Treatment of malaria in health care facilities in Benin city, Nigeria

Abstract

Malaria is a leading cause of morbidity and mortality in Africa, especially in the sub-Saharan region and an assumption is that medical practitioners in this part of the world should be skilled in prescribing drugs for the treatment of malaria. This study assessed the patterns of prescriptions for antimalarial drugs by doctors. Prescriptions were collected retrospectively from the outpatient clinics of all public hospitals, and 9 randomly selected private hospitals in Benin City, Nigeria from January 2000 to July 2001. Out of the 1,970 prescriptions assessed, 32.1% (633) had antimalarials prescribed. Antimalarial prescriptions showed that the most frequently prescribed drug was chloroquine (54.8%). Other antimalarials prescribed were sulphadoxine/pyrimethamine (20.9%), quinine (12.5%), halofantrine (6.2%), sulphalene/pyri- methamine (2.7%), sulphadoxine/pyrimethamine/mefloquine (1.7%), amodiaquine (0.8%), and artesunate (0.5%). More than half of the prescriptions for chloroquine (52%) were for injections. Oral chloroquine for adults was prescribed in doses ranging from 600mg to 3g for a course of therapy. More than one antimalarial drug was prescribed in 29% of encounters, with quinine plus sulphadoxine/pyrimethamine being the most frequent combination. Co-prescription of analgesics with antimalarials occurred in 517 (82.1%) encounters with paracetamol as the most frequently prescribed analgesic. Almost all (95.8%) of dipyrone prescriptions were for injections. Antibiotics were coprescribed in 48.2% of encounters, and ampicillin/amoxicillin were the most frequently prescribed antibiotics. The values for the WHO Core Prescribing Indicators were: average number of drugs per encounter – 4.4; percentage of drugs prescribed by generic name – 50.2%; percentage of encounters with injections prescribed – 42.2%, and percentage of drugs prescribed from the Essential Drugs List – 96.7%. Vitamin/mineral supplements were co-prescribed in 323 (51.3%) encounters. The findings suggest that there is inappropriate use of parenteral chloroquine, dipyrone and antibiotics in the treatment of malaria. There is also the questionable use of vitamin and mineral supplements alongside antimalarials in the therapeutic setting Keywords : Malaria, antimalarial drugs, prescriptions, WHO indicators West African Journal of Pharmacology and Drug Research Vol. 20(1&2) 2005: 26-30