title: Prescription patterns and drug use among pregnant women with febrile Illnesses in Uganda: a survey in out-patient clinics.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Public Health, Makerere University and Commissioner Health Services, Ministry of Health, Box 7272, Kampala, Uganda. vpadmn@infocom.co.ug
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mbonye
authors.forename: Josephine
authors.initials: J
authors.lastname: Birungi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Yanow
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology / Q000469:parasitology; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology / Q000469:parasitology; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents; D000962:Antimalarials