Introduction: Medication use by women of childbearing age is common. During pregnancy, medications should be used cautiously because some are teratogenic and/or feto-toxic, especially during the first trimester. Few studies have assessed exposure to contraindicated medications in developing countries. Aims and objectives: The overall aim was to assess the risk of exposure to contra-indicated medicines in early pregnancy (less than 13 weeks gestation) in Malawi. Specific objectives were to (i) determine the proportion of women inadvertently prescribed contraindicated medicines in the first trimester of pregnancy in a general outpatient clinic; (ii) explore women's beliefs, views and practices concerning medication use during pregnancy; (iii) determine the prevalence of congenital abnormalities by review of records at community and central hospital sites; (iv) to make appropriate recommendations for policy and practice in Malawi relating to medication use in pregnancy. Methods: A mixed methods approach was used. Survey data were collected at an outpatient clinic at Mitundu Community Hospital (MCH) between 1st February 2010 and 30th July 2010 to determine the range of medicines taken by potentially pregnant women. A pregnancy test established the pregnancy rate in this group. These data were summarised using descriptive and inferential statistics, and the proportions of exposed women who were pregnant were estimated. To understand women's beliefs, views and practices, semi-structured interviews were held with 21 pregnant women at their first visit to an antenatal clinic at MCH. The main themes were identified by Framework analysis. Retrospective data were abstracted from birth registers at MCH and Kamuzu Central Hospital (KCH) to estimate the prevalence of congenital abnormalities. Results: Of 1103 women prescribed contraindicated medicines in the outpatient clinic, 272 were potentially pregnant. Of the 63 (23.2%) confirmed pregnant (95% CI 18.3%-28.6%), 20 knew or thought they were pregnant, 22 were not sure and 21 did not think they were pregnant. Only 153 (55.9%) were asked about pregnancy by a medical officer before prescription. 3.2% of all pregnant women (95% CI 2.5%-4.1%) attending the clinic were estimated to have been prescribed contraindicated medicines. Eight pregnant women also self-prescribed unsuitable modern medications. Women accepted as safe any medications prescribed in the clinic. They also accepted potions given by traditional birth attendants to counter witchcraft, which they believed caused pregnancy loss. They did not associate use of these medicines with congenital abnormalities, the prevalence of which (6.58/1000 births at MCH, 14.55/1000 births at KCH) was similar to international figures. Conclusion: The study highlights areas of concern for practice, policy and research relevant to maternal health care in Malawi. Clinicians need to reduce the rate of exposure to potentially harmful medicines by paying attention to the possibility of pregnancy in women of childbearing age. There is also a need to facilitate public awareness especially among women about dangers of taking medicines.

Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.