title: Antimalarial treatment patterns among pregnant women attending antenatal care clinics in south east Nigeria and the future implications.
abstract: BACKGROUND
  Prompt and effective treatment of malaria in pregnancy in accordance with recommended guidelines is essential to help prevent adverse events among pregnant mothers and the foetus.
  
  
  OBJECTIVE
  The aim of this study was to assess current prescribing of antimalarial medicines in pregnancy against policy guidelines in south east Nigeria to provide future guidance.
  
  
  METHODS
  A review of prescription records of pregnant women treated for malaria over a 6-month period between August 2013 and January 2014 was carried out to assess the prescribing patterns for both the prevention and treatment of malaria in each trimester and analyzed for conformity to recommended guidelines.
  
  
  RESULTS
  Among 859 antenatal records reviewed, the majority (83.2%) were in the second and third trimesters. Artemisinin-based combination therapies (40.9%) and sulfadoxine-pyrimethamine (37.5%) were the most prescribed antimalarial medicines for both treatment and prophylaxis (prevention), respectively, in all trimesters. Overall, 68.5% of the prescriptions conformed to guideline recommendations, with the prescriptions for non-recommended drugs occurring most often in the first trimester. In the second and three trimesters, up to 79.9% of pregnant women received appropriate medicines for both treatment and prevention of malaria, with artemether-lumefantrine the most prescribed regimen.
  
  
  CONCLUSIONS
  Current practice indicates greater conformity with guidelines particularly in the second and three trimesters vs previous studies. However, there are still concerns with prescribing practices in the first trimester, especially in private health facilities. This needs addressing.
authors.affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, NnamdiAzikiwe University, Awka, Nigeria.
authors.forename: Charles
authors.initials: C
authors.lastname: Ezenduka
authors.affiliation: Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, NnamdiAzikiwe University, Awka, Nigeria.
authors.forename: Chizoba
authors.initials: C
authors.lastname: Nworgu
authors.affiliation: Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
authors.forename: Brian Barr
authors.initials: BB
authors.lastname: Godman
authors.affiliation: Department of Clinical Pharmacology, School of Medicine, University of Botswana, Gaborone, Botswana.
authors.forename: Amos
authors.initials: A
authors.lastname: Massele
authors.affiliation: Department of Pharmaceutical Microbiology & Biopharmaceutics, Faculty of Pharmaceutical Sciences, NnamdiAzikiwe University, Awka, Nigeria.
authors.forename: Charles
authors.initials: C
authors.lastname: Esimone
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000962:Antimalarials / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D009549:Nigeria; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care / Q000458:organization & administration*; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
keywords: Antimalarial medicines; Nigeria; pregnant women; treatment guidelines