Page 90 - 78_04

M.
MALIK
&
col

Laboratory
diagnosis
can
improve
the
treatment
of
malaria,
but
the
results

of
the
present
study
showed
that
only
few
facilities
were
offering
any
laboratory

diagnostic
services
for
the
confirmation
of
malaria
before
prescribing
anti-­-malarial

drugs
to
the
patients.
However,
it
was
observed
that
prescribing
of
anti-­-malarial

drugs
after
laboratory
confirmation
only
decreased
significantly
the
total
number

of
prescriptions
in
Malawi
(11).

Antibiotics
are
usually
not
preferred
in
the
treatment
of
malaria
and
do
not

conform
to
the
treatment
guidelines.
But
prescribing
of
anti-­-malarial
drugs
along

with
an
antibiotic
and
an
antipyretic
was
seen
as
a
common
practice
at
both
public

and
private
healthcare
facilities.

The
results
of
the
present
study
are
in
line
with
another
study
indicating

overuse
of
antibiotics
and
injections
promoting
irrational
drug
use
and
higher
rate

of
emergence
of
resistance
of
anti-­-malarial
drugs
(12).
Dose
of
the
anti-­-malarial

drugs
was
not
calculated
as
per
patient
body
weight
and
drugs
were
mostly
being

prescribed
by
their
brand
names.
The
overall
low
generic
prescribing
observed

was
comparable
to
the
results
of
the
other
studies
conducted
in
Nigeria
and
Nepal

(13,
14).

Chloroquine
is
usually
the
most
commonly
prescribed
oral
antimalarial

drug
in
most
of
the
countries
as
compared
to
quinine
and
other
anti-­-malarial
drugs

due
to
its
continuous
availability,
affordable
price
or
an
established
pattern
by

which
most
doctors
treat
uncomplicated
malaria
initially
by
giving
chloroquine,

followed
by
oral
quinine
for
non-­-responding
cases.
Similar
pattern
was
followed
in

healthcare
facilities
in
Nigeria
(15).
Although,
Chloroquine
is
recommended
as
first

line
drug
in
the
treatment
of
all
types
of
malaria
while
Sulfadoxine/pyrimethamine

and
artemether/lumefentraine
are
only
recommended
as
first
line
drugs
for

confirmed
cases
of
Plasmodium
falciparum
in
national
standard
treatment

guidelines
of
Pakistan.

The
prevalence
of
P.
vivax
is
more
common
in
Punjab
while
P.
falciparum
is

more
frequently
seen
in
Baluchistan
and
Sindh
(4).
But
the
results
of
the
present

study
showed
significant
use
of
artemisinin
based
combination
therapy
for
the

treatment
of
malaria
in
Punjab
although
most
of
them
were
aware
of
the
fact
that

P.
vivax
is
more
common
in
Punjab.

Rational
prescribing
requires
that
prescribers
follow
a
standard
process
of

prescribing
and
in
accordance
with
standard
treatment
guidelines.
High
rate
of

inappropriate
prescriptions
for
treating
malaria
are
mostly
due
to
lack
or
incorrect

doses,
frequency,
dosages
and
duration
of
treatment
(15).

The
result
of
the
present
study
showed
poor
adherence
of
prescribers
with

the
standard
treatment
guidelines
for
malaria.
Prescribers
having
different

designations
and
levels
of
experience
working
in
public
or
private
sector
were
not

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