Attitude and Practice of Doctors Toward Adverse Drug Reactions (adrs) Reporting in a Nigerian Tertiary Health Facility

Background : Adverse drug reactions, (ADRs), constitute an importantcause of morbidity and mortality worldwide. Spontaneous adverse drugreaction (ADR) reporting is the bedrock of post-marketing surveillancebut under-reporting remains its major drawback.Objectives : This study aimed at evaluating the attitude and practiceof ADR among doctors in a tertiary health facility in Oyo State, Nigeria, with a view to improving ADRs reporting.Methods : This was a cross-sectional questionnaire based study involving medical doctors working at the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso. Consenting doctors were  evaluated on their attitude and practice of ADRs through self-administered questionnaire. Data obtained were entered and analyzed using SPSS version 17.Results : A total of 35 doctors responded to the questionnaires. Only about 57.1% considered ADR before prescribing, all of whom were also aware of the procedure for reporting. Awareness of the existence of National Pharmacovigilance Center (NPC) was 71.4%. Thirty (85.7%) of the respondents have encountered ADR, but only 2.9% have ever reported it with yellow form. Majority (85.7%) of the respondents did not consider ADR reporting as a useful tool in the prevention of drug related morbidities and mortalities. Other factors that may hinder ADR reporting include: lack of awareness of the existence of yellow forms for reporting (68.6%) and poor knowledge of procedure for reporting (48.6%).Conclusion : ADR reporting rate was very low among the participants in this small study; large studies aimed at evaluating the determinants of ADR reporting should be considered. Should these findings be confirmed, training and re-retraining through Continuing Medical Education (CME), and establishment of pharmacovigilance committee would be required to ensure a national pharmaovigilance system.Keywords: Adverse drug reactions, Attitude, Practice, Reporting, Clinical Pharmacolog

Association between skin diseases and severe bacterial infections in children: case-control study

BACKGROUND: Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. If our hypothesis is true the GP could reduce the risk of sepsis or bacteraemia by managing skin diseases appropriately. METHODS: We performed a case-control study using data of children aged 0–17 years of the second Dutch national survey of general practice (2001) and the National Medical Registration of all hospital admissions in the Netherlands. Cases were defined as children who were hospitalized for sepsis or bacteraemia. We selected two control groups by matching each case with six controls. The first control group was randomly selected from the GP patient lists irrespective of hospital admission and GP consultation. The second control group was randomly sampled from those children who were hospitalized for other reasons than sepsis or bacteraemia. We calculated odds ratios and 95% confidence intervals (CI). A two-sided p-value less than 0.05 was considered significant in all tests. RESULTS: We found odds ratios for skin related GP consultations of 3.4 (95% CI: [1.1–10.8], p = 0.03) in cases versus GP controls and 1.4 (95% CI: [0.5–3.9], p = 0.44) in cases versus hospital controls. Children younger than three months had an odds ratio (cases/GP controls) of 9.2 (95% CI: [0.81–106.1], p = 0.07) and 4.0 (95% CI: [0.67–23.9], p = 0.12) among cases versus hospital controls. Although cases consulted the GP more often with skin diseases than their controls, the probability of a GP consultation for skin disease was only 5% among cases. CONCLUSION: There is evidence that children who were admitted due to sepsis or bacteraemia consulted the GP more often for skin diseases than other children, but the differences are not clinically relevant indicating that there is little opportunity for GPs to reduce the risk of sepsis and/or bacteraemia considerably by managing skin diseases appropriately

Multilingual examinations: towards a schema of politicization of language in end of high school examinations in sub-Saharan Africa

In many countries of sub-Saharan Africa, the release of each year’s results for the end of high school examinations heralds an annual ritual of public commentary on the poor state of national education systems. However, the exoglossic/monolingual language regime for these examinations is infrequently acknowledged as contributing to the dismal performance of students. Even less attended to is the manner in which the language of examinations, through shaping students’ performances, may be exacerbating social inequalities. This article politicizes the language of examinations in the region in the hope of generating policy and research interest in what is arguably an insidious source of inequality. The article makes three arguments. Firstly, it is argued that current exoglossic/monolingual practices in these examinations constitute a set of sociolinguistic aberrations, with demonstrable negative effects on students’ performance. Secondly, it is argued that the gravity of these paradoxical sociolinguistic disarticulations is better appreciated when their social ramifications are viewed in terms of structural violence and social inequality. Thirdly, in considering how to evolve a more socially equitable examination language regime, it is argued that the notion of consequential validity in testing positions translanguaging as a more ecologically valid model of language use in examinations

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Behavioural interventions to address rational use of antibiotics in outpatient settings of low‐income and lower‐middle‐income countries

OBJECTIVES: To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low-income and lower-middle-income countries, an underrepresented area in the literature. METHODS: The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low-income and lower-middle-income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full-text review, with 13 studies included in the final narrative synthesis. RESULTS: Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists. CONCLUSIONS: Multi-faceted bundle interventions that combine regulation enforcement with face-to-face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use

Disposition of amodiaquine and desethylamodiaquine in HIV-infected Nigerian subjects on nevirapine-containing antiretroviral therapy.

OBJECTIVES: Artesunate plus amodiaquine is used for malaria treatment in regions with overlapping HIV endemicity. Co-administration of artesunate/amodiaquine with antiretroviral therapy (ART) may result in drug-drug interactions, but minimal data exist. This study evaluated the impact of nevirapine-based ART, containing a backbone of zidovudine and lamivudine, on the disposition of amodiaquine and its active metabolite, desethylamodiaquine (DEAQ). METHODS: This was an open-label, parallel-group pharmacokinetic comparison between HIV-infected, adult subjects receiving steady-state nevirapine-based ART (n = 10) and ART-naive subjects (control group, n = 11). All subjects received a loose formulation of artesunate/amodiaquine (200/600 mg) daily for 3 days, with serial pharmacokinetic sampling over 96 h following the final dose of artesunate/amodiaquine. Amodiaquine and DEAQ were quantified using a validated HPLC method with UV detection. Pharmacokinetic parameters were determined using standard non-compartmental methods. RESULTS: Exposures to both amodiaquine and DEAQ were significantly lower in the nevirapine-based ART group compared with the control group (amodiaquine AUC₀₋₂₄ 145 versus 204 ng·h/mL, P = 0.02; DEAQ AUC₀₋₉₆ 14,571 versus 21,648 ng·h/mL, P &lt; 0.01). The AUCDEAQ/AUC(amodiaquine) ratio was not different between groups (ART group 116 versus control group 102, P = 0.67). CONCLUSIONS: Subjects on nevirapine-based ART had lower exposure to both amodiaquine and DEAQ (28.9% and 32.7%, respectively). Consequently, this may negatively impact the effectiveness of artesunate/amodiaquine in HIV-infected individuals on this ART combination