Over fifteen years of chloroquine withdrawal in Nigeria: a qualitative investigation into the execution of this policy by healthcare providers and amongst patients in a rural community.

<ns3:p>Background Chloroquine (CQ) was once an important drug used in malaria treatment especially due to its affordability, ease of use and high anti-malarial efficacy. However, it was withdrawn for the treatment of malaria in Nigeria in 2005 following a widespread of resistance cases reported locally and globally. This study aims to ascertain the level of compliance with the policy on CQ withdrawal amongst patients, Patent and proprietary medicine vendors (PPMVs), Pharmacists and Physicians. Method A cross-sectional survey involving both online and offline survey was carried out. A total of 582 participants were recruited and consisted of patients (N = 300), PMVs (N = 94), Physicians (N = 94), and Pharmacists (N = 94). Patients spanned across health services at the primary health centres and hospitals in the Anaocha community. Result 20.67% of patients still used CQ with patients from Adazi Enu accounting for most of these. 42.19% of healthcare providers still used CQ with PPMVs accounting for most of this proportion. The knowledge of CQ resistance amongst the patients increased the odds of CQ use with an OR of 4.39. Pharmacists and physicians were less likely to use CQ, while the knowledge of CQ resistance reduced the odds of using CQ amongst the healthcare providers (OR = 0.08). However, the inability of PPMVs to adhere to the discontinuation of CQ usage was due to their poor knowledge of CQ resistance and the CQ withdrawal policy amongst other inadequacies. Conclusion The study revealed that chloroquine use in Nigeria is still sustained notwithstanding the switch in the antimalarial drug policy to ACTs in 2005. Strategies focussing on public health education and contextual education of healthcare providers especially the PPMVs through the Nigeria Association of Patent and Proprietary Medicine Dealers (NAPPMED) is required. Continued professional education of pharmacists and physicians is recommended.</ns3:p>