Antimalarial Prescription Patterns and Adherence to the WHO 2024 Guidelines among Pregnant Women: A Case Study from a Nigerian Tertiary Hospital

Background: Adherence to the World Health Organization (WHO) treatment guidelines for malaria in pregnancy (MiP) is crucial for improved maternal and perinatal health outcomes. This study assessed antimalarial prescription patterns and adherence of each prescription to the WHO 2024 MiP guidelines using a Nigerian tertiary hospital as a case study. Methods: A retrospective, cross-sectional study was conducted using antenatal care (ANC) records of pregnant women who attended ANC at FMC Makurdi in 2024. A total of 1,062 eligible prescriptions were selected via systematic random sampling and analysed using R. Descriptive statistics summarized patient demographics and treatment patterns. Adherence to guidelines was subsequently assessed. Results: Among the 1,062 prescriptions analysed, the majority (96.1%) were for IPTp rather than acute treatment with most for women in their second (44.4%) or third trimester (55.0%). Overall, sulfadoxine-pyrimethamine (SP) was the most prescribed antimalarial medication during pregnancy (96.0%). Artemether-lumefantrine (AL, 92.5%) and SP (99.9%) were mostly prescribed for uncomplicated malaria and IPTp respectively. Adherence to treatment guidelines was high (99.4%); however, trimester-specific deviations were noted where most instances of non-compliance occurred in the first trimester. Conclusion: While overall adherence to MiP guidelines was high at FMC Makurdi, specific deviations—particularly regarding first-trimester prescriptions and the use of Al for prevention—were observed. These findings underscore the need for continuous education and reinforcement of guideline adherence among healthcare providers to ensure optimal and safe antimalarial management especially in malaria-endemic settings.