Abstract:

Background: Malaria remains a significant public health challenge, in tropical regions, impacting over 247 million individuals globally and resulting in more than 619,000 fatalities each year. Tanzania ranks third among highly burdened countries, with over 69% of individuals practicing self-medication with antimalarial drugs. Despite the widespread practice of self-medication, research focusing on adherence to leaflet dosing instructions remains scarce in Tanzania.

Methodology: A household-based analytical cross-sectional study was conducted among 600 adults residing in Kibondo district between December 2023 and February 2024. The IBM SPSS® version 25 software was used to analyze data, and univariate analysis and multivariate logistic regression were conducted to identify factors.

Results: The study recruited 600 adult residents of Kibondo district. Approximately two-thirds of the participants (378/600 (63.0%) were females, with a median age of 36 years (interquartile range, IQR=25-75). The majority of participants (285/600 (47.5%) had attained primary education, and farming was the primary occupation for more than half of the participants (391/600 (65.2%). Self-medication was practiced by two-thirds of the participants (404/600 (67.3%). The most common source of drugs used without a prescription was the pharmacy (209/404 (51.7%). Sulfadoxine-pyrimethamine (SP) was the most frequently used antimalarial drug, utilized by over two-thirds of the participants (280/404 (69.3%), followed by artemether-lumefantrine (ALU) (119/404 (29.5%).

Several factors significantly influenced self-medication behavior, including the use of ALU (adjusted odds ratio [aOR]=0.41, 95% confidence interval [CI] 0.28-0.60, p<0.001), availability of antimalarial drugs at the health facilities (aOR=0.55, 95% CI 0.35-0.86, p=0.008), and shorter waiting times for consultation (aOR=0.35, 95% CI 0.-0.60, p<0.001).
Lastly, participants who reported using ALU for self-medication were less likely to adhere to leaflet instructions (odds ratio [OR]=0.008, 95% CI 0.004-0.019, p<0.001) compared to those who reported using other drugs.

Conclusion: The high prevalence of self-medication underscores a concerning lack of awareness and understanding among individuals regarding the appropriate usage of these medications and the dangers associated with their misuse. These findings emphasize the critical necessity for urgent public health interventions aimed at addressing antimalarial drug resistance, particularly in high-risk border areas. Moreover, it was observed that long waiting hours and unavailability of antimalarial drugs were the leading factors towards self-medication. Therefore, it is essential to enhance the healthcare environment to ensure that patients experience minimal inconvenience, ultimately leading to a decrease in self-medication rates.

Keywords: Antimalarial drugs, self-medication, leaflet instructions, Tanzania