Objective: In view of the increased prevalence of chloroquine resistance and the recent WHO malaria drug policy recommendation to use a combination of therapies especially artemisinin-based combination therapies (ACTs) in Africa, we tried to assess the prescription pattern and level of knowledge in the use of antimalarial drugs including ACTs among medical practitioners in Osogbo metropolis, southwest Nigeria, an endemic area of Plasmodium falciparum infection. Method: Questionnaires were sent to every medical practitioner working in all the health facilities in the metropolis, namely, a teaching hospital, general hospital, mission hospital, comprehensive health centre and 20 privately owned health facilities. Of the total of 100 questionnaires sent out, 96 were completed and returned while the remaining 4 were not returned. The questionnaires were self-administered. Result: Sixty-seven percent of the respondents work in the teaching hospital, while the remaining 33% either work in the general hospital or in private medical practice. 82.4% prescribed chloroquine despite the widespread resistance, indicating that this remains the most prescribed antimalarial drug. 45.7% apply the dosage regimen correctly (Χ2 P<0.005); 66.7% prefer the use of chloroquine injection; 85.6% give chlorpheniramine with chloroquine because of pruritus; 14.4% give it because of its synergistic and reversal mechanism. Other commonly prescribed drugs include sulphadoxine-pyrimethamine (71.1%), halofantrine (53.6%), amodiaquine and quinine (51.1%), mefloquine (20.6%), artemisinin or ACTs (18.6%) and co-trimoxazole (17.5%). Of these, the dosage regimen was applied correctly for: sulphadoxine-pyrimethamine (30.9%), halofantrine (12.8%), amodiaquine (3.2%), co-trimoxazole (2.1%), ACTs, quinine and artemisinin monotherapy (1.1%). About 40% of practitioners prefer the use of combination therapy in the future. Conclusion: There is an obvious paucity of knowledge on the prescription of antimalarial drugs. The proportion of practitioners anticipating the use of combination therapy in the future indicates that with continued medical education the use of combination therapies especially ACTs will be accepted easily.

ABSTRACT: Randomised controlled trials (RCT s) are gold standard in the evaluation of treatment efficacy in medical investigations, only if well designed and implemented. Till date, distorted views and misapplications of statistical procedures involved in RCTs are still in practice. Hence, clarification of concepts and acceptable practices related to certain statistical issues involved in the design, conduct and reporting of randomised controlled trials is needed. This narrative synthesis aimed at providing succinct but clear information on the concepts and practices of selected statistical issues in RCT s to inform correct applications. The use of tests of significance is no longer acceptable as means to compare baseline similarity between treatment groups and in determining which covariate(s) should be included in the model for adjustment. Distribution of baseline attributes simply presented in tabular form is however, rather preferred. Regarding covariate selection, such approach that makes use of information on the degree of correlation between the covariate(s) and the outcome variable is more in tandem with statistical principle(s) than that based on tests of significance. Stratification and minimisation are not alternatives to covariate adjusted analysis; in fact they establish the need for one. Intention-to-treat is the preferred approach for the evaluation of primary outcome measures and researchers have responsibility to report whether or not the procedure was followed. A major use of results from subgroup analysis is to generate hypothesis for future clinical trials. Since RCT s are gold standard in the comparison of medical interventions, researchers cannot afford the practices of distorted allocation or statistical procedures in this all important experimental design method.