Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study.
BACKGROUND
Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs.


OBJECTIVE
To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State.


METHODS
Audit of 665 patient records at six private and seven government health facilities in 2003.


RESULTS
Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%), sulphadoxine-pyrimethamine (22.7%) or artemisinin derivatives alone (15.8%). Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5%) were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments.


CONCLUSIONS
Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.
Meremikwu
Martin
M
Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria. mmeremiku@yahoo.co.uk
Okomo
Uduak
U
Nwachukwu
Chukwuemeka
C
Oyo-Ita
Angela
A
Eke-Njoku
John
J
Okebe
Joseph
J
Oyo-Ita
Esu
E
Garner
Paul
P
D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008485:Medical Audit; D009549:Nigeria; D010963:Plasmodium falciparum / Q000187:drug effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice; D012424:Rural Population; D012717:Sesquiterpenes / Q000627:therapeutic use*; D014505:Urban Population
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; C031327:artemisinin