Survey of Drugs Prescribed for the Treatment of Malaria and Compliance Level among Pregnant Women in Tertiary Hospitals in Enugu State, Nigeria

ABSTRACT 

The purpose of this study was to survey antimalaria drug prescriptions and compliance to treatment among pregnant women attending antenatal clinic in the two tertiary hospitals in Enugu State. The study surveyed 92 doctors from UNTH and ESUTH Parklane, Enugu. 368 pregnant women from both hospitals (156 from ESUT and 212 From UNTH) who consented were surveyed. Purposive sampling was used to select the two tertiary hospitals. Proportionate stratified random sampling was used to select the pregnant women for the study. Convenience sampling was then used to reach the respondents. Questionnaire was used to identify the drugs prescribed by the doctors and their reason for prescription while the other questionnaire was used to elicit compliance level and factors affecting compliance from pregnant mothers. Descriptive statistics using frequency, percentages, means and standard deviations were computed for the demographic variables. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 15. The result revealed that the most frequently prescribed antimalaria drug for pregnant women was Artemisinin combined therapy, (76.3%), (73.1%) Artemether Lumefantrine 32.9%, 56.5%, Sulphadoxine Pyrimethamine 31.8% & 42.4% for first and second choice drug, Quinine 10.6% & 3.5% for first and second choice drug, Artesunate single therapy 5,9% & 2.4%. The least prescribed drug were Amodiaquine, Chloroquine, Proguanil and Halofantrine. Their major reason was gestational age of pregnancy 67.1%, severity of signs and symptoms 38.8%, past experience 28.2%. The least reasons were age of the woman, hospital policy, cost of drug, parity of the woman, availability of drug etc. The result also showed that pregnant women comply more to taking the number of prescribed drug not more 4.31, not less 3.91, mean values. The least in the compliance is timing, saving for future use, taking another drug in place of the prescribed one. The results suggest that there is high compliance only in number of dosage prescribed but low compliance in timing, completion and sticking to the particular antimalaria drugs. The major factors affecting compliance were forgetfulness, quick recovery, side effects. Doctors prescribed more of artemisinin combination therapy in both first and second choice drug and their reasons were to consider gestational age, severity of signs and symptoms. Hypothesis was tested using Spearman’s rho correlation analysis; there was no significant association between the levels of education of women with their level of compliance. There is a relationship between doctors’ years of experience with their reasons for their choice of prescription shown using chi-square cross tabulation. It is therefore recommended that patient centred care will be vital to encourage compliance to new treatment algorithms developed in response to the changing malaria environment in Enugu. Efforts should be made by the Federal Ministry of Health and other stakeholders to organise training and refresher courses on the current and national antimalaria treatment guidelines. Lastly, behaviour change communication (BCC) programmes should be initiated to aid in awareness creation on the consequences of non compliance.

TABLE OF CONTENTS

Title Page i

Approval ii

Certification iii

Dedication iv

Acknowledgement v

Table of Content vi

List of Appendix ix

List of Table x

List of Figure xi

Abstract xii

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Statement of the Problem 4

Purpose of the Study 5

Research Questions 5

Research Hypothesis 6

Significance of the Study 6

Scope of the Study 7

Operational definition of terms 7

CHAPTER TWO: LITERATURE REVIEW

Conceptual review 9

National policy on malaria treatment 10

Common antimalaria drugs prescribed in pregnancy 12

Prescribers reasons for choice of anti-malaria drugs they prescribe during pregnancy 19

Compliance to Drug Taken and its Importance 22

Factors that influence compliance 25

Theoretical Review 29

Theory of reasoned action(TRA) 29

Empirical Review 31

Summary of literature review 41

CHAPTER THREE: RESEARCH METHOD

Research design 43

Area of study 43

Population of the study 45

Inclusion criteria 45

Sample size 46

Sampling technique 46

Instrument for data collection 47

Validity of instrument 48

Reliability of the instrument 48

Ethical Consideration 49

Procedure for Data Collection 49

Method of data analysis 50

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

Research question 1 54

Research question 2 56

Research question 3 57

Research question 4 60

Hypothesis testing. 61

Summary of findings 64

CHAPTER FIVE: DISCUSSION OF FINDINGS, SUMMARY, CONCLUSION AND RECOMMENDATIONS

Discussion of findings 66

Implications of the study to Nursing Practice 71

Limitations to the study 72

Suggestion for further study 72 

Summary of the study 72

Conclusion 74

Recommendations 74

References 76

Appendix

· Calculation of sample size

· Distribution of sample size

· Questionnaire for doctors

· Questionnaire for pregnant women

· Approval letters from UNTH Ituku-Ozalla and Enugu State Ministry of Health.