Plasmodium falciparum malaria and antimalarial interventions in sub-Saharan Africa: Challenges and opportunities

Plasmodium falciparum malaria is one of the most important parasitic diseases affecting sub-Saharan Africa, despite the availability of interventions. It exerts tremendous socio-economic and medical burden on the continent, particularly in under five children and pregnant women. In this review, we have attempted to highlight the problems, constraints and the opportunities that are available for effective prevention and control within the region

Profile of Antimicrobial Drug Use Patterns in a Nigerian Metropolitan City

Purpose: To evaluate self-medication practices and prescribing patterns of antimicrobial agents. Methods: The study was carried out in Port Harcourt, Nigeria in 6 hospitals/clinics, 4 community pharmacies and the campus of University of Port Harcourt. 1,200 case files or charts of outpatients treated at the selected hospitals/clinics were reviewed for relevant information. Thereafter, independent physician assessors evaluated the “appropriateness” of antimicrobial prescribing. The antibiotic self-medication practices were assessed at the university campus and selected community pharmacies. Results: Metronidazole, ampicillin/cloxacillin (19%), amoxicillin (16%) and co-trimoxazole (12%) were the most frequently prescribed antimicrobials. Malaria (21%), followed by upper respiratory tract infection (19%), were the most frequent medical conditions in which antimicrobials were used. Over onehalf (56%) of the antimicrobial prescriptions were considered “appropriate” by the physician assesors; 23% of the cases “inappropriate”, while in 17% and 4% of cases, there were disagreement and query, respectively. There was a significant difference in the patterns of antimicrobial prescribing by physicians at both public and private hospitals, (χ2 = 16.808, df = 3, P< 0.01). Cough (20%), stomach upset (20%) and boils (20%) were the most frequent conditions in which the respondents self-medicated with antimicrobials. Ampicillin (23%), co-trimoxazole (17%) and tetracycline (16%) were the frequently used antimicrobial agents. Conclusion: Antimicrobial drug use was common. Sometimes, the agents were inappropriately used by the public and private health facilities as well as members of the public through self-medication.Keywords: Antimicrobial drug, Prescribing patterns, Self-medication, Surve

Patients’ Assessment of Pharmacists’ Medication Counseling in a Psychiatric Hospital in Nigeria

Purpose: To assess the impact of an educational intervention on pharmacists’ medication counselling practice, and evaluate the reliability of an instrument to assess medication counselling in a psychiatric setting.Methods: The study was undertaken on a sample of 297 psychiatric patients. Pre- and post-intervention surveys were conducted immediately after the patients had been attended to at the hospital’s outpatient pharmacy, using a self-administered questionnaire, comprising 4 components. Internal consistency of the questionnaire was computed using Cronbach’s alpha. Differences between means or proportions of variables were evaluated using Student’s t-test or Chi-square test, as appropriate.Results: The study achieved a response rate of 89 and 92 % for pre– and post–intervention surveys, respectively. Cronbach’s alpha reliability of the instrument was found to be 0.74. The mean values for the different components evaluated during the pre- and post–intervention surveys were: Needs assessment, 1.89± 0.76 and 2.58 ± 0.61; Precaution and warning, 1.50 ± 0.67 and 2.15 ± 0.63; Managing therapy, 1.87 ± 0.89 and 2.46 ± 0.78, and Communication, 2.23 ± 0.77 and 2.69 ± 0.62, respectively. The post–intervention results were significantly higher in all the components (p < 0.05). Conclusion: The educational intervention provided for pharmacists resulted in an improvement in patient counselling. The survey instrument achieved a fairly satisfactory reliability result in a psychiatric setting. Efforts to sustain this intervention are recommended.Keywords: Assessment, Patient counselling, Pharmacists, Psychiatric settin

Assessment of Knowledge, Interventional Practices for, and Impact of Malaria in Pregnancy among Parturient Women in a Nigerian Tertiary Healthcare Facility

Purpose: To assess knowledge of and intervention for malaria in pregnancy among immediate postpartum women, as well as the impact of malaria on some specific birth outcomes.Methods: A cross-sectional study in which 358 immediate postpartum women were recruited in the labour and maternity wards of University Benin Teaching Hospital, Benin City, Nigeria. Information on demographics, knowledge of malaria, and utilization of malaria interventions were assessed. Immediately after expulsion of placentae, both maternal and placental blood samples were collected from a subset (236) of the study group for parasitaemia and haematocrit determination.Results: The mean age of the women was 29.5 ± 4.55 years. Poor knowledge of adverse effects of malaria during pregnancy was observed. Using an arbitrary scale, low, average and high knowledge of malaria were recorded in 22.4, 50.3 and 27.3 % of the respondents, respectively. Use of insecticidetreated net (ITN) was reported by 48.9, 19.1 and 14.3 % of women with high, average and low knowledge of malaria respectively (p = 0.004) while there was no statistical difference in the use of sulphadoxine/pyrimethamine (IPTp-SP) among the different levels of knowledge of malaria as its practice was reported by 61, 70 and 78.7 % of women with high, average, and low knowledge of malaria, respectively, (p = 0.078). Incidence rates of parasitaemia of 4.0, 1.6 and 6.25 % were obtained using peripheral microscopy, placental microscopy and peripheral rapid diagnostic test (RDT), respectively. Maternal infection was significantly associated with low birth weight (p = 0.020, peripheral microscopy; p = 0.020, placental microscopy) and maternal anaemia (p = 0.009, peripheral microscopy; p = 0.000, peripheral RDT).Conclusion: Knowledge gap still exists with regard to malaria and its interventions among mothers. Knowledge of malaria significantly influences the use of insecticide-treated bed nets. The negative impact of malaria infection during pregnancy is maternal anaemia and low birth weight infants.Keywords: Insecticide-treated bed nets, Low birth weight, Malaria in pregnancy, Maternal anaemia

Peer education: The effects on knowledge of pregnancy related malaria and preventive practices in women of reproductive age in Edo State, Nigeria

<p>Abstract</p> <p>Background</p> <p>There is limited uptake of measures to prevent malaria by pregnant women in Nigeria which is often related to the lack of knowledge on Malaria in Pregnancy (MIP) and its effects on mother and foetus. This study, explored peer to peer education as a tool in raising knowledge of MIP among women of child bearing age.</p> <p>Methods</p> <p>1105 women of child bearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP and use of preventive measures. Thereafter, a peer education campaign was launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared.</p> <p>Results</p> <p>In the pre-assessment women on average answered 64.8% of the question on malaria and its possibility to prevent malaria correctly. The peer education campaign had a significant impact in raising the level of knowledge among the women; after the campaign the respondents answered on average 73.8% of the questions correctly. Stratified analysis on pre and post assessment scores for malaria in general (68.8 & 72.9%) and MIP (61.7 & 76.3%) showed also significant increase. Uptake of bed nets was reported to be low: 11.6%</p> <p>Conclusion</p> <p>Peer education led to a significant increase in knowledge of malaria and its prevention but we could not asses its influence on the use of preventive measures.</p

Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya

<div><p>We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap.</p></div

The Burden of Malaria in Pregnancy and Intervention Strategies – A Review

Malaria infection during pregnancy results in poor maternal and foetal outcomes, especially maternal anaemia and low birth weight infant. Anaemia results from depletion of erythrocytes which are attacked by the malaria parasites. Low birth weight is primarily a consequence of intrauterine growth restriction (IUGR). The pathologic disarray of placental basal structure following intense infiltration of leucocytes into the placenta is known to mediate IUGR. Identifying other pathogenic factors which may be present would greatly improve the intervention strategies. In this review, the burden of malaria infection and malaria in pregnancy (MIP), histological and pathologic changes in parasitized placenta and protection against MiP are discussed with reference to infection with Plasmodium falciparum. The level of utilization of intervention measures, the need for urgent assessment of new anti-malarial drugs (e.g. artemisinin-based combination therapies, ACTs) in pregnancy and the problem posed by poor detection of placental parasitaemia are highlighted.Keywords: anaemia, intrauterine growth restriction, low birth weight, malaria, Plasmodium falciparumNigerian Journal of Pharmaceutical Research, Vol. 9 No 1 pp. 82 - 91 (February 2011