{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:49:51Z","timestamp":1773316191048,"version":"3.50.1"},"reference-count":85,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malaria remains a significant public health challenge in Nigeria, accounting for substantial morbidity, mortality, and economic loss. Successive administrations have implemented various anti-malarial drug policies aimed at curbing this endemic disease. This study applies a formal economic evaluation framework\u2014integrating both cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA)\u2014to assess and compare anti-malarial drug policies across different presidential regimes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comparative economic evaluation was conducted using incremental cost-effectiveness ratios (ICERs) and benefit-cost ratios (BCRs) derived from regime-specific expenditure and health outcome data. The study reviewed policy documents, drug procurement records, and health outcome data spanning multiple administrations from 1999 to the present. Costs were calculated based on drug procurement expenses, implementation costs, and healthcare savings from reduced malaria incidence. Effectiveness was measured by reductions in malaria morbidity and mortality, along with improvements in health-adjusted life years (HALYs). Analyses were conducted from both the healthcare system and societal perspectives, with all financial figures adjusted for inflation and purchasing power parity (PPP) to 2024 Naira equivalents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study found varying effectiveness and cost-efficiency across different administrations. During the 1999\u20132007 administration, the National Malaria Control Program (NMCP) had an implementation cost of \u20a6120 billion, leading to a 35% reduction in malaria prevalence and an ICER of \u20a6150,000 per HALY gained. The 2007\u20132010 administration saw a decrease in malaria control investment to \u20a675 billion, resulting in only a 15% reduction in cases and a less favorable ICER of \u20a6220,000 per HALY. In 2010\u20132015, funding increased to \u20a6140 billion, achieving a 40% reduction in malaria cases and improving cost-effectiveness to \u20a6130,000 per HALY, corresponding to a BCR of 1.25. From 2015 to 2023, despite economic challenges, \u20a6200 billion was invested in expanding access to Artemisinin-based Combination Therapy (ACT), reducing malaria mortality by 20% and yielding a moderate ICER of \u20a6170,000 per HALY and a BCR of 1.10. Preliminary data from the 2023\u2013present administration indicate an allocation of \u20a6220 billion, focusing on innovative financing models and domestic production of ACTs, with early results suggesting potential cost reductions to \u20a6160,000 per HALY and an estimated BCR of 1.30.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The scientific evaluation demonstrates that while all regimes contributed to progress in malaria control, the degree of cost-effectiveness varied significantly based on policy focus, funding efficiency, and governance structure. Regimes that prioritized evidence-based drug policy and stable financing achieved superior health gains per Naira spent. This underscores the importance of data-driven, economically sustainable policy design to sustain malaria control achievements and improve population health outcomes in Nigeria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344909","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:44:18Z","timestamp":1773251058000},"page":"e0344909","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic evaluation of anti-malarial drug policies across presidential regimes in Nigeria: A comparative analysis from 1999 to present"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0249-1865","authenticated-orcid":true,"given":"Chukwuka","family":"Elendu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"pone.0344909.ref001","article-title":"Chapter 2, the cost and cost-effectiveness of antimalarial drugs.","volume-title":"Saving lives, buying time: economics of malaria drugs in an age of resistance","author":"Institute of Medicine (US) Committee on the Economics of Antimalarial Drugs","year":"2004"},{"issue":"1","key":"pone.0344909.ref002","doi-asserted-by":"crossref","DOI":"10.4084\/mjhid.2012.060","article-title":"Epidemiology of malaria in endemic areas","volume":"4","author":"B Autino","year":"2012","journal-title":"Mediterr J Hematol Infect Dis"},{"issue":"1","key":"pone.0344909.ref003","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1038\/s41467-022-30273-z","article-title":"A broader perspective on the economics of malaria prevention and the potential impact of SARS-CoV-2","volume":"13","author":"E Sicuri","year":"2022","journal-title":"Nat Commun"},{"issue":"7","key":"pone.0344909.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001488","article-title":"Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis","volume":"10","author":"J Hill","year":"2013","journal-title":"PLoS Med"},{"issue":"8","key":"pone.0344909.ref005","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.jval.2021.01.013","article-title":"Costs and cost-effectiveness of malaria control interventions: a systematic literature review","volume":"24","author":"L Conteh","year":"2021","journal-title":"Value Health"},{"issue":"1623","key":"pone.0344909.ref006","doi-asserted-by":"crossref","first-page":"20120149","DOI":"10.1098\/rstb.2012.0149","article-title":"Economic considerations for the eradication endgame","volume":"368","author":"S Barrett","year":"2013","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"1","key":"pone.0344909.ref007","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1038\/s41467-019-09991-4","article-title":"The economics of malaria control in an age of declining aid","volume":"10","author":"E Maskin","year":"2019","journal-title":"Nat Commun"},{"issue":"1","key":"pone.0344909.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1162\/qjec.2010.125.1.1","article-title":"Free distribution or cost-sharing? Evidence from a randomized malaria prevention experiment","volume":"125","author":"J Cohen","year":"2010","journal-title":"Q J Econ"},{"issue":"7","key":"pone.0344909.ref009","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1257\/aer.104.7.1909","article-title":"Micro-loans, insecticide-treated bednets, and malaria: evidence from a randomized controlled trial in Orissa, India","volume":"104","author":"A Tarozzi","year":"2014","journal-title":"Am Econ Rev"},{"key":"pone.0344909.ref010","volume-title":"Methods for the economic evaluation of health care programmes","author":"MF Drummond","year":"2015","edition":"4"},{"issue":"11","key":"pone.0344909.ref011","first-page":"670","article-title":"Introduction to the special issue on \u201cThe World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update\u201d","volume":"10","author":"MY Bertram","year":"2021","journal-title":"Int J Health Policy Manag"},{"key":"pone.0344909.ref012","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jhealeco.2015.08.002","article-title":"Malaria eradication and economic outcomes in sub-Saharan Africa: evidence from Uganda","volume":"44","author":"J Barofsky","year":"2015","journal-title":"J Health Econ"},{"issue":"3","key":"pone.0344909.ref013","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1086\/669261","article-title":"The impact of malaria eradication on fertility","volume":"61","author":"AM Lucas","year":"2013","journal-title":"Econ Dev Cult Change"},{"issue":"6","key":"pone.0344909.ref014","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.4269\/ajtmh.18-0897","article-title":"The investment case for malaria elimination in Thailand: a cost-benefit analysis","volume":"100","author":"P Sudathip","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"10","key":"pone.0344909.ref015","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine","volume":"316","author":"GD Sanders","year":"2016","journal-title":"JAMA"},{"issue":"50","key":"pone.0344909.ref016","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2026797118","article-title":"Economic evaluation of disease elimination: an extension to the net-benefit framework and application to human African trypanosomiasis","volume":"118","author":"M Antillon","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pone.0344909.ref017","first-page":"1","article-title":"Antimalarial medicine preference and usage in rural and peri-urban communities in Lagos and Osun states in southwestern Nigeria","volume":"8","author":"M Tola","year":"2017","journal-title":"Malar World J"},{"issue":"4","key":"pone.0344909.ref018","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.ijpara.2020.10.001","article-title":"Polymorphisms in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) in Nigerian children 10 years post-adoption of artemisinin-based combination treatments","volume":"51","author":"AT Kayode","year":"2021","journal-title":"Int J Parasitol"},{"issue":"1","key":"pone.0344909.ref019","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1257\/pol.1.1.75","article-title":"Housing, health, and happiness","volume":"1","author":"MD Cattaneo","year":"2009","journal-title":"Am Econ J Econ Policy"},{"issue":"1","key":"pone.0344909.ref020","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1468-0262.2004.00481.x","article-title":"Worms: identifying impacts on education and health in the presence of treatment externalities","volume":"72","author":"E Miguel","year":"2004","journal-title":"Econometrica"},{"key":"pone.0344909.ref021","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1017\/S0031182001008344","article-title":"Plasmodium falciparum: linkage disequilibrium between loci in chromosomes 7 and 5 and chloroquine selective pressure in Northern Nigeria","volume":"123","author":"IS Adagu","year":"2001","journal-title":"Parasitology"},{"issue":"1","key":"pone.0344909.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0146908","article-title":"Assessment of markers of antimalarial drug resistance in plasmodium falciparum isolates from pregnant women in Lagos, Nigeria","volume":"11","author":"CO Agomo","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0344909.ref023","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s40249-018-0503-7","article-title":"Parasite reduction ratio one day after initiation of artemisinin-based combination therapies and its relationship with parasite clearance time in acutely malarious children","volume":"7","author":"K Akano","year":"2018","journal-title":"Infect Dis Poverty"},{"issue":"3","key":"pone.0344909.ref024","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/004947559702700309","article-title":"Chloroquine-resistant Plasmodium falciparum among children in Calabar, south eastern Nigeria","volume":"27","author":"OE Antia-Obong","year":"1997","journal-title":"Trop Doct"},{"issue":"7481","key":"pone.0344909.ref025","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/nature12876","article-title":"A molecular marker of artemisinin-resistant Plasmodium falciparum malaria","volume":"505","author":"F Ariey","year":"2014","journal-title":"Nature"},{"issue":"4","key":"pone.0344909.ref026","first-page":"15","article-title":"Prevalence of Pfmdr-1 86Y and 184F alleles is associated with recurrent parasitemia following treatment of uncomplicated malaria with artemether-lumefantrine in Nigerian patients","volume":"6","author":"E Ayogu","year":"2016","journal-title":"J Appl Pharm Sci"},{"issue":"3","key":"pone.0344909.ref027","doi-asserted-by":"crossref","first-page":"290","DOI":"10.3855\/jidc.6853","article-title":"Asymptomatic falciparum malaria and genetic polymorphisms of Pfcrt K76T and Pfmdr1 N86Y among almajirai in northeast Nigeria","volume":"10","author":"ST Balogun","year":"2015","journal-title":"J Infect Dev Ctries"},{"issue":"1","key":"pone.0344909.ref028","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1186\/s12936-018-2623-8","article-title":"Characterization of Plasmodium falciparum structure in Nigeria with malaria SNPs barcode","volume":"17","author":"BE Bankole","year":"2018","journal-title":"Malar J"},{"issue":"11","key":"pone.0344909.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0026005","article-title":"Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast","volume":"6","author":"S Borrmann","year":"2011","journal-title":"PLoS One"},{"issue":"2","key":"pone.0344909.ref030","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0004551","article-title":"Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment","volume":"4","author":"VI Carrara","year":"2009","journal-title":"PLoS One"},{"key":"pone.0344909.ref031","first-page":"279028","article-title":"Occurrence of pfatpase6 single nucleotide polymorphisms associated with artemisinin resistance among field isolates of Plasmodium falciparum in North-Eastern Tanzania","volume":"2015","author":"J Chilongola","year":"2015","journal-title":"Malar Res Treat"},{"issue":"1","key":"pone.0344909.ref032","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1186\/s12936-018-2551-7","article-title":"Towards a re-emergence of chloroquine sensitivity in C\u00f4te d\u2019Ivoire?","volume":"17","author":"O Dagnogo","year":"2018","journal-title":"Malar J"},{"issue":"6","key":"pone.0344909.ref033","doi-asserted-by":"crossref","first-page":"2976","DOI":"10.1128\/AAC.05737-11","article-title":"Rapid, field-deployable method for genotyping and discovery of single-nucleotide polymorphisms associated with drug resistance in Plasmodium falciparum","volume":"56","author":"R Daniels","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"issue":"50","key":"pone.0344909.ref034","doi-asserted-by":"crossref","first-page":"12799","DOI":"10.1073\/pnas.1812317115","article-title":"Mutations in Plasmodium falciparum actin-binding protein coronin confer reduced artemisinin susceptibility","volume":"115","author":"AR Demas","year":"2018","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"5","key":"pone.0344909.ref035","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1056\/NEJMoa0808859","article-title":"Artemisinin resistance in Plasmodium falciparum malaria","volume":"361","author":"AM Dondorp","year":"2009","journal-title":"N Engl J Med"},{"key":"pone.0344909.ref036","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1186\/1475-2875-12-426","article-title":"Survey of Plasmodium falciparum multidrug resistance-1 and chloroquine resistance transporter alleles in Haiti","volume":"12","author":"MA Elbadry","year":"2013","journal-title":"Malar J"},{"key":"pone.0344909.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0064299","article-title":"The role of Pfmdr1 and Pfcrt in changing chloroquine, amodiaquine, mefloquine and lumefantrine susceptibility in western Kenya P. falciparum samples during 2008\u20132011","volume":"8","author":"FL Eyase","year":"2013","journal-title":"PLoS One"},{"issue":"3","key":"pone.0344909.ref038","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.actatropica.2011.08.013","article-title":"In vitro amodiaquine resistance and its association with mutations in pfcrt and pfmdr1 genes of Plasmodium falciparum isolates from Nigeria","volume":"120","author":"OA Folarin","year":"2011","journal-title":"Acta Trop"},{"key":"pone.0344909.ref039","doi-asserted-by":"crossref","first-page":"74","DOI":"10.2174\/1874315300801010074","article-title":"Chloroquine resistant Plasmodium falciparum in Nigeria: relationship between pfcrt and pfmdr1 polymorphisms, in-vitro resistance and treatment outcome","volume":"1","author":"OA Folarin","year":"2008","journal-title":"Open Trop Med J"},{"issue":"6272","key":"pone.0344909.ref040","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/345255a0","article-title":"Several alleles of the multidrug-resistance gene are closely linked to chloroquine resistance in Plasmodium falciparum","volume":"345","author":"SJ Foote","year":"1990","journal-title":"Nature"},{"key":"pone.0344909.ref041","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1186\/1475-2875-8-313","article-title":"Potential contribution of prescription practices to the emergence and spread of chloroquine resistance in south-west Nigeria: caution in the use of artemisinin combination therapy","volume":"8","author":"GO Gbotosho","year":"2009","journal-title":"Malar J"},{"issue":"3","key":"pone.0344909.ref042","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1128\/AAC.00968-08","article-title":"Selection of Plasmodium falciparum multidrug resistance gene 1 alleles in asexual stages and gametocytes by artemether-lumefantrine in Nigerian children with uncomplicated falciparum malaria","volume":"53","author":"CT Happi","year":"2009","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"pone.0344909.ref043","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s41669-017-0021-8","article-title":"Evaluating the treatment costs for uncomplicated malaria at a public healthcare facility in Nigeria and the implications","volume":"1","author":"CC Ezenduka","year":"2017","journal-title":"Pharmacoecon Open"},{"key":"pone.0344909.ref044","volume-title":"The economic burden of illness for households: a review of cost of illness and coping strategy studies focusing on malaria, tuberculosis and HIV\/AIDS","author":"S Russell","year":"2004"},{"issue":"9176","key":"pone.0344909.ref045","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/S0140-6736(99)02141-8","article-title":"Cost-effectiveness of malaria control in sub-Saharan Africa","volume":"354","author":"CA Goodman","year":"1999","journal-title":"Lancet"},{"issue":"2","key":"pone.0344909.ref046","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0168-8510(00)00105-6","article-title":"Economic burden of malaria illness on households versus that of all other illness episodes: a study in five malaria holo-endemic Nigerian communities","volume":"54","author":"O Onwujekwe","year":"2000","journal-title":"Health Policy"},{"key":"pone.0344909.ref047","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/0025-5564(93)90029-A","article-title":"A three-state Markov model of Plasmodium falciparum parasitemia","volume":"117","author":"A Richard","year":"1993","journal-title":"Math Biosci"},{"issue":"3","key":"pone.0344909.ref048","first-page":"261","article-title":"Evaluating recurrent episodes of malaria incidence in Timika, Indonesia, through a Markovian multiple-state model","volume":"7","author":"N Lusiyana","year":"2022","journal-title":"Infect Dis Model"},{"issue":"2","key":"pone.0344909.ref049","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.mbs.2007.07.001","article-title":"A stochastic model of immune-modulated malaria infection and disease in children","volume":"210","author":"D Gurarie","year":"2007","journal-title":"Math Biosci"},{"issue":"25","key":"pone.0344909.ref050","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1056\/NEJMoa1606701","article-title":"Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015","volume":"375","author":"PW Gething","year":"2016","journal-title":"N Engl J Med"},{"issue":"10112","key":"pone.0344909.ref051","doi-asserted-by":"crossref","first-page":"2532","DOI":"10.1016\/S0140-6736(17)33080-5","article-title":"The global fight against malaria is at crossroads","volume":"390","author":"P Alonso","year":"2017","journal-title":"Lancet"},{"key":"pone.0344909.ref052","first-page":"15","article-title":"Rise in malaria cases sparks fears of a resurgence","volume":"552","author":"A Maxmen","year":"2017","journal-title":"Nature"},{"issue":"4","key":"pone.0344909.ref053","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S1473-3099(15)00423-5","article-title":"Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study","volume":"16","author":"JT Griffin","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pone.0344909.ref054","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4269\/ajtmh.2001.64.85","article-title":"The economic burden of malaria","volume":"64","author":"JL Gallup","year":"2001","journal-title":"Am J Trop Med Hyg"},{"issue":"6872","key":"pone.0344909.ref055","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1038\/415680a","article-title":"The economic and social burden of malaria","volume":"415","author":"J Sachs","year":"2002","journal-title":"Nature"},{"key":"pone.0344909.ref056","volume-title":"An investment case for eliminating malaria in the Asia Pacific region","author":"R Shretta","year":"2017"},{"key":"pone.0344909.ref057","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/1475-2875-12-200","article-title":"Malaria and protective behaviours: is there a malaria trap?","volume":"12","author":"J-C Berth\u00e9lemy","year":"2013","journal-title":"Malar J"},{"key":"pone.0344909.ref058","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.econlet.2015.03.022","article-title":"Prevention or treatment? The case of malaria","volume":"131","author":"JC Berth\u00e9lemy","year":"2015","journal-title":"Econ Lett"},{"key":"pone.0344909.ref059","doi-asserted-by":"crossref","first-page":"111","DOI":"10.11604\/pamj.2023.45.111.31780","article-title":"Overtreatment of malaria in the Nigerian healthcare setting: prescription practice, rationale and consequences","volume":"45","author":"ET Anjorin","year":"2023","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0344909.ref060","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/2052-3211-7-15","article-title":"Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the \u201ctest and treat\u201d policy of malaria case management","volume":"7","author":"CC Ezenduka","year":"2014","journal-title":"J Pharm Policy Pract"},{"issue":"3","key":"pone.0344909.ref061","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0092782","article-title":"Major improvements in the quality of malaria case-management under the \u201ctest and treat\u201d policy in Kenya","volume":"9","author":"D Zurovac","year":"2014","journal-title":"PLoS One"},{"key":"pone.0344909.ref062","volume-title":"World malaria report 2012","author":"World Health Organization","year":"2012"},{"issue":"7519","key":"pone.0344909.ref063","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1136\/bmj.331.7519.734","article-title":"Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study","volume":"331","author":"D Zurovac","year":"2005","journal-title":"BMJ"},{"key":"pone.0344909.ref064","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/1475-2875-10-218","article-title":"Taking stock: provider prescribing practices in the presence and absence of ACT stock","volume":"10","author":"B Hensen","year":"2011","journal-title":"Malar J"},{"key":"pone.0344909.ref065","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/1475-2875-10-155","article-title":"Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria","volume":"10","author":"LJ Mangham","year":"2011","journal-title":"Malar J"},{"key":"pone.0344909.ref066","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1475-2875-6-55","article-title":"Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study","volume":"6","author":"M Meremikwu","year":"2007","journal-title":"Malar J"},{"key":"pone.0344909.ref067","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1186\/1475-2875-8-243","article-title":"Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets","volume":"8","author":"J Chuma","year":"2009","journal-title":"Malar J"},{"key":"pone.0344909.ref068","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/1475-2875-8-246","article-title":"Malaria treatment perceptions, practices and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria","volume":"8","author":"O Onwujekwe","year":"2009","journal-title":"Malar J"},{"key":"pone.0344909.ref069","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1186\/1475-2875-13-243","article-title":"Drugs use pattern for uncomplicated malaria in medicine retail outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy","volume":"13","author":"CC Ezenduka","year":"2014","journal-title":"Malar J"},{"issue":"10","key":"pone.0344909.ref070","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/0169-4758(96)10055-7","article-title":"Strategies for the prevention of antimalarial drug resistance: rationale for combination chemotherapy for malaria","volume":"12","author":"NJ White","year":"1996","journal-title":"Parasitol Today"},{"key":"pone.0344909.ref071","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1475-2875-5-4","article-title":"The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania","volume":"5","author":"H Reyburn","year":"2006","journal-title":"Malar J"},{"issue":"1","key":"pone.0344909.ref072","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1186\/s12936-016-1473-5","article-title":"Markov chain Monte Carlo and expectation maximization approaches for estimation of haplotype frequencies for multiply infected human blood samples","volume":"15","author":"G Ken-Dror","year":"2016","journal-title":"Malar J"},{"issue":"9","key":"pone.0344909.ref073","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1093\/jac\/dkad219","article-title":"An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria","volume":"78","author":"S Saralamba","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"pone.0344909.ref074","doi-asserted-by":"crossref","DOI":"10.30875\/f309483f-en","volume-title":"World malaria report 2018","author":"World Health Organization","year":"2018"},{"issue":"7","key":"pone.0344909.ref075","article-title":"Estimating the most efficient allocation of interventions to achieve reductions in Plasmodium falciparum malaria burden and transmission in Africa: a modelling study","volume":"4","author":"PGT Walker","year":"2016","journal-title":"Lancet Glob Health"},{"key":"pone.0344909.ref076","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/1475-2875-12-252","article-title":"Anti-malarial prescription practices among outpatients with laboratory-confirmed malaria in the setting of a health facility-based sentinel site surveillance system in Uganda","volume":"12","author":"D Sears","year":"2013","journal-title":"Malar J"},{"key":"pone.0344909.ref077","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1365-3156.2010.02724.x","article-title":"Drug dispensing practices during implementation of artemisinin-based combination therapy at health facilities in rural Tanzania, 2002\u20132005","volume":"16","author":"JI Thwing","year":"2011","journal-title":"Trop Med Int Health"},{"key":"pone.0344909.ref078","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1186\/1471-2458-10-486","article-title":"Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria","volume":"10","author":"BSC Uzochukwu","year":"2010","journal-title":"BMC Public Health"},{"issue":"7476","key":"pone.0344909.ref079","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1136\/bmj.38251.658229.55","article-title":"Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study","volume":"329","author":"H Reyburn","year":"2004","journal-title":"BMJ"},{"issue":"3","key":"pone.0344909.ref080","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3923\/ijp.2007.270.274","article-title":"Interactions between retinol and some established antimalarials in Plasmodium nigeriensis infection in mice","volume":"3","author":"AI Oreagba","year":"2007","journal-title":"Int J Pharmacol"},{"issue":"10","key":"pone.0344909.ref081","first-page":"96","article-title":"A study of the effect of ascorbic acid on the antiplasmodial activity of artemether in Plasmodium berghei-infected mice","volume":"2","author":"KA Ganiyu","year":"2012","journal-title":"J Appl Pharm Sci"},{"key":"pone.0344909.ref082","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1475-2875-8-2","article-title":"Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy","volume":"8","author":"ANO Dodoo","year":"2009","journal-title":"Malar J"},{"key":"pone.0344909.ref083","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1186\/1475-2875-10-290","article-title":"Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses","volume":"10","author":"G Mtove","year":"2011","journal-title":"Malar J"},{"key":"pone.0344909.ref084","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1186\/1475-2875-8-313","article-title":"Potential contribution of prescription practices to the emergence and spread of chloroquine resistance in south-west Nigeria: caution in the use of artemisinin combination therapy","volume":"8","author":"GO Gbotosho","year":"2009","journal-title":"Malar J"},{"issue":"5","key":"pone.0344909.ref085","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1179\/136485905X51283","article-title":"Where do people from different socio-economic groups receive diagnosis and treatment for presumptive malaria, in south-eastern Nigeria?","volume":"99","author":"O Onwujekwe","year":"2005","journal-title":"Ann Trop Med Parasitol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344909","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:44:33Z","timestamp":1773251073000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344909"}},"subtitle":[],"editor":[{"given":"Benedikt","family":"Ley","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":85,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0344909","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}