malaria is a major public health problem with 300500 million new infections each year and an estimated 584,000 deaths from malaria were reported worldwide , with most ( 90% ) of the deaths occurring in africa .
the decline of susceptibility of plasmodium falciparum to chloroquine and sulfadoxine - pyrimethamine in many high - transmission areas resulted in the change of drug use policy in africa . in democratic republic of congo ( drc ) , current recommendation therapy for severe malaria in drc is artemisinin - based combination therapy ( act ) ; mainly , artesunate - amodiaquine has been recommended formally as a first - line antimalarial regimen since 2005 .
however , this policy is not controlled and the use of antimalarials without a prescription can have adverse effects on chemosensitivity in kinshasa , the drc .
the aim of the present study was to assess the self - medication against malaria infection in population of congolese students living in kinshasa , drc .
this cross - sectional study was carried out in university of kinshasa , kinshasa , drc .
medical records of all students with malaria admitted to centre de sant universitaire ( csu ) of university of kinshasa from january 1 , 2008 , to april 30 , 2008 , were reviewed retrospectively .
csu is a primary level centre located in the city of university of kinshasa , kinshasa , drc , and serving an estimated 30,000 students .
students who experienced an episode of malaria and presented the following criteria , axillary temperature > 38.0c with positive plasmodium falciparum parasites in thick blood smears and absence of febrile conditions caused by diseases other than malaria , were included in this study . students who took an antimalarial
malaria parasitaemia was confirmed with thick blood smears stained giemsa and examined for trophozoites of plasmodium falciparum .
the following information was collected and analyzed : ( 1 ) age and gender and ( 2 ) nature , dosage , and duration of antimalarial treatment .
statistical analysis was performed using the statistics software spss for windows ( 15.0 spss , chicago ) .
data are represented as means  sd when the distribution was normal and median with range when the distribution was not normal .
frequencies of different parameters of self - medication are expressed as proportions ( % ) .
during the study period , 458 students had been admitted in our centre and 133 ( 29.0% ) had a diagnostic of malaria infection .
the median age of the patients was 25.4 years ( range : from 18 to 36 years ) .
self - medication was associated with the ingestion of artemisinin - based combination treatments ( acts ) in 14 cases ( 50% ) , sulfadoxine / pyrimethamine ( sp ) in 9 cases ( 32.1% ) , and quinine in 5 cases ( 19.9% ) .
to our knowledge , the present study is the first attempt to examine the notion of self - medication with antimalarials drugs in a university of central africa . in kinshasa , malaria is highly endemic , stable with a perennial transmission .
university of kinshasa is located in one of four districts of kinshasa , district of mont amba in the west region of this urban area .
prevalence of anopheles gambiense was higher than that in other districts of the town [ 69 ] . in this report
this high figure shows the existence of a gap in the health care system including the freedom to buy drugs without prescription in pharmacies .
recent study in drc reported parasite genotyping which showed high frequencies of dihydrofolate reductase ( dhfr ) and dihydropteroate synthase ( dhps ) molecular sp - resistance markers , with 57% of the samples showing more than three mutations linked to sp resistance .
self - medication with quinine was found in 20% of students . in national health care policy
this rate is high for a molecule reserved for severe disease in congolese health care policy in management of malaria .
a recent study supports our concerns and shows the appearance of an intermediate level of resistant forms to amino alcohols in the city of kinshasa compared with other areas of africa . in the drc
however , with an important self - medication , surveillance of efficacy of these drugs becomes a necessity since here there are recent concerns that the efficacy of such therapies has declined on the thai - cambodian border . in our series ,
50% of students used acts in self - medication . in comparison with our general population , fever treatment with acts
another crucial health problem is counterfeit antimalarials , mainly act and sulfadoxine - pyrimethamine in developing countries as democratic republic of congo .
this situation increases the risk of artemisinin and sp resistance developed by the use of subtherapeutic dosage of these drugs .
self - medication remains an important public health problem in high school students of kinshasa .
the recommendations of the national program against malaria are not sufficiently known in these communities .
this should draw the attention of all partners involved in the fight against malaria in drc .
the academic community should be a priority target for the information campaign about the disease and the dangers of self - medication and risk - taking counterfeit drugs .
training and information actions must be reinforced for a better care of malaria and to preserve efficacy and safety of acts and quinine in drc .
 
 aim . to assess the self - medication against malaria infection in population of congolese students in kinshasa , democratic republic of congo ( drc ) 
 . methods . 
 a cross - sectional study was carried out in university of kinshasa , kinshasa , democratic republic of congo . 
 medical records of all students with malaria admitted to centre de sant universitaire of university of kinshasa from january 1 , 2008 , to april 30 , 2008 , were reviewed retrospectively . 
 results . 
 the median age of the patients was 25.4 years ( range : from 18 to 36 years ) . 
 the majority of them were male ( 67.9% ) . 
 artemisinin - based combination treatments ( acts ) was the most used self - prescribed antimalarial drugs . 
 however , self - medication was associated with the ingestion of quinine in 19.9% of cases . 
 no case of ingestion of artesunate / artemether in monotherapy was found . 
 all the medicines taken were registered in drc . in this series , 
 self - prescribed antimalarial was very irrational in terms of dose and duration of treatment . conclusion . 
 this paper highlights self - medication by a group who should be aware of malaria treatment protocols . 
 the level of self - prescribing quinine is relatively high among students and is disturbing for a molecule reserved for severe disease in congolese health care policy in management of malaria . 
1. Introduction
2. Population and Methods
3. Results
4. Discussion