Drug utilisation study of antimalarials for the treatment of hospitalised children under five in south-eastern Nigeria

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PurposeThis study aimed at describing the trend in the use of antimalarials for the treatment of malaria in children under 5 years from year 2000 to 2006 in south-eastern Nigeria. Adherence to the 2005 National Antimalarial Treatment Policy was
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[ ] Please tick the box if you do NOT  wish to receive this information. E-MAIL ALERTING SERVICE We also offer an alerting service to our author base via e-mail, with regular special offers and competitions. If you DO  wish to receive these, please opt in by ticking the box [ ]. If, at any time, you wish to stop receiving information, please contact the Database Group (databasegroup@wiley.co.uk) at John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, PO19 8SQ, UK. TERMS & CONDITIONS This offer is exclusive to Wiley Authors, Editors, Contributors and Editorial Board Members in acquiring books for their personal use. There should be no resale through any channel. The offer is subject to stock availability and may not be applied retrospectively. This entitlement cannot be used in conjunction with any other special offer. Wiley reserves the right to vary the terms of the offer at any time. PLEASE RETURN THIS FORM TO:  Database Group (Author Club), John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, PO19 8SQ, UK author@wiley.co.uk  Fax: +44 (0)1243 770154     U   N   C   O   R   R   E   C    T   E   D    P   R   O   O   F   S ORIGINAL REPORT Drug utilisation study of antimalarials for the treatment of hospitalised children under five in south-eastern Nigeria Chinwe Victoria Ukwe Q2 and Obinna Ikechukwu Ekwunife* Clinical Pharmacy Q3 and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria SUMMARY This Q4 study aimed at describing the trend in the use of antimalarials for the treatment of malaria in children under 5 yearsfrom year 2000 to 2006 in south-eastern Nigeria. Adherence to the 2005 National Antimalarial Treatment Policy wasassessed. Quality of drug use was also evaluated. Quality indices studied were the use of international non-proprietary name(INN)inprescription,numberantimalarials perepisodeanduseofdrugsfromessential druglist.Thestudywasretrospectiveand longitudinal, using data obtained from in-patients folders of children under 5 years, hospitalised for malaria infection in11 secondary health care centres in south-eastern Nigeria. The result of the study showed that chloroquine was mostly usedfor treating severe malaria in children less than 5 years despite the indication of a switch to quinine and parenteralartemisinins by the National Treatment Policy. Prescriptions of drugs were also not by INN names. However, manyprescribers do not practice polypharmacy and most of the drugs used in secondary health care centres for treatment of severemalaria were in the essential drug list. There is a need for further studies to establish factors that affect the dissemination anduse of treatment guidelines in Nigeria. Copyright # 2008 John Wiley & Sons, Ltd. key words —malaria; Nigeria; drug utilisation research  Received 15 May 2008; Accepted 30 August 2008 INTRODUCTIONOver 90% of the world’s public health burden frommalaria is borne by populations in Africa. 1 Malaria isone of the four commonest causes of childhoodmortality in Nigeria. 2 It has been estimated that underfive children have up to 2–4 attacks of malariaannually. 2 Severe malaria is a medical emergencyrequiring in-patient care. In children, malaria infec-tions easily degenerate into severe malaria because of their low immunity, especially if prompt and effectivetreatment is not initiated on time. Severe malaria inchildren is often devastating and can lead to manycomplicationsincludinganemia,cerebralmalariawithassociated neuronal damage, hypoglycaemia, acido-sis, breathing difficulties, renal failure and heaemo-globinuria. 3 One of Roll Back Malaria strategies and also a keyintervention in the Nigerian Antimalarial TreatmentPolicy is that patients with malaria should have accessto appropriate and adequate treatment within 24 hoursof the onset of symptoms. Antimalarial drugs used insevere case management should be drugs for whichthere is sufficient evidence of efficacy and safety fromlocal and global controlled clinical studies and fromexperience in general use. 2 Evidence based practicecoupled with rational use of antimalarials would nodoubt contribute immensely in rolling back malaria inNigeria. Monitoring of prescriptions and drugutilisation studies could identify associated problemswith drug use and provide feedback to the prescriberso as to create awareness for rational use of drugs. 4 pharmacoepidemiology and drug safety  2008;  17 : 1–6 Published online in Wiley InterScience (www.interscience.wiley.com)  DOI : 10.1002/pds.1669 *Correspondence to: O. I. Ekwunife, Clinical Pharmacy and Phar-macy Management, University of Nigeria, Nsukka, Enugu, Nigeria.E-mail: obinna.ekwunife@unn.edu.ng Q Q3Q4 Copyright # 2008 John Wiley & Sons, Ltd.  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122
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