Patterns of treatment of reported malaria cases during pregnancy in a Nigerian hospital.

BACKGROUND: Prompt and effective case management is one of the control measures for malaria during pregnancy. The objective of the study was to assess treatment patterns of presumed cases of malaria during pregnancy in a Nigerian tertiary health care facility. METHODS: A cross-sectional study involving immediate postpartum women admitted to the maternity wards of the University of Benin Teaching Hospital was undertaken. History of occurrence and treatment practices of presumed malaria during the immediate past pregnancy were obtained from the women's medical case files and by interview, using a pre-developed data collection form. RESULTS: Two hundred and ninety-seven of the 428 study participants (69.4%) reported a total number of 544 cases of malaria in pregnancy (MiP). More than 85% (n = 469/544) of the reported MiP cases occurred after the first trimester, while 55.5% (302/544) occurred during the second trimester. Among the reported MiP cases, parasite-based diagnosis was done for only 8.6% (n = 47). The use of antimalarial medications was reported in the treatment of 86.6% of the total number of cases. Antimalarial medication was used across the 3 trimesters, including artemisinin-based combination therapy (49.6%), artemisinin monotherapy (15.2%), and other monotherapies, such as sulfadoxine-pyrimethamine, chloroquine, amodiaquine (33.3%), and oral quinine (2%). Sulfadoxine-pyrimethamine and artemisinin derivatives were used in the treatment of 38.8% and 34.7% of first trimester malaria cases, respectively. CONCLUSIONS: Parasite-based diagnosis prior to treatment was poorly practiced, and inappropriate antimalarial drug management of MiP was observed. Addressing these observed deficiencies is necessary in order to achieve success in the fight against malaria during pregnancy in Nigeria.

Actionable theranostics for global maternal health: a focus on HIV and malaria.

A new wave of rapid and accurate molecular diagnostics, which harness the power of genomics and proteomics, hold great potential to improve aspects of maternal health on a global scale. This review will provide a context to issues related to global maternal health and highlight international endeavors aimed to alleviate morbidity and mortality during pregnancy, childbirth and into the postnatal period. The authors will couple these efforts to actionable and promising theranostic advancements in the detection and treatment of HIV and malaria through the lens of maternal global health strategies.

Patterns of paediatric analgesic use in Africa: a systematic review.

We conducted a systematic literature review with two objectives: (1) to assess reported patterns of analgesic use in African children and compare these observed patterns to the analgesics given in the WHO Essential Medicines List for Children (EMLc); and (2) to summarise outcomes related to effectiveness, adverse events, cost and accessibility of these analgesics. Eligible participants were children (≤12 years) living in any African country who received an analgesic administered with the intention of relieving pain in any setting. Thirty-four peer-reviewed, observational studies representing 7772 African children were accepted. Studies were conducted in 25 different regions of 12 countries. Pain was attributed to surgery, burns, sickle cell anaemia and conditions requiring palliation in 32% of children, and was unspecified in the other 68%. Of the three EMLc analgesics, paracetamol and ibuprofen were widely employed, constituting ∼60% of all analgesics, while morphine was used in 20 children (0.2%). There were 455 suspected adverse drug reactions which included 17 deaths. Analgesic use reported in African children appears to fall short of WHO standards.

Assessment of Disease Profiles and Drug Prescribing Patterns of Health Care Facilities in Edo State; Nigeria

Few studies have systematically characterized drug-prescribing patterns; particularly at the primary care level in Nigeria; a country disproportionately burdened with disease. The aim of this study was to assess the disease profiles and drug-prescribing pattern in two health care facilities in Edo State; Nigeria. The medical records of 495 patients who attended a primary or secondary health care facility in Owan-East Local Government Area of Edo State; Nigeria; between June and November 2009 were reviewed. Disease profiles and drug prescribing patterns were assessed. Data were analyzed based on the World Health Organization Anatomic Therapeutic Chemical classification system; and core drug prescribing indicators. Five hundred and twelve clinical conditions were identified. Infectious disease was most prevalent (38.3); followed by disorder of the alimentary tract (16.4). Malaria was responsible for 55.6 of the infectious diseases seen; and 21.3 (109/512) of the total clinical conditions managed at the two health facilities during the study period. Consequently; anti-infective medications were the most frequently prescribed medicines (21.5); followed by vitamins (18.2). Use of artesunate monotherapy at both facilities (15.7); and chloroquine at the primary health facility (24.9) were common. Paracetamol (41.8) and non-steroidal anti-inflammatory drugs (24.9) were the most frequently used analgesic/antipyretic. At the primary health care facility; dipyrone was used in 21.6 of cases. The core drug prescribing use indicators showed inappropriate prescribing; indicating poly-pharmacy; overuse of antibiotics and injectio. Inappropriate drug use patterns were identified at both health care facilities; especially with regard to the use of ineffective antimalarial drugs and the use of dipyrone

Perceptions of Health Care Professionals towards Pharmacogenomics in Nigeria: Preliminary Results

"Background: Pharmacogenomics/pharmacogenetics has the potential to mitigate adverse drug reactions and optimize pharmacotherapy in individuals. Over the past several years; there has been increasing attention towards the characterization of pharmacogenomic biomarkers in African populations; both locally and internationally. However; the perceptions of the African health care community towards pharmacogenomic testing have not been studied. Objectives: To assess knowledge and perceptions of pharmacogenomics among health care professionals in Benin City; Nigeria. Methods: In this preliminary and pilot investigation; we used a semi-structured qualitative survey methodology to understand the perceptions of pharmacists and pharmacologists towards pharmacogenomics in an academic care centre in Benin City; Nigeria. Three themes were explored: Knowledge and experience with pharmacogenetics; Expectations about how a pharmacogenetic testing service could be used; and Capacity building for pharmacogenetic service delivery. Results: Though none of the participants had received training or undertaken research in pharmaco- genomics; all participants were familiar with the field and listed beneficial outcomes associated with pharmacogenetic testing. Participants identified factors such as lack of funding; infrastructure; and manpower for limitations of pharmacogenomic testing in Nigeria. Participants listed numerous ethical issues and concerns in recruiting participants for research and introducing pharmacogenetics in the clinic; including the need to ""win the confidence of the people."" Conclusion: Pharmacists and pharmacologists in an academic centre in Nigeria are aware of the benefits of pharmacogenomics; but cite many hurdles to overcome before this field can become a routine part of patient care in their communities."

Medication utilization and illness management study in Nigeria.

BACKGROUND: Little is known about rates of illness, illness management, or drug utilization in developing countries. OBJECTIVE: To determine patterns of illness and drug utilization in urban and rural households in Nigeria. METHODS: A survey was developed and validated for data collection. A random sample from some communities in Owan East Local Government Area (LGA) of Edo State, Nigeria, was selected, based on a national population survey, using both the supervisory and enumeration areas of the LGA. We determined the sample size using methods described by Cochran, including 5% precision, 5% α, and allowing for 5% data error. Respondents were queried in face-to-face interviews about illnesses in their households during the previous 2 weeks; demographic information; how they were treated; and where they sought treatment, advice, and medicines. As well, we determined how they kept families well. Descriptive statistics were used to summarize data. RESULTS: Out of 549 persons, 497 completed the questionnaires, giving a response rate of 90.5%. Of these respondents, 395 (79.5%) reported 517 illnesses during the previous 2 weeks. The average age of the ill person was 30.6 ± 24.3 years (range 3 months to 95 years). Percentages by age were: infants younger than 1 year 1.0%, children aged 1-17 years 36.0%, and adults aged ≥18 years 63.0%. Average monthly income per household was low (13,247 naira/88.31 US$). Malaria and its symptoms (fever, chills, joint pain, headache, gastrointestinal problems) and upper respiratory symptoms were most common. A majority (44.8%) of the ill persons self-treated, with 93.6% using antibiotic and antimalarial drugs. Among the households surveyed, 42.1% had drugs on hand (average 2.3 ± 1.3, range 1-7, median 2) for disease prevention, and the most used drugs were analgesics (46.2%) and antimalarial drugs (37.3%). CONCLUSIONS: Illness is frequent in Nigeria and is usually self-treated with antibiotic and antimalarial drugs. Medications were reported to be the most frequently used measure to prevent household illness. The implications of these findings are discussed.

Evaluation of the pharmaceutical quality of some quinine preparations sold in Nigeria.

OBJECTIVE: The purpose of this study was to determine the pharmaceutical quality of quinine preparations sold in Nigerian markets. MATERIALS AND METHODS: The organoleptic and physicochemical properties of quinine tablets, as well as oral liquids and parenteral quinine preparations, were assessed according to British Pharmacopoeia (BP) and unofficial standards as recommended by the manufacturers. RESULTS: Of the 6 brands of tablets assessed, 4 passed the uniformity of content test and 5 the disintegration test, but only 2 the dissolution test. The pH of 2 of the 6 brands of oral liquid preparations met BP standards, while only 1 oral liquid met the BP standard for percentage content. The assay further demonstrated that 4 brands of the parenteral preparations met BP standards for quinine content. All the parenteral preparations were found to be sterile. CONCLUSION: Quinine preparations sold in Nigeria varied considerably in their pharmaceutical quality. A strict check of the quality of brands of quinine by regulatory agencies and distributors before they are sold to the public is therefore recommended.

Assessment of prescription profile of pregnant women visiting antenatal clinics

Managing medical complications in pregnancy is a challenge to clinicians. Objectives: This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. Methods: Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. Results: A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. Conclusion: The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent anti-malarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low (AU)

Manejar las complicaciones médicas en el embarazo es un reto para los clínicos. Objetivos: Este estudio delineó algunos patrones de enfermedades y prescripciones en embarazadas que visitan una clínica prenatal en Nigeria. Se determinó una clasificación de riesgo de los medicamentos. Métodos: Se investigaron los historiales médicos de 1200 mujeres embarazadas que visitaron las clínicas de preparto de tres centros en la ciudad de Benin , Nigeria. Los patrones de enfermedades se determinaron desde sus diagnósticos. Los patrones de prescripción se evaluaron utilizando los indicadores del a OMS y la clasificación de medicamentos de la Food and Drug Administration de Estados Unidos según el riesgo para el feto. Resultados: Durante el periodo de revisión, se evaluaron 1897 prescripciones de las 1200 mujeres embarazadas que visitaron. Los resultados indicaron que la malaria con 554 (38%) fue la enfermedad más prevalente, seguida de las infecciones respiratorias altas (IRA) con 13% y enfermedades gastrointestinales (GI) con 12%. La media de medicamentos prescritos por visita fue de 3,0 y 2434 (43%) fueron prescritas en genéricos. Minerales/vitaminas, con 2396 (42%) fueron los medicamentos mas prescritos, y los antibióticos aparecieron en 502 (8,8%). De todos los medicamentos prescritos, 984 (17%) se incluían en la categoría de riesgo fetal C y 286 (5%) en la categoría D. Conclusión: Este estudio concluyó que entre las mujeres embarazadas, la malaria era la enfermedad más frecuente, seguida de las IRA y las GI. Los minerales y vitaminas seguidos el os antibióticos encabezaron l alista de medicamentos prescritos. La media de medicamentos por visita fue mucho mayor que los estándares recomendados por la OMS. La aparición de medicamentos contraindicados era baja (AU)

Prevalence of malaria during pregnancy and antimalarial intervention in an urban secondary health care facility in Southern Nigeria.

OBJECTIVE: To investigate the prevalence of malaria during pregnancy and antimalarial interventions in an urban secondary health care facility. SUBJECTS AND METHODS: Of 432 pregnant women who delivered or were attending an antenatal clinic in a secondary health care facility in Benin City, Nigeria, 199 were recruited for the study. Demographic data were obtained from the pregnant women at delivery, and maternal peripheral, placental, and cord blood samples were collected for microscopy. Among the antenatal clinic attendees, a questionnaire was used to assess their antimalarial preventive measures. RESULTS: Of the 199 pregnant women, 60 (30%) reported that they had had malaria during the preceding 3 months, and a majority of them (85%) used chloroquine. Almost all reported the drug was efficacious (98%) and well tolerated (80%). Only 18 (13%), 14 (10%), and 2 (1%) of the women had positive maternal peripheral, placental, and cord blood parasitaemia, respectively. The geometric mean (+/- SD) numbers of malaria parasites per microliter were 636.06 +/- 1,450.11 in peripheral blood, 4,250.36 +/- 13,866.01 in placental blood, and 59.50 +/- 27.58 in umbilical cord blood. Only 31 (12%) and 13 (5%) of antenatal women believed in the efficacy of insecticide-treated bed nets or sulphadoxine/pyrimethamine-based intermittent preventive therapy as antimalarial preventive measures, respectively, while 23 (9%) and 31 (12%), respectively, reported they currently use them. CONCLUSIONS: Despite the common occurrence of malaria during pregnancy, there was a limited knowledge and use of the recommended antimalarial interventions by pregnant women attending the antenatal clinic of this health care facility. There is, therefore, an urgent need to increase the implementation of antimalarial interventions during pregnancy.

A survey of knowledge, attitude and practice of malaria management among pregnant women from two health care facilities in Nigeria.

BACKGROUND: Malaria remains one of the most important causes of maternal and child morbidity and mortality in sub-Saharan Africa, despite the availability of effective interventions. The objective of this study was to assess the knowledge, attitude and practice of malaria management among pregnant women attending antenatal clinics in Nigeria. METHODS: A cross-sectional study was undertaken on a sample of 867 pregnant women attending antenatal clinics in 2 health care facilities in Edo State, Nigeria, using a self-administered questionnaire. RESULTS: Of the respondents, 87% said that they had undergone at least 1 episode of malaria during their current pregnancy. Most respondents (89%) attributed malaria to bites from infected mosquitoes, while 75% consider malaria an important health risk during pregnancy. However, knowledge of the consequences of malaria during pregnancy was poor, especially the risk posed to the fetus. Overall, the mean knowledge score on a scale of '0-7' was 3.5 (median 4.0). Respondents had poor belief in the effectiveness and use of insecticide-treated bed nets and intermittent preventive therapy, in preventing malaria during pregnancy. CONCLUSIONS: This study has revealed that malaria is perceived as a common health problem among pregnant women attending these 2 health care facilities, and that knowledge, attitude and practice of its management is poor. Efforts should be made to improve anti-malarial intervention during pregnancy, to ensure that the goals of the Roll Back Malaria Initiative are achieved in Nigeria.

Assessment of prescription profile of pregnant women visiting antenatal clinics.

UNLABELLED: Managing medical complications in pregnancy is a challenge to clinicians. OBJECTIVES: This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. METHODS: Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. RESULTS: A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. CONCLUSION: The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent antimalarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.

A survey of anti-malarial activity during pregnancy, and children's malaria care-seeking behaviour in two Nigerian rural communities.

This study investigated anti-malarial prophylaxis during pregnancy and children's malaria care-seeking behaviour by mothers with children 5 y of age and below drawn from 2 rural communities in southern Nigeria. Findings showed that 37% of mothers said they had used anti-malarial prophylaxis (chloroquine, 50%) during pregnancy, while only 30% of them had bed net (untreated) at home, with 44% of the bed net damaged. Over half (59%) of the respondents reported that their children had had fever/malaria in the forthnight recall period, and a majority of them (44%) were treated in medicine shops. Injections accounted for 33% of the medications received by them. Of the 74% of children who were given treatment, there were delays of 2 or more d in seeking care for a quarter of them. Only 21% of the mothers attributed malaria to bites from infected mosquitoes, despite the high prevalence of childhood malaria. Low coverage of anti-malarial intervention during pregnancy and inappropriate children's malaria care-seeking behaviour has been identified. An appropriate mechanism for delivery of insecticide-treated bed nets in addition to educational interventions is recommended in order to reduce the burden of malaria among pregnant women and children in these communities.