Higher Readability Levels and Suboptimal Design of Medicine Information Leaflets in Artemisinin-based Combination Therapy Antimalarial Packages: A Consequence for Over-the-Counter-Medicines Use

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DOI: 10.21522/TIJAR.2014.SE.22.02.Art010

Authors : Rachel Obonose Titus, Margaret Olubunmi Afolabi, Omoniyi Joseph Ola- Olorun


The study aimed to determine the readability level and assess the design layout of medicine information leaflets in packages of Artemisinin-based Combination (ACT) antimalarials used as over-the-counter medicines in Nigeria where malaria is endemic with higher adverse events in under-five children and pregnant women. A cross-sectional study design was adopted to evaluate thirty-two medicine information leaflets of ACTs obtained from community pharmacies. Texts in selected passages of the leaflets were subjected to the Flesch-Kincaid (F-K) formula to determine the F-K score and the corresponding reading-grade level. The Baker Able Leaflet Design (BALD) assessment tool was employed to assess the medicine information leaflets design layout. The mean Flesch-Kincaid score for the MILs was 14.22 ±5.06. A proportion of 15.63% of the MILs were readable at the postgraduate level, 28.13% at the undergraduate level, 37.5% at the senior secondary school level and 18.76% at the junior secondary school level. This represented the total proportion of leaflets readable at the junior secondary school level which is the average level of education in Nigeria. On the BALD tool, 46.28% of the MILs were rated ‘above standard’ and 53.72% were ‘poor’ in design. The dimension of the longest MIL was 80cm by 36cm. A large proportion of the MILs were written above the reading level of average Nigerians and were poorly designed. Most Nigerians are not likely to be able to read these leaflets for reference purposes and to serve as reminder for instructions obtained during medication counselling.


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