Introduction:
Malaria has been a major global health issue for centuries. Pre
sently, the Artemisinin-based
combination therapy (ACTs) is the most effective antimalarial drug
and the recommended first line treatment by the
WHO for uncomplicated malaria cases. Despite the current global
reduction in malaria mortality and morbidity, the
burden of malaria is still very significant, especially considering
the economic, social, political and public health
effects to endemic countries. A major threat to sustaining the re
duction in malaria burden is the development and
spread of resistance to antimalarial drugs by the Plasmodium parasit
es (mostly
P. falciparum
and
P. vivax
).
Socioeconomic factors have been identified to affect antimalari
al drug use behaviours. Nevertheless, the
contributions of socioeconomic factors to antimalarial drug use be
haviours have only been sparsely reported in
studies; with most of the studies not primarily designed to id
entify or assess the association of these variables. In
addition there is no existing systematic review of studies on th
e socioeconomic determinants of antimalarial drug
use. Therefore, there is an important need for a systematic review
to integrate the findings from the different primary
studies so as to provide an insight into the interaction bet
ween these variables.
Methods
Search:
A systematic search of literature on the socioeconomic factors associate
d with antimalarial drug use
behaviours was conducted in May, 2015. The following datab
ases were searched: PubMed, EMBASE, Sociological
Abstracts, Biomedical and Science Direct. A hand search was also conduct
ed. Appraisal of the studies was
conducted using the Principles of Critical Appraisal for Quantit
ative Studies (PCAQS) recommended by the
Cochrane Library.
Synthesis:
This study adopted a narrative approach in synthesising the resul
ts from individual included studies
using a vote count table. This approach was the ideal for i
ntegrating the data considering the type of data extracted
from the studies and the need to achieve the aim of this revi
ew.
Results:
The synthesis of the findings from all the studies revealed d
ifferent socioeconomic factors reported in
relation to antimalarial drug use behaviours. These socioeconomi
c actors were categorized into Educational level
(10 studies); Level of income/wealth (6 studies); Type of settle
ment (3 studies); Ability to read (2 studies);
Occupation/Source of income (2 studies); and Household size (1 stud
y). These factors were reported in line with
antimalarial drug use behaviours such as non-adherence (12 studies);
self-medication/presumptive diagnosis (5
studies) and non-compliance with malarial treatment guideline
(4 studies). Educational level and income were the
most reported socioeconomic factors. Most of the studies reported a si
gnificant relationship between higher
educational level and adherence.
Discussion:
Educational level was the most reported socioeconomic factor in re
lation to antimalarial drug use
behaviours. This relationship between educational level and
antimalarial drug use is further explained when one
considers the level of poor education in some of the malaria e
ndemic areas where there have been widespread of
resistance to antimalarial drugs in the past. As a key socioeconomic
factor, educational level has the ability to
influence other socioeconomic factors. Some of the reasons given by
participants for non-adherence (such as
saving drugs for future use, sharing drugs, no food to administe
r drugs) as reported in some of the studies reviewed
are less likely to occur among individuals of high socioeconomic sta
tus. There is need to integrate the concept of
socioeconomic development in the design of strategies and poli
cies to control antimalarial drug resistance.