Utilization and Incidence of Adverse Drug Reactions to Artemisinin-Based Combination Therapy Among Pregnant Women in an Ambulatory Care Facility in Southwestern Nigeria
As increasing number of countries in sub-Sahara Africa is changing to artemisinin-based combination therapy (ACT) as first or second line treatment for malaria, hence, post-marketing surveillance of ACT use in vulnerable population is a necessity. This study aimed at evaluating the extent of use and assessing the incidence of adverse reactions to artemisinin-based combination therapy among pregnant women in Ibadan, southwestern Nigeria. A prospective cross-sectional study was conducted at the antenatal clinic of Adeoyo Maternity Hospital in Ibadan, between 15th March and 16th May, 2008. Pre-tested questionnaires were administered to 140 consented pregnant women at the study site. Of these, 134 (95.7%) properly filled questionnaires were subsequently analyzed. Descriptive statistics were used to summarize the data. Chisquare was used for tests of proportions, with p<0.05 considered statistically significant. More than three fourth, 120 (89.6%) of the respondents had malaria in their current pregnancy. Of these, 115 (95.8%) took antimalarial drugs. Of the cohort, 70 (60.9%) took ACT group of antimalarials with 42 (60.0%) of the respondents having their administered ACTs prescribed by physician, 15 (21.4%) took ACTs on recommendation or advice by other healthcare professionals, while 13 (18.6%) took the ACT on selfinitiated basis. Fifteen (21.4%) utilized the ACT during the first trimester. Incidence of experiences of adverse reactions to ACT was generally mild, <10% for most of the reactions. The majority, (75.0%) did not report the reactions to health care practitioners, mostly for reason of tolerability of the adverse reactions (50%). The use of ACT for malaria treatment among pregnant women in Ibadan, is common. Efforts to monitor the use of ACTs among this group of vulnerable population are recommended. Furthermore, institutionalization of a functioning and effective mechanism to increase awareness and improve reporting of adverse effects of ACT generally is also suggested.
Keywords: Malaria, artemisinin-based combination therapy, pregnancy, adverse drug reaction, Nigeria