First trimester medication use in pregnancy in Cameroon: a multi-hospital survey

Abstract

Background: There is a paucity of epidemiological data on medication use in pregnancy in Cameroon.

Methods: Between March and August 2015, 795 pregnant women attending 8 urban and 12 rural hospitals in Cameroon for antenatal (ANC) or other care were interviewed on first trimester medication use using structured questionnaires. Multivariate logistic regression was used to analyse the association of 18 sociodemographic factors with medication use.

Results: A total of 582 (73.2%) women took at least one orthodox (Western) medication during the first trimester, 543 (68.3%) women a non-pregnancy related orthodox medication, and 336 (42.3%)women a pregnancy related orthodox medication. 44% of the women took anti-infectives including antimalarials (33.6%) and antibiotics (20.8%).The other most common medications were analgesics (48.8%) and antianaemias (38.6%). Sulfadoxine/pyrimethamine, contraindicated in the first trimester of pregnancy, was the most commonly used antimalarial(13% of women).0.2% of women reported antiretroviral use. Almost 80% of all orthodox medications consumed by women were purchased from the hospital. 12.8% of the women self-prescribed. Health unit and early gestational age at ANC booking were consistent determinants of prescribing of non-pregnancy related, pregnancy related and anti-infective medications. Illness and opinion on the safety of orthodox medications were determinants of the use of non-pregnancy related medications and anti-infectives. Age and parity were associated only with non-pregnancy related medications.

Conclusion: This study has confirmed the observations of studies across Africa indicating the increasing use of medications during pregnancy. This is an indication that access to medicine is improving and more emphasis now must be placed on medication safety systems targeting pregnant women, especially during the first trimester when the risk of teratogenicity is highest.

Keywords: Cameroon; Medication; determinants; drug safety; drug use; pharmacoepidemiology; pharmacovigilance; pregnancy.

Fig. 1

Distribution of pregnancy and non - pregnancy related orthodox medications (N=795)

Fig. 2

Distribution of reported orthodox medications taken by class (N=795 women)

Fig. 3

Frequency of consumption of class of anti-infectives (N=795 women)

Fig. 4

Exposure of women to antimalarials (N=795). NB 30% of women who took a non sulfadoxine/pyrimethamineantimalaria did not report any malaria illness

Fig. 5

Exposure of women to antibacterials

Fig. 6

Othodox medication by FDA pregnancy categories (N=582) (based only on women who took orthodox medication, FDA category U=Undefined)