Antimalarial Self-medication among Adults during the COVID-19 National Lockdown in Northern Uganda: Implications for Antimicrobial Resistance. A cross-sectional study.

Background: The practice of self-medication is increasingly becoming a major health concern globally. In Uganda, there is documented evidence of self-medication, especially for common endemic illnesses such as malaria. This has individual and public health consequences, including drug misuse and resistance. We assessed the prevalence and factors associated with antimalarial self-medication among adults during the COVID-19 national lockdown in Lira district, Northern Uganda.  Methods: We conducted a mixed-method cross-sectional study among adults in Lira District, Uganda. A total of 315 participants selected using a systematic random selection method from the community were enrolled in the study. Quantitative data were collected using a researcher-administered questionnaire. Conditional logistics regression was used to analyse data. Results: A total of 315 participants were enrolled in the study. The prevalence of antimalarial self-medication was 80.6% (254/315). Artemether-lumefantrine (Coartem) was the most commonly used antimalarial drug (62.5%). Factors significantly associated with antimalarial self-medication included age 45–64 years (aOR=3.10, 95% CI: 1.29–7.44), secondary education (aOR=3.30, 95% CI: 1.11–9.85), waiting time of one hour or more at health facilities (aOR=9.10, 95% CI: 4.15–19.94), distance greater than 5 km to a health facility (aOR=2.05, 95% CI: 1.14–3.69), and lack of awareness about the dangers of self-medication (aOR=4.69, 95% CI: 2.06–10.70).  Conclusion: The prevalence of antimalarial self-medication among adults in Northern Uganda was high during the COVID-19 national lockdown and has the potential to worsen antimicrobial resistance. Health education messages about the dangers of self-medication, targeting the entire population, and improved access to health facilities could be enforced by the Uganda Ministry of Health and health partners. Recommendation: The Ministry of Health should strengthen regulation of drug outlets, increase supervision of private health facilities and pharmacies, and intensify public education on the dangers of self-medication with antimalarial drugs.