Assessment of Knowledge, Practice and Perception of Nigerian Medical Practitioners on COVID-19 and Its Treatment Using Antimalarial Drugs

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DOI: 10.21522/TIJPH.2013.09.02.Art028

Authors : Oluwafunmibi E. Anjorin, Olawunmi R. Oyerinde, Ikechukwu A. Orji, Mercy U. Ikechukwu-Orji, Ibukun A. Anjorin

Abstract:

Pharmaceutical interventions are being investigated as possible treatment options for COVID-19. Antimalarial drugs-Hydroxychloroquine and chloroquine are also being investigated in clinical trials due to their antiviral effects though their efficacy in the treatment of COVID-19 is largely inconclusive. This study assessed the knowledge, perception, and practice of prescribing these drugs in the treatment of COVID-19 by practicing medical doctors in Nigeria. The survey was conducted online using Google forms sent via a link on WhatsApp© and Facebook© through the authors’ contacts to medical doctors in the six geo-political zones of Nigeria from April-May 2020. Ethical issues were addressed by ensuring the anonymity of respondents, voluntary participation, and non-incentivized. Descriptive statistics were used to determine the mean and frequencies of data generated using SPSS version 22. Responses were obtained from 145 medical doctors with mean age of 37.78±6.47 years and 10.9±5.58 years of practice experience. All the respondents knew that the virus affects the lungs. Over 48% of the doctors believed in the efficacy of the antimalarial drugs, and more than half of them thought it would be more effective for mild disease presentation. About 46.8% of respondents agreed to prescribe the drug to COVID-19 patients, and most based their decisions on case reports, recommendations of NCDC or WHO. However, 75.9% believed a randomized control trial should be conducted to determine the efficacy and safety of the drugs. Practicing doctors in Nigeria are knowledgeable on COVID-19, and their perceptions and decision to prescribe antimalarial drugs are largely dependent on clinical trial outcomes.

References:

[1] Greenland JR, Michelow MD, Wang L, London MJ. COVID-19 Infection: Implications for Perioperative and Critical Care Physicians. Anesthesiology. 2020 Jun; 132(6):1346–61. https://doi.org/10.1097/ALN.0000000000003303 PMID:32195698.

[2] Mani Mishra P, Uversky VN, Nandi CK. Serum albumin-mediated strategy for the effective targeting of SARS-CoV-2. Med Hypotheses. 2020 Apr; 140:109790. https://doi.org/10.1016/j.mehy.2020.109790 PMID:32353740.

[3] World Health Organization. Novel Coronavirus (COVID-19) Situation. WHO (June 11). 2020.

[4] Marzo, R. R., Ismail, Z., Htay, M. N. N., Bahari, R., Ismail, R., Villanueva III, E. Q., & Su, T. T. (2021). Psychological distress during pandemic Covid-19 among adult general population: Result across 13 countries. Clinical Epidemiology and Global Health, 10, 100708. https://doi.org/10.1016/j.cegh.2021.100708.

[5] Marzo, R. R., Singh, A., & Mukti, R. F. (2021). A survey of psychological distress among Bangladeshi people during the COVID-19 pandemic. Clinical epidemiology and global health, 10, 100693. https://doi.org/10.1016/j.cegh.2020.100693.

[6] Bhagavathula A, Aldhaleei W, Rahmani J, Mahabadi M, Bandari D. (2020). Novel Coronavirus (COVID-19) Knowledge and Perceptions: A Survey of Healthcare Workers (Preprint). https://doi.org/10.1101/2020.03.09.20033381.

[7] Li L quan, Huang T, Wang Y qing, Wang Z ping, Liang Y, Huang T bi, et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. Journal of Medical Virology. 2020.

[8] Nonpharmaceutical Interventions (NPIs) | CDC [Internet]. [cited 2020 Jun 24]. Available from: https://www.cdc.gov/nonpharmaceutical-interventions/index.html.

[9] Cortegiani A, Ippolito M, Ingoglia G, Einav S. Chloroquine for COVID-19: rationale, facts, hopes. Crit Care. 2020 May; 24(1):210. https://doi.org/10.1186/s13054-020-02932-4 PMID:32384908.

[10] Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020 Mar; 14(1):72–3. https://doi.org/10.5582/bst.2020.01047 PMID:32074550.

[11] Hashem AM, Alghamdi BS, Algaissi AA, Alshehri FS, Bukhari A, Alfaleh MA, et al. Therapeutic use of chloroquine and hydroxychloroquine in COVID-19 and other viral infections: A narrative review. Travel Med Infect Dis. 2020 May - Jun; 35:101735. https://doi.org/10.1016/j.tmaid.2020.101735 PMID:32387694.

[12] Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Jul; 56(1):105949. https://doi.org/10.1016/j.ijantimicag.2020.105949 PMID:32205204.

[13] Ria V, Palmeira A, Braga Costa L, Giandoni Perez L, Ribeiro VT, Lanza K, et al. Do we have enough evidence to use chloroquine/ hydroxychloroquine as a public health panacea for COVID-19? Simõ es e Silva 0 0 0 0-0 0 0 0-0 0 0 0-0 0 0 0 *. [cited 2020 Jun 24]; Available from: https://doi.org/10.1590/0037-8682-0155-2020.

[14] Htay MNN, Marzo RR, AlRifai A, Kamberi F, El-Abasiri RA, Nyamache JM, Hlaing HA, Hassanein M, Moe S, Su TT, Abas AL. Immediate impact of COVID-19 on mental health and its associated factors among healthcare workers: A global perspective across 31 countries. J Glob Health. 2020 Dec; 10(2):020381. doi: 10.7189/jogh.10.020381. PMID: 33214890; PMCID: PMC7649521.

[15] Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive Symptoms in COVID-19 Patients with Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol. 2020 Jun; 115(6):916–23. https://doi.org/10.14309/ajg.0000000000000664 PMID:3230176113.

[16] Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020 May; 158(6):1831 1833.e3. https://doi.org/10.1053/j.gastro.2020.02.055 PMID:32142773.

[17] Chen L, Lou J, Bai Y, Wang M. COVID-19 disease with positive fecal and negative pharyngeal and sputum viral tests. Am J Gastroenterol. 2020 May; 115(5):790. https://doi.org/10.14309/ajg.0000000000000610 PMID:32205644.

[18] Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May; 97(5):829–38. https://doi.org/10.1016/j.kint.2020.03.005 PMID:32247631.

[19] Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J Am Soc Nephrol. 2020 Jun; 31(6):1157–65. https://doi.org/10.1681/ASN.2020030276 PMID:32345702.

[20] Wang L, Li X, Chen H, Yan S, Li D, Li Y, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am J Nephrol. 2020;51(5):343-8. https://doi.org/10.1159/000507471 PMID:32229732.

[21] Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020 Jul;98(1):219–27. https://doi.org/10.1016/j.kint.2020.04.003 PMID:32327202.

[22] Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J,
et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020 Jul; 5(7):667–78. https://doi.org/10.1016/S2468-1253(20)30126-6 PMID:32405603.

[23] Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020 Mar; 30(3):269–71. https://doi.org/10.1038/s41422-020-0282-0 PMID:32020029.

[24] Jixin Z, Jungen T, Cong Y, Lingli D. The immunology of COVID 19; Is immune modulation an option for treatment? The Lancet. 2020 May; doi; https://doi.org/10.1016/s2665-9913(20)30120-X.

[25] Aghahowa SE, Obianwu HO, Isah AO, Arhewoh IM. Chloroquine-induced Pruritus. Indian J Pharm Sci. 2010 May; 72(3):283–9. https://doi.org/10.4103/0250-474X.70471 PMID:21188034.

[26] Chatre C, Roubille F, Vernhet H, Jorgensen C, Pers YM. Cardiac Complications Attributed to Chloroquine and Hydroxychloroquine: A Systematic Review of the Literature. Drug Saf. 2018 Oct; 41(10):919–31. https://doi.org/10.1007/s40264-018-0689-4 PMID:29858838.

[27] Stokkermans TJ, Goyal A, Bansal P, Trichonas G. Chloroquine and Hydroxychloroquine Toxicity [Updated 2020 Jul 4] Stat Pearls [Internet]Treasure Island (FL): Stat Pearls Publishing; 2020 Jan., Available from https://www.ncbi.nlm.nih.gov/books/NBK537086/.

[28] Bykowski A, Logan TD. Cinchonism [Updated 2020 Jun 16] Stat Pearls [Internet]Treasure Island (FL): StatPearls Publishing; 2020 Jan., Available from https://www.ncbi.nlm.nih.gov/books/NBK559319/.