Antimalarial prescribing patterns in state hospitals and selected parastatal hospitals in Lagos, Nigeria

Malaria is a curable and preventable disease and it is a major public health problem in Nigeria. Chloroquine was the first line drug in its treatment in Nigeria until recently where the Artemisinin based Combination Therapies (ACTs) are being promoted. Inappropriate prescribing, i.e., the failure to prescribe drugs in accordance with guidelines based on scientific evidence to ensure safe, effective, and economic use, is an irrational drug use behavior. Increased benefits from chloroquine or a slowdown of progression to resistance could be achieved by improving prescribing practice, drug quality, and patient compliance.

To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State.

The study was carried out in all the ten government General Hospitals under Lagos State Hospitals Management Board (now Lagos State Health Service Commission), one parastatal hospital and one oil company clinic, using patient prescriptions. One hundred prescriptions each for adults and children for each month for a period of one year (January to December 2000) were systematically sampled. Where there were fewer than 100 prescriptions in a month, all the prescriptions available were sampled for analysis.

Average number of drugs per encounter in all the hospitals was 4.259 +/- 0.009. Average number of injections per encounter was 1.215 +/- 0.009. About 48.5% of all the presriptions had at least one injection while 40.9% of the prescriptions had dipyrone injection. Average drug cost per encounter was N 147.40 +/- 0.765. Percentage of encounters with chloroquine was 82.5% followed by sulphadoxine-pyrimethamine 14.2%. Percentage of prescriptions with correct dose of chloroquine was 47.5%

Polypharmacy exists in all the hospitals. The average number of drugs per encounter for the majority of the hospitals was above 4. Less than half of the prescriptions had the correct dose of chloroquine. This study can serve as a baseline for intervention on irrational prescribing.