News: The problem of overtreatment: why antimalarials are being used by malaria-negative patients

Photo: scottgunn/Flickr licensed under CC BY-NC 2.0

25/04/2018

According to the latest World Malaria Report, recent progress against malaria stalled between 2015 and 2016, while aid from the international community is on the decline. In such an environment, it is critical to ensure that precious resources - particularly antimalarial medications – are appropriately targeted to the patients who truly need them. In recognition of World Malaria Day, we would therefore like to call attention to the problem of overtreatment – the use of antimalarials by malaria negative patients. Reducing overtreatment makes more subsidised medication available for the truly sick, and is important for managing the threat of drug resistance.

Managing overtreatment is especially important in settings where prevalence rates are relatively low, but access to low-cost medication is high. For example, in recent research in Bamako, Mali, we verified the malaria status of acutely ill patients visiting public health centres and found that 58 per cent of malaria-negative patients received an antimalarial prescription from the doctor. This finding is not unique – similar rates of malaria overtreatment have been found in countries across Africa, and overtreatment with antibiotics and other drugs was documented in India, China, and many other countries.   

The main objective of our study was to unpack what causes these high rates of overtreatment. One reason may be that doctors convince malaria-negative patients to purchase antimalarials, perhaps because the doctors themselves aren’t aware of correct treatment protocols, or because they feel that they need to generate health facility revenues to secure their own and their staff’s salary. But another reason may be that doctors are simply responding to patients’ demand for antimalarials. In fact, over half the health providers we surveyed during our project reported feeling pressure to prescribe medications from patients.

Distinguishing between these two channels is very important for crafting effective malaria policy: in settings where patients drive overtreatment, interventions that make it easier for doctors to resist patient demands (like patient communication tools) could help sustain subsidies while limiting overtreatment. If it is doctors who drive overtreatment, an entirely different set of policy instruments is required, for example changing doctors’ financial incentives.

Our results are nearly ready to be made public, so stay tuned – we will blog about our findings in this space within the next few weeks.