Self-Medication Practices with Antimalarial Drugs among Under-five Children attending Muhimbili National Hospital in Tanzania

Abstract Background Self-medication with antimalarial drugs among children may contribute to inappropriate treatment of febrile illness, antimalarial drug resistance and unwarranted drug side effects. However, evidence on self-medication with antimalarials among children under five years in Tanzania is limited. This study assessed the prevalence of antimalarial self-medication and associated factors among children under five years attending Muhimbili National Hospital, Tanzania. Methods A hospital-based cross-sectional study was conducted among caregivers of children under five years attending the paediatric outpatient clinic at Muhimbili National Hospital between April and June 2023. Caregivers were recruited using convenience sampling and interviewed using a structured questionnaire. Antimalarial self-medication was defined as use of an antimalarial drug for the child without consultation with a healthcare provider. Associations between participant characteristics and self-medication were assessed using logistic regression adjusting for key confounders; p values < 0.05 was considered statistically significant. Results Of 385 enrolled children, the estimated prevalence of antimalarial self-medication in the preceding six months was 14.7% (95% CI 11.2–19.2) using multiple imputation; among 340 children with complete data, 49 (14.4%) had been self-medicated. Artemether-lumefantrine was the most commonly used antimalarial, accounting for 47/49 (95.9%) of reported cases of self-medication. Pharmacies were the most common source of antimalarial drugs 42 (85.7%). The most frequently reported reasons for self-medication were receiving advice to self-medicate 23 (46.9%) and proximity to a pharmacy 19 (38.8%). In multivariable analysis, older child age was independently associated with antimalarial self-medication (adjusted odds ratio [aOR] 1.03, 95% CI 1.01–1.05; p = 0.01). Children with health insurance, caregiver education, and number of children were not independently associated with self-medication. Conclusion Antimalarial self-medication occurred among a sizeable proportion of children attending a tertiary hospital in Tanzania, with artemether-lumefantrine accounting for most reported use. Advice to self-medicate and accessibility of pharmacies were commonly reported factors, highlighting the importance of interventions addressing caregiver treatment decisions and engagement with medicine outlets. Strengthening access to appropriate malaria assessment and reinforcing rational antimalarial use may help reduce inappropriate self-medication among under-five children, minimising the risk of suboptimal treatment and potentially contributing to efforts to prevent antimalarial drug resistance.