Issues associated with malaria self-medication in sub-Saharan Africa: A systematic literature review and meta-analysis

Background. Malaria is a leading cause of death in sub-Saharan Africa, which is home to more than 90% of both cases and deaths globally. Self-medication with antimalarials is a common practice in the region, mainly due to high malaria endemicity, poverty, and difficulty in accessing services in formal settings. Malaria self-medication is implicated in the rising trend of antimalarial drug resistance which threatens decades of gains made in controlling the disease. Previous studies have somewhat itemised the reasons for malaria self-medication and the factors driving it but have not been able to estimate the overall prevalence of the practice and its dynamics over time regarding period, region and country.

Materials and Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic review of literature and meta-analysis on malaria self-medication in sub-Saharan Africa was conducted by searching PubMed, Cochrane Library, Web of Science, Scopus and Embase databases for relevant studies written in English and published up to 12th April, 2023, using a combination of different keywords derived from the main keywords (‘malaria’, ’self-medication’ and ‘sub-Saharan Africa’), broadening chances of retrieval by using Boolean operators ‘OR' and ‘AND’.

Results. Twenty-seven studies met the inclusion criteria and were included in the review, giving rise to a pooled prevalence of 55.3% for malaria self-medication. Factors driving self-medication with antimalarials in the region include low-income level, cheap availability of non-prescription drugs, large family size, lack of health insurance, difficulty in accessing healthcare in formal settings and previous satisfactory use of specific drugs.

Conclusion. Due to the underlying factors driving the practice, health authorities and regulatory agencies in sub-Saharan Africa should step up actions by incorporating stakeholders in the informal drug market into a framework that advocates for an enlightened use of antimalarial drugs in the management of the disease.