Acute Pain Management in Children with Sickle Cell Anaemia during Emergency Admission to a Teaching Hospital in Lagos; Nigeria

Background. Optimal pain management in children with sickle cell anaemia (SCA) begins with accurate and thorough pain assessment. However; little or no evidence of this practice exists among SCA patients in developing countries. Objectives. To evaluate pain management in children with SCA during emergency admission. Methods. Children with SCA who were =12 years old; on admission for a painful crisis and who were not using herbal remedies for pain relief; were prospectively studied at the Lagos University Teaching Hospital (LUTH) over a period of 1 year. A proforma data collection form was used to obtain information about the demographics of the patients and their parents; as well as pain score; and non-pharmacological and pharmacological treatments documented in the patients' case files. Pain was assessed for each patient using the Wong-Bakers Faces Pain Rating Scale. Results. The median age and weight of the patients were 4 years and 16 kg; respectively. Pain assessment by the physicians was documented in 10 (8.3%) patients. However; among those assessed for pain by the researchers; 90 (75%) had a moderate pain score of 5 - 8. Fluid therapy (n=110; 91.7%) and prayers (n=120; 100%) were the most common non-pharmacological therapies administered to the patients while admitted. Analgesics; either in combinations or as a single medicine; were administered to 100 (83.3%) patients. Paracetamol (n=90; 75%) and pentazocine (n=80; 66.7%) were the most frequently used analgesics. The dosage of the analgesics prescribed did not conform to the recommendations of the World Health Organization (WHO). Conclusion. The SCA children in this study were managed sub-optimally with analgesics. Pain management among this group of children did not fully conform to the guidelines of the WHO

Assessment of treatment pattern of uncomplicated malaria in peadiatric patients attending a teaching hospital in northwest Nigeria.

Malaria remains an important public health concern in countries where transmission occurs regularly, as well as in areas where transmission has been largely controlled or eliminated. This study assesses the pattern of treatment of uncomplicated malaria in young children attending a Teaching Hospital in Northwest Nigeria and prescribers awareness and attitude towards the new National Antimalarial Treatment Guidelines. The study design consist of a prospective cross-sectional study to assess caregivers treatment seeking habit for uncomplicated malaria in children and prescribers knowledge and attitude on the ACTs and a retrospective study to assess prescribing pattern and adherence to the Federal Government National Antimalarial Treatment Guidelines. The prospective study showed that 72% of the children received ACTs, 6% received chloroquine and 2% sulphadoxine/pyrimethamine, 20% other antimalarials . Analgesics and antibiotics were reportedly administered. 60% were diagnosis with malaria only, 15% malaria plus upper respiratory tract infections and 15% malaria with other conditions. Sixty percent of the physicians recommended ACTs as first line treatment of uncomplicated malaria, Twenty three percent of prescribers rated treatment response to ACTs to be excellent, 55% above average and 18.2% average. In the retrospective study, a total of 342 prescriptions were reviewed. sixty six percent of prescriptions contained ACTs. Average number of medicines per prescription was 5.4. Percentage of prescriptions containing more than 4 medicines was 6.7% and percentage of prescriptions containing less than 4 medicines was 40.4%. The study showed that the pattern of treatment of uncomplicated malaria reflect high compliance with the policy change from chloroquine to ACTs as first line antimalarial drugs. Despite some significant side effects, and irrational prescribing practices most prescribers opined that treatment outcome was above average.