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

Accuracy of History, Wheezing, and Forced Expiratory Time in the Diagnosis of Chronic Obstructive Pulmonary Disease

OBJECTIVE: To determine the accuracy of the history and selected elements of the physical examination in the diagnosis of chronic obstructive pulmonary disease (COPD). DESIGN: Independent blind comparison of the standard clinical examination (evaluating the accuracy of history, wheezing, and forced expiratory time [FET]) with spirometry. The gold standard for diagnosis of COPD was a forced expiratory volume at 1 second (FEV(1)) below the fifth percentile (adjusted for patient height and age). SETTING: Seven sites in 6 countries, including investigators from primary care and secondary care settings. PARTICIPANTS: One hundred sixty-one consecutive patients with varying severity of disease (known COPD, suspected COPD, or no COPD) participated in the study. MAIN RESULTS: One hundred sixty-one patients (mean age 65 years, 39% female, 41% with known COPD, 27% with suspected COPD, and 32% normal) were recruited. Mean (±SD) FEV(1) and forced vital capacity were 1,720 (±830) mL and 2,520 (±970) mL. The likelihood ratios (LR) for the tested elements of the clinical examination (and their P values on χ2 testing) were: self-reported history of COPD, 5.6 (P < .001); FET greater than 9 seconds, 6.7 (P < 0.01); smoked longer than 40 pack years, 3.3 (P = .001); wheezing, 4.0 (P < .001); male gender, 1.6 (P < .001); and age over 65 years, 1.6 (P = .025). The accuracy of these elements was not appreciably different when reference standards other than FEV(1) below the 5th percentile were applied. Only 3 elements of the clinical examination were significantly associated with the diagnosis of COPD on multivariate analysis: self-reported history of COPD (adjusted LR 4.4), wheezing (adjusted LR 2.9), and FET greater than 9 seconds (adjusted LR 4.6). Area under the receiver operating characteristic curve for the model incorporating these 3 factors was 0.86. CONCLUSIONS: Less emphasis should be placed on the presence of isolated symptoms or signs in the diagnosis of COPD. While numerous elements of the clinical examination are associated with the diagnosis of COPD, only 3 are significant on multivariate analysis. Patients having all 3 of these findings have an LR of 33 (ruling in COPD); those with none have an LR of 0.18 (ruling out COPD)

How Far Is the Sternal Angle from the Mid-right Atrium?

BACKGROUND: The central venous pressure (CVP) is commonly estimated at the bedside by measuring the height of the jugular venous pressure (JVP) relative to the sternal angle. Determining the CVP from this measure requires that the distance from the sternal angle to the level of the mid-right atrium be known. Classical clinical teaching quotes this distance as 5 cm, invariable between patients, and invariable with changes in the elevation of the patient's head. The validity of these JVP characteristics has been questioned. OBJECTIVES: To measure the distance from the sternal angle to the level of the mid-right atrium (SA-RA) and determine if the SA-RA distance varies with patient position. METHODS: Cross-sectional study conducted at a single-center teaching hospital on ambulatory patients undergoing computed tomography of the chest. RESULTS: One hundred sixty patients were included. The median SA-RA distance with the patient lying supine was 5.4 cm (interquartile range, 4.7 to 6.1). Using geometric calculations to estimate the SA-RA distance when the patient's torso was elevated above the supine position, the median SA-RA distance was calculated to be 8 cm, 9.7 cm, and 9.8 cm at 30, 45, and 60 degrees elevation respectively. The SA-RA distance varied extensively between patients and was independently associated with smoking, age, and antero-posterior chest diameter. CONCLUSIONS: The distance from the sternal angle to the level of the mid-right atrium varies considerably between individuals and with patient position. When using the JVP to calculate the CVP, physicians need to consider specific patient factors and the patient's position