Why People Risk Non-Prescribed Drugs Despite Health Dangers
In the bustling Bolgatanga Municipality of northern Ghana, where malaria remains an ever-present threat, a quiet revolution in healthcare practices is unfolding—with potentially dangerous consequences. Imagine facing the familiar fever, chills, and body aches of malaria, but instead of visiting a health facility, you opt for medication from a local chemical seller or even use leftover drugs from a previous illness. This scenario plays out daily in communities across northern Ghana, where non-prescribed anti-malarial drugs have become a common, yet risky, solution to a perennial problem 1 .
A 2013 study conducted in this very region revealed that approximately 16.8% of malaria patients were treating themselves with non-prescribed medications, with the majority using older drugs that Ghana's health policy had already replaced with more effective alternatives 1 2 . This practice isn't just about individual health choices—it represents a complex web of accessibility, knowledge, social influence, and healthcare infrastructure that continues to challenge public health officials years after Ghana officially adopted the WHO-recommended artemisinin-based combination therapy (ACT) as its first-line malaria treatment 1 7 .
The implications extend far beyond individual treatment failures. When patients use incorrect medications, take improper dosages, or use outdated drugs, they potentially contribute to one of modern medicine's greatest threats: drug-resistant parasites 1 .
This article explores why residents of Bolgatanga municipality continue to gamble with non-prescribed anti-malarials, what this means for malaria control in Ghana, and how researchers uncovered this concerning public health issue.
Malaria remains a significant global health challenge, with the World Health Organization reporting an estimated 219 million cases and 660,000 deaths in 2010 alone—the majority in sub-Saharan Africa 1 . In response to growing resistance to traditional treatments like chloroquine, Ghana changed its national malaria policy in 2005, replacing single-drug therapies with artemisinin-based combination therapy (ACT), specifically artemether-lumefantrine and amodiaquine/artesunate 1 3 .
This move aligned with WHO recommendations that combining anti-malarial drugs with different modes of action improves efficacy, increases cure rates, and slows the development of drug resistance 1 .
In the context of the Bolgatanga study, "non-prescribed anti-malarial drugs" refer to medications not prescribed by a qualified health professional or community health volunteer. This includes:
The dangers of these practices include incorrect dosage, inappropriate medication for the specific malaria strain, and the potential for substandard or falsified drugs 1 .
Chloroquine and other single-drug therapies were the primary malaria treatments, but resistance was growing.
Ghana officially adopts WHO-recommended Artemisinin-based Combination Therapy (ACT) as first-line treatment.
Bolgatanga study reveals 16.8% of malaria patients still using non-prescribed medications, many outdated.
Challenges persist with self-medication and adherence to "Test, Treat, and Track" policy 9 .
To understand the extent and underlying factors of non-prescribed anti-malarial use, researchers conducted a cross-sectional survey in 2013 involving 392 adults and children who had experienced malaria episodes in the four weeks preceding the study 1 2 . The study employed a rigorous three-stage sampling technique to ensure representative data:
Trained interviewers administered questionnaires covering participants' knowledge about malaria causes, symptoms, treatment, and prevention, plus their experiences with their most recent malaria episode—including where care was sought, type of medication taken, source of medication, and influences on treatment decisions 1 .
Bolgatanga Municipality, located in Ghana's Upper East Region, covers 729 square kilometers with a population of 152,658 1 . The region experiences a tropical climate with distinct rainy (May-October) and dry (November-April) seasons. Despite having two hospitals, six health centers, six clinics, and 14 Community Health Planning Services (CHPS) compounds, the municipality also contains several underserved areas with poor housing conditions and inadequate drainage systems that foster mosquito breeding 1 .
The study revealed that 16.8% of respondents used non-prescribed anti-malarial drugs for their most recent malaria episode 1 2 . Perhaps more concerning was the finding that about 56% of these self-medicating patients used non-artemisinin combination therapies, including chloroquine, artemether, amodiaquine, and sulphadoxine-pyrimethamine—medications that Ghana had officially replaced with ACT due to effectiveness concerns 1 .
Figure: Initial treatment actions for malaria episodes in Bolgatanga
The research identified several key factors that significantly influenced whether individuals would self-medicate with anti-malarials:
Respondents who knew the appropriate source for malaria treatment were less likely to use non-prescribed medications 1
Those influenced by people around them using non-prescribed anti-malarials were significantly more likely to engage in the practice themselves 1
| Factor | Impact on Likelihood | Statistical Significance |
|---|---|---|
| Age over 5 years | Increased likelihood | P < 0.001 |
| Knowledge of correct treatment source | Decreased likelihood | P = 0.002 |
| Influence by others using non-prescribed drugs | 4.44x higher odds | P = 0.004 |
Malaria research relies on specialized reagents and methodologies to accurately diagnose, treat, and study the disease. The following table highlights essential tools referenced in the Bolgatanga study and related malaria research.
| Reagent/Method | Function and Importance | Context from Search Results |
|---|---|---|
| Rapid Diagnostic Tests (RDTs) | Enable quick confirmation of malaria parasites without sophisticated lab equipment | Noted as available in 29 of 30 health facilities in a 2025 Ghana study 9 |
| Artemisinin-based Combination Therapy (ACT) | WHO-recommended first-line treatment for uncomplicated malaria; combines fast-acting artemisinin with longer-lasting partner drug | Ghana switched to ACT in 2005; study found 44% of non-prescribed drugs were ACT 1 3 |
| WHO Reference Reagent (10/198) | Standardized human serum with anti-malarial antibodies used to harmonize immunological assays | Helps compare results across vaccine trials and epidemiological studies |
| Competition ELISA (cELISA) | Laboratory method to measure antibody responses against malaria antigens | Used with WHO reference reagent to assess cross-reactive antibodies 4 |
| Microscopy | Traditional gold standard for malaria diagnosis using blood smears | Used alongside RDTs in health facilities for malaria confirmation 9 |
Malaria diagnosis has evolved from traditional microscopy to include rapid diagnostic tests (RDTs) that provide results in minutes without laboratory infrastructure. These tools are essential for implementing WHO's "Test, Treat, and Track" policy 9 .
Artemisinin-based Combination Therapy (ACT) remains the gold standard for uncomplicated malaria treatment. However, research continues into optimizing dosing regimens based on pharmacogenetic variations that affect drug metabolism 3 .
The findings from Bolgatanga reflect broader challenges in Ghana's malaria treatment landscape. A 2025 study evaluating adherence to WHO's "Test, Treat, and Track" (T3) policy across Ghana revealed that while testing and treating had improved, patient tracking remained inadequate 9 . This missing component potentially contributes to continued self-medication practices, as patients may not receive proper follow-up to ensure complete recovery.
The 2025 study also found significant regional disparities, with health facilities in southern Ghana having nearly three times higher odds of adhering to the T3 policy compared to those in the middle zone 9 . This geographical inequality in healthcare quality may further drive patients toward non-prescribed alternatives in underserved regions.
The practice of non-prescribed treatment extends beyond conventional pharmaceuticals. A 2017 study investigating Ghanaian herbal anti-malarial products found high patronage, with five top products demonstrating chemo-suppressive activity against malaria parasites in animal studies 5 . However, researchers discovered that two of these preparations contained chloroquine or chloroquine-like compounds, revealing concerning adulteration practices that could contribute to drug resistance 5 .
The discovery of conventional drugs in herbal preparations highlights the complex interplay between traditional and modern medicine, and the risks of unregulated treatment markets.
Recent research has also explored why anti-malarial treatments may vary in effectiveness between individuals. A 2024 study found that pharmacogenetic variations in genes encoding drug-metabolizing enzymes (CYP2B6 and CYP3A5) can significantly affect plasma concentrations of artemether-lumefantrine and its metabolites 3 . This emerging understanding may eventually help explain some treatment failures and optimize dosing regimens for different populations.
The use of non-prescribed anti-malarial drugs in Bolgatanga and throughout Ghana represents a multifaceted public health challenge rooted in accessibility, knowledge, social influence, and systemic healthcare limitations. The Bolgatanga study's revelation that 16.8% of malaria patients use non-prescribed medications—most often less effective, non-ACT drugs—highlights the gap between national policy and ground-level practice 1 2 .
Addressing this issue requires more than simply enforcing regulations. As the research indicated, knowledge alone is insufficient—while most respondents understood malaria symptoms and transmission, this didn't always translate into appropriate treatment-seeking behavior 1 . Effective solutions must address the underlying drivers, including:
The battle against malaria is not just fought in laboratories and clinics, but in the daily choices of individuals and communities—making their safe access to effective treatment a public health priority.