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.

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 However, it was withdrawn from clinical practice in Nigeria in 2005 following a widespread of resistance cases reported in the public health domain. This study aims to ascertain the level of compliance with the policy on CQ withdrawal among patients, Patent and proprietary medicine vendors (PPMVs), Pharmacists and Physicians.<br>A cross-sectional survey involving both online and offline data collection 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 primary health centers and hospitals in the Anaocha community.<br>Our findings show that the patients were equally aware of what CQ is used for (χ² = 7.071, p = 0.215). However, significant disparities were observed in the knowledge, attitude, and perception of CQ resistance and its continual use among health professionals and PPMVs (χ² = 160.54 and 158.54, p = 0.000). Additionally, despite the chloroquine withdrawal policy in Nigeria, there was evident non-compliance among majorly PPMVs and other healthcare professionals. A few of patients continued to utilize CQ for malaria treatment and PPMVs were mostly likely to prescribe and stock CQ. <br>The study revealed that chloroquine use in Nigeria is still sustained notwithstanding the switch in the antimalarial drug policy from chloroquine to ACTs in 2005. Feasible implementation strategy through awareness program and campaign especially in the primary health centers across Nigeria and through associations such as Nigeria Association of Patent and Proprietary Medicine Dealers (NAPPMED), Pharmaceutical Society of Nigeria (PSN) and Nigeria Medica Association (NMA) is recommended.