatment outcomes. National malaria control programme managers should strengthen education on adherence to curtail this misconception. Another study [18] on adherence and uptake of ACTS in northern Ghana also did not indicate the caliber of people that must not take ACTs. In light of the effects these may have on compliance, experiences in the malaria control efforts studies have come up with some suggestions. A study in Tanzania [19] suggested incorporating local beliefs and practices surrounding use of anti-malarials into programmatic goals to significantly improve uptake malaria control interventions. In Malawi [15], caregivers deliberately altered dosing regimens of artemether–lumefantrine and dihydoartemisinin–piperaquine depending on whether they perceived the medication to be strong or weak. The study by Eving et al. [15] suggested further optimization of anti-malarial adherence among children, with the development of anti-malarials with pharmacological properties that allow user-friendly administration with easy and simplified dosing schedules.
The use of herbal preparations in treatment of diseases is a well-documented phenomenon in many parts of Africa [20–24]. Ethno pharmacological studies on the use of herbal remedies for malaria in Ghana [25] concluded that the use of herbal remedies to treat malaria was a common practice. This study also documents the continual use of herbal preparations in treating malaria. Many unexpected health problems could arise if this not checked and properly managed. Sometimes, doses are not too clear to the end user, chemical composition and toxicity effects are also not clearly documented. These and other contributory factors could make end users vulnerable to other health problems that may lead to fatalities including deaths.
Treatment practices including self-medication with anti-malarials has been widely reported in many parts of Africa [26–31], reasons cited were health facilities challenges such as shortages of medicines, long waiting time, perceived quality of services, location of facilities and distance from homes, inability to pay for health care costs, and lack of freedom to choose medicines of their choice [27, 32]. Drug shops still remain one of the significant sources of anti-malarials distributed to communities [26]; though the main source of anti-malarials, the knowledge of those in-charge of the drug shops was not satisfactory when it comes to malaria case management and other diseases as previously documented [26]
Also, the findings on malaria diagnosis and treatment practices corroborates the fact that, the lack of laboratories and malaria test kits in lower health facilities are the major setback in the diagnosis and treatment of malaria in Ghana. As regards the WHO malaria treatment guidelines [33] adopted by Ghana suspected malaria cases are to be tested and confirmed before malaria drugs are prescribed. There are efforts by the Ghana Health Services to supply malaria test kits to health centres but the supply has been erratic
The categories of health staff in rural health facilities play a major role in the health delivery process. The absence of qualified staff serves as a big disincentive to rural and deprived communities. Their continuous presence in the health facilities and how easily they are accessible contributes immensely to the timely provision of cure for ailments including uncomplicated malaria. The finding on the category of staff in health facilities in this study is in agreement with findings from a systematic review on motivation and retention of health staff in rural communities in developing countries [34]. The review emphasized that, health worker retention is therefore critical for health system performance and efforts must be put in place to ensure their motivation [34].