Self-medication as a factor in treatment failure in patients treated for malaria with ACTs in a rural community of Enugu State, Southeast Nigeria


  • Emmanuel I. Umegbolu Outpatient Department, General Hospital Oji River, Enugu State, Nigeria
  • Nwachukwu C. Ugwunna Department of Community Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Nigeria
  • David C. Ikwuka Department of Human Physiology, Faculty of Basic Medical Sciences, Nnamdi Azikiwe, University Nnewi, Nigeria



Self-medication, Treatment failure, Triple ACT, Drug cycling, Antimalarial


Background: Self-medication (SM) is the taking of drugs, herbs or home remedies on one’s own initiative, or following the advice of another person, without consulting the doctor. Drugs that are prone to SM include analgesics, antibiotics, cough syrups, and antimalarials. Treatment failure (TF) in malaria is defined as the inability to clear malarial parasitaemia or resolve clinical symptoms despite administration of an antimalarial medicine. Among other factors, SM has been implicated as a cause of TF. The study aimed to determine the role of SM in TF observed in patients treated with artemisinin-based combination therapies (ACTs) and the strategies employed to tackle this problem.

Methods: 172 patients diagnosed with malaria within the period of the study, were interviewed and 102 of them who engaged in SM with ACTs prior to presentation to the hospital were purposively selected. Data were collected over a period of one month (January 2021) and analysed as descriptive statistics of proportion.

Results: Prevalence of SM among the patients diagnosed with malaria was 59%, and TF in those who engaged in SM 99%. 100% cure rate was recorded using modified triple ACT (TACT) and drug cycling with chloroquine tablets.

Conclusions: The prevalence of SM was 59%, TF 99% and cure rate with modified TACT and drug cycling 100%. The drug regulatory body needs to ensure quality assurance of the ACTs used in the country, and in addition, promote patient education on the adverse effects of irrational SM.




Hernandez JM, Job QJR. Dentistry and self-medication: a current challenge. Med Oral. 2002;7:344-7.

World Health Organisation. The role of the pharmacist in self-care and self-medication. Hangue: WHO;1998.

World Self-medication Industry. WSMI declaration on self-care and self-medication, 2006a. Available at: . Accessed on 9 January 2021.

Almasdy D, Sharrif A. Self-medication practice with nonprescription medication among university students: a review of literature. Arch Pharm Pract. 2011;2:95-100.

Patil AD. Self-medication: a potentially avoidable cause of antibiotic nuisance and resistance. Int J Bas Clin Pharmocol. 2013;2:498-99.

Bennadi D. Self-medication: a current challenge. J Bas Clin Pharmacol. 2014;5(1):19-23.

Phalke VD, Phalke DB, Durgawale PM. Self-medication practices in rural Maharashtra. Ind J Com Med. 2006;31:34-5.

Sarahroodi S, Maleki-Jamshid A, Sawalha AF, Mikaili P, Safacian L. Pattern of self-medication with analgesics among Iranian University students in Central Iran. J Fam Com Med. 2012;19(20):125.

Jalilian F, Hazavehei SMM, Vahidinia AA, Jalilian M, Moghimbeigi A. Prevalence and related factors for choosing self-medication among pharmacies visitors based on health belief model in Hamadan Province, West of Iran. J Res Health Sci. 2013;1391:81-5.

Osemene KP, Lamikanra A. A study of the prevalence of self-medication practice among university students in Southwest Nigeria. Trop J Pharm Res. 2012;11(4):683-9.

James D, French H. The development of the self-medicating scale (SMS): a scale to measure people’s belief about self-medication. Pharm World Sci. 2008;30:794-800.

Ren J, Kan H, Duan G. Present situation, problems, countermeasures and suggestions of self-medication. China Pharm. 2016;27:4888-90.

Fuentes AK, Villa ZI. Analysis and quantification of self-medication patterns of customers in community pharmacies in southern Chile. Pharm World Sci. 2008;30:863-8.

Bertoldi AD, Carmago AL, Silveira MP, Merezes AM, Assunҫāo MC, Gonҫalves H et al. Self-medication among adults aged 18 years: the 1993 Pelotas birth cohort study. J Adolesc Health. 2014;55:175-81.

Balbuena F, Aranda A, Figueras A. Self-medication in older urban Mexicans: an observational, descriptive, cross-sectional study. Drugs Aging. 2009;26:51-60.

World Health Organisation. Global report on antimalarial drug efficacy and drug resistance: 2000-2010. Geneva: WHO. 2010.

van Hensbroek MB, Morris-Jones S, Meisner S, Jaffar S, Bayo L, Dackour R et al. Iron but not folic acid, combined with effective antimalarial therapy provides haematologic recovery in African children after falciparum malaria. Trans R Soc Trop Med Hyg. 1995;89:672-6.

Bloland PB. Drug resistance in malaria. Switzerland: WHO. 2001.

Schapira A, Almeida FLT, Averkiev L, Omawale SJF, Suleimanov G. The Plasmodium falciparum chloroquine in vivo test: extended follow-up is more important than parasite counting. Trans R Soc Trop Med Hyg. 1998;82:39-43.

World Health Organisation. World malaria report. Geneva: WHO. 2018.

Ouija M, Augerean JM, Paloque L, Benoit-Vical F. Plasmodium falciparum resistance to artemisinin-based combination therapies: a sword of Damocles in the path toward malaria elimination. Parasite. 2018;25:24.

Newton PN, Hanson K, Goodman C. Do antimalarials in Africa meet quality standards? The market penetration of non-quality-assured artemisinin combination therapy in eight African countries. Mal J. 2017;16:204.

Tindana P, de Haan F, Amaratunga C, Dhorda M, van der Pluijm RW, Dondorp AM et al. Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical considerations. Mal J. 2021;20:19.

Nsanzabana C. Resistance to artemisinin combination therapies (ACTs): do not forget the partner drugs! Trop Med Inf Dis. 2019;4:26.

Pluncki MM, Talundzic E, Morton L, Dimbu PR, Macaia AP, Fortes F et al. Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for treatment of uncomplicated malaria in children in Zaire and Uige provinces, Angola. Antimcrob Agents Chemother. 2015;59:437-43.

Pluncki MM, Dimbu PR, Macaia AP, Ferreira CM, Samutondo C, Quivinja J et al. Efficacy of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for treatment of uncomplicated Plasmodium falciparum malaria in Angola 2015. Mal J. 2017;16:62.

World Health Organisation. World malaria report. Geneva: WHO. 2017.

Ajayi NA, Ukwaja KN. Possible artemisinin-based combination therapy-resistant malaria in Nigeria: a report of the cases. Rev Soc Bras Med Trop. 2013;46(4):525-7.

Ebohon O, Irabor F, Ebohon LO, Omoregie ES. Therapeutic failure after regimen with artemether-lumefantrine combination therapy: a report of three cases in Benin City, Nigeria. J Braz Soc Trop Med. 2019;52:20190163.

Tun KM, Jeeyapant A, Miyint AH, Kyaw ZT, Dhorda M, Mukaka M et al. Effectiveness and safety of 3 and 5 day courses of artemeter-lumefantrine for the treatment of uncomplicated falciparum malaria in an area of emerging artemisinin resistance in Myanmar. Mal J. 2018;17:258.

Worldwide Antimalarial Resistance Network (WWARN) AL Dose Impact Study Group. The effect of dose on the antimalarial efficacy of artemether-lumefantrine: systematic review and pooled analysis of individual patient data. Lancet Inf Dis. 2015;15:692:702.

Kloprogge F, Workman L, Borrumann S, Telele M, Lefevre G, Hamed K et al. Artemether-lumefantrine dosing for malaria treatment in young children and pregnant women: a pharmacokinetic-pharmacodynamic meta-analysis. PLoS Med. 2018;15:e1002579.

Ursing J, Rombo L, Bergqvist Y, Rodrigues A, Kofoed P-E. High-dose chloroquine for treatment of chloroquine-resistant Plasmodium falciparum malaria. J Infect Dis. 2016;213:1315-21.

Dipanjan B, Shivaprakash G, Balaji O. Triple combination therapy and drug cycling-tangential strategies for countering artemisinin resistance. Curr Infect Dis Rep. 2017;19-25.

Dini S, Zaloums S, Cao P, Price RN, Fowkes FJI, van der Pluijm RW et al. Investigating the efficacy of triple artemisinin-based combination therapies for treating Plasmodium falciparum malaria patients using mathematical modelling. Antimicrob Agents Chemother. 2018;62:e01068-18.

Okell LC, Reiter LM, Ebbe LS, Baraka V, Bisanzio O, Watson OJ. Emerging implications of policies on malaria treatment: genetic changes in Pfmdr-1 gene affecting susceptibility to artemether-lumefantrine and artesunate-amodiaquine in Africa. BMJ Glob Health. 2018;3:e00099.

Kuriachan KE, George GS, Cherian J, CheriyanSM, Paul L. A cross-sectional study on the prevalence of self-medication practices and its associated factors among housewives in rural areas of Emakulan district. J Evol Med Dent Sci. 2016;5(46):3009-13.

Shalfie M, Eyasu M, Muzeyin K, Worku Y, Martin-Aragon S. Prevalence and determinants of self-medication practice among selected households in Addis Ababa community. PLoS One. 2018;13(3):e0194122.

Zeid W, Hamed M, Mansour N, Diab R. Prevalence and associated risk factors of self-medication among patients attending El-Mahsama family practice centre, Ismaila, Egypt. Bull Nat Res Centre. 2020;44:92.

Ahmed NM, Sulaiman KH. Self-medication practice among patients attending a sample of primary healthcare centres in Erbil City. J Edu Pract. 2016;7(24):73-9.




How to Cite

Umegbolu, E. I., Ugwunna, N. C., & Ikwuka, D. C. (2021). Self-medication as a factor in treatment failure in patients treated for malaria with ACTs in a rural community of Enugu State, Southeast Nigeria. International Journal Of Community Medicine And Public Health, 8(12), 5765–5770.



Original Research Articles