Malaria chemoprophylaxis during pregnancy: a survey of current practice amongst general practitioners in Port Harcourt, Nigeria

Background: Malaria is a common health problem especially among the pregnant women in endemic countries such as Nigeria. Sulphadoxine/pyrimethamine (SP) has been recommended by the World Health Organisation (WHO) for malaria chemoprophylaxis in pregnancy and has been incorporated into our national malaria control programme. General medical practitioners provide prenatal care for significant proportion of our women in pregnancy.Aim: To examine the current knowledge and practice of malaria chemoprophylaxis during pregnancy among general medical practitioners in Port Harcourt, southern Nigeria.Methods: It was a questionnaire based study of 90 general medical practitioners in Port Harcourt, southern Nigeria which sought for their socio-demographic characteristics and knowledge and practice of malaria chemoprophylaxis during pregnancy. The data were entered into a personal computer and analysed using SPSS for windows version 10.0 and presented as frequency tables and percentages.Results: Of the 90 questionnaires, 59 duly completed forms were retrieved, giving a response rate of 65.60%. The age range of the respondents was 21-60 years with 31-40 years as the most common range. Only 33(55.93%) respondents knew the current malaria chemoprophylactic agent in pregnancy as recommended by WHO. Almost all (98.30%) respondents administered malaria chemoprophylaxis routinely to their antenatal women but only 44.06% administered correctly SP as recommended.Conclusion: The knowledge and practice of the WHO recommended malaria chemoprophylaxis in pregnancy among general medical practitioners is below average. Training and re-training of these primary care physicians on the use of sulphadoxine-pyrimethamine will tremendously improve their knowledge and practice of this WHO recommended chemoprophylactic agent in pregnancy which will in turn reduce malaria - related perinatal and maternal complications.Keywords: Malaria, Chemoprophylaxis, Pregnancy, WHO, General Practitioner

Infections with spore-forming bacteria in persons who inject drugs, 2000-2009.

Since 2000 in the United Kingdom, infections caused by spore-forming bacteria have been associated with increasing illness and death among persons who inject drugs (PWID). To assess temporal and geographic trends in these illnesses (botulism, tetanus, Clostridium novyi infection, and anthrax), we compared rates across England and Scotland for 2000-2009. Overall, 295 infections were reported: 1.45 per 1,000 PWID in England and 4.01 per 1,000 PWID in Scotland. The higher rate in Scotland was mainly attributable to C. novyi infection and anthrax; rates of botulism and tetanus were comparable in both countries. The temporal and geographic clustering of cases of C. novyi and anthrax into outbreaks suggests possible contamination of specific heroin batches; in contrast, the more sporadic nature of tetanus and botulism cases suggests that these spores might more commonly exist in the drug supply or local environment although at varying levels. PWID should be advised about treatment programs, injecting hygiene, risks, and vaccinations

Practical Approach to Sub-specialty Training in Maternal Foetal Medicine (MFM) in Nigeria

The heavy burden of maternal and perinatal morbidities and mortalities in Nigeria, most of which are MFM-related has stimulated the introduction of subspecialty training in MFM. Unfortunately in the available curriculum, less attention was paid to the ultrasound-related aspect of the training and also there was less clarity on the order of navigation through the various modules of the training. The objective of the present study therefore was to design a sub-specialty training curriculum in MFM with practical approach to its execution, taking into consideration the Nigerian ethno- cultural peculiarities, its disease topography and the level of its economic development. It was of mixed design study, with both observational and review components. A literature search and telephone communication with MFM specialists in tertiary health institutions in Nigeria on the subject were carried out. There was no structured training program in MFM in Nigeria. A competency-based modular training framework whereby acquisition of ultrasound-based competencies intertwined with the maternal medicine components of the training was proposed. The ultrasound modules to be covered were as following: first trimester scan at 11+0 to 13+6 weeks, the 20 + 0 to 23 + 6 weeks scan, growth and doppler ultrasound, cervical assessment, foetal echocardiography, application of ultrasound in the management of labour, screening for and diagnosis of placenta accrete spectrum and invasive procedures. Successful completion of the training modules, including rural posting, rotation in allied disciplines will earn the trainee an exemption from the dissertation component of the part II fellowship examination and award of fellowship or diploma in MFM, depending on whether the trainee completed the invasive module or not