Prescription patterns and drug use among pregnant women with febrile Illnesses in Uganda: a survey in out-patient clinics

BMC Infectious Diseases

Pascal Magnussen⁴  Stephanie Yanow³  Josephine Birungi²  Anthony K Mbonye¹ 

[1] School of Public Health, Makerere University and Commissioner Health Services, Ministry of Health, Box 7272, Kampala, Uganda;Senior Principal Research Officer, Division of Entomology, Uganda Virus Research Institute, Entebbe, Uganda;Research and Development, Provincial Laboratory for Public Health, WMC 2B4.59, 8440 112th Street, Edmonton AB T6G 2J2, Alberta, Canada;Centre for medical Parasitology, University of Copenhagen, Copenhagen, Denmark

关键词: Uganda;    SP;    Appropriate treatment;    Pregnant women;    Malaria;   

Others  :  1148199
DOI  :  10.1186/1471-2334-13-237

 received in 2012-12-05, accepted in 2013-05-13,  发布年份 2013

【 摘 要 】

Background

Malaria is a public health problem in Uganda; affecting mainly women and children. Effective treatment has been hampered by over-diagnosis and over-treatment with anti-malarial drugs among patients presenting with fever. In order to understand the effect of drug pressure on sulfadoxine-pyrimethamine (SP) resistance in pregnancy, a sample of pregnant women presenting with fever in out–patient clinics was studied. The main objective was to assess prescription patterns and drug use in pregnancy especially SP; and draw implications on the efficacy of SP for intermittent preventive treatment of malaria in pregnancy (IPTp).

Methods

A total of 998 pregnant women with a history of fever were interviewed and blood samples taken for diagnosis of malaria and HIV infections. Data were captured on the drugs prescribed for the current febrile episode and previous use of drugs especially SP, anti-retroviral drugs (ARVs) and cotrimoxazole.

Results

Few pregnant women, 128 (12.8%) were parasitaemic for P.falciparum; and of these, 72 (56.3%) received first-line treatment with Artemether-lumefantrine (Coartem®) 14 (10.9%) SP and 33 (25.8%) quinine. Of the parasite negative patients (non-malarial fevers), 186 (21.4%) received Coartem, 423 (48.6%) SP and 19 (2.1%) cotrimoxazole. Overall, malaria was appropriately treated in 35.5% of cases. Almost all febrile pregnant women, 91.1%, were sleeping under a mosquito net. The majority of them, 911 (91.3%), accepted to have an HIV test done and 92 (9.2%) were HIV positive. Of the HIV positive women, 23 (25.0%) were on ARVs, 10 (10.9%) on cotrimoxazole and 30 (32.6%) on SP. A significant proportion of women, 40 (43.5%), were on both SP and cotrimoxazole. Age and occupation were associated with diagnosis and treatment of malaria and HIV infections.

Conclusion

There is inappropriate treatment of malaria and non-malarial fevers among pregnant women in these facilities. This is due to non-adherence to the guidelines. Over-prescription and use of anti-malarial drugs, especially SP may have implications on resistance against SP for malaria prevention in pregnancy. The policy implications of these findings are to evaluate SP efficacy as IPTp; and the need to enforce adherence to the current clinical treatment guidelines.

【 授权许可】

   
2013 Mbonye et al.; licensee BioMed Central Ltd.

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