Evaluation of prescription pattern and glycaemic control among diabetes patients in an ambulatory tertiary care setting in southwestern Nigeria

Background: Drug prescription in diabetes is complex, thereby making diabetes patients a high-risk group. Thus, treating the patient with diabetes remains a practice that entails constant re-evaluation and assessment of patient’s therapy and response.Objective: To evaluate pattern of antidiabetes and adjunctive medications prescribed for patients as well as extent of glycaemic control.Method: A cross-sectional concurrent review of case-notes of diabetes patients attending the endocrinology out-patient clinic of the University College Hospital, Ibadan, for 4-consecutive weeks. In-patient case-notes, newly diagnosed, and those with incomplete data were excluded. Data were summarised using descriptive statistics. Chi-square was used to investigate categorical variables at p<0.05.Results: Mean age and duration of diagnosis were 60.6±13.0 and 10.2±7.9 years, respectively. Type-1-diabetes accounted for 4 (6.9%) and type-2-diabetes (54; 93.1%). Co-administered combination of metformin and glimepiride (15; 25.9%) was most commonly prescribed. Mean glycosilated haemoglobin was 6.9±1.8%. Nineteen (59.4%) were adjudged to have good glycaemic control (HbA1c<7%). Calcium-channel-blockers (23; 19.5%), statins (23; 19.5%), angiotension-converting-enzyme inhibitors (22; 18.6%) and low-dose aspirin (20; 17.0%) were the commonly prescribed adjuncts. Of the 16 (27.6%) patients whose adherence status was documented, 8 (50.0%) who were regular on medication were subjectively adjudged adherent.Conclusion: Metformin-based regimen, specifically, the co-administered combination of metformin and glimepiride is mostly prescribed. Overall blood glucose profile indicates fair glycaemic control. There is a greater likelihood of evidence-based prescriptions for the patients. However, there is a need for concerted efforts by providers in ensuring improved medication adherence, in order to ensure better therapeutic outcomes.Keywords: Antidiabetes medication, glycaemic control, diabetes patients, ambulator

Evaluation of drug therapy problems among outpatient hypertensive and type-2-diabetic patients at a Tertiary Hospital, South-West Nigeria

Background: Health-related burden and poor outcomes due to drug therapy problems (DTPs) is a major concern in healthcare delivery especially in resource-poor countries.Objective: To evaluate extent and types of DTPs as well as disease-specific clinical parameters in outpatient hypertensive and type-2-diabetic (T2D) patients attending a tertiary hospital in Nigeria.Materials and Methods: This entailed questionnaire-guided interaction with 205-adult hypertensive and 198-T2D patients who were purposively enrolled, followed by a retrospective review of their medical records from September - November 2018. Domains of DTP explored included drug and dose selection, drug form, treatment duration, patients’ adherence and drug interactions. Data were summarised using descriptive statistics, while categorical variables were evaluated with Chi-square test at p<0.05 level of significance.Results: Overall, 840 DTPs were identified among participants. This comprised 422(50.2 %) DTPs among T2D (average = 2.13 DTPs per patient), and 418(49.8 %) DTPs in the hypertensive (average = 2.04 DTPs per patient). The order of occurrence of DTPs among T2D was non-adherence [intentional, 173 (41.0 %) and unintentional, 69 (16.4 %)]>drug interactions, 155 (36.7 %)>drug selection, 25 (5.9 %); while for hypertensive patients, the order was non-adherence [intentional, 156 (37.3 %); unintentional, 57 (13.6 %)]>drug interactions, 157 (37.6 %)>dose selection, 25 (6.0 %)>drug selection, 23 (5.5 %). A total of 133(65.5 %) hypertensive patients had good blood pressure (≤140/90 mmHg) control, while the mean glycosilated haemoglobin was 7.5 (SD=2.6 %).Conclusion: Extent of DTPs among participants is high, with non-adherence and drug interactions constituting the highest DTPs burden. There is generally a need for prescribers and pharmacists in particular to be wary of potential or actual DTPs during patient encounters, as this may ensure better therapeutic outcomes.Keywords: Drug therapy problems, Hypertensive and type-2-diabetic patients, Outpatient, Nigeri

Assessment of the Knowledge of Community Pharmacists Regarding Common Phytopharmaceuticals Sold in South Western Nigeria

Purpose: The study was carried out to assess the knowledge of community pharmacists who sell herbal/phytopharmaceutical formulations in pharmacy retail outlets. Method: Questionnaires were administered to the pharmacists to gather information on phytopharmaceuticals regarding their use, side effects, potential drug-herb interactions and contraindications of the phytopharmaceuticals sold in their retail outlets. Opinions on regulation, safety and efficacy of herbal remedies were also obtained. Descriptive statistical tests and median scores were used to evaluate the distribution of responses, opinions and perception of the pharmacists on their level of knowledge of the phytopharmaceuticals, and effects of demographic data on the pharmacists' knowledge of the herbal remedies. Results: The study revealed that 31 (62%) sold imported herbal remedies and nutritional supplements. Seventy-two (72) % had received no postgraduate training on herbal medications. Most of the community pharmacists agreed that they did not possess adequate knowledge of potential interaction profiles and side effects of the herbal remedies sold. The training in pharmacy schools on herbal drugs and sale of phytopharmaceuticals in their outlets also had no influence (p>0.05) on desired knowledge. Community pharmacists with less than 10 years of experience in the practice however possessed better knowledge than pharmacists with more than ten years of professional practice (p=0.05) Conclusions: There was gross inadequacy in the pharmacists' knowledge of the phytopharmaceuticals sold in pharmacies indicating an urgent need for intensive training in order to render better services to their clients. Keywords: Community Pharmacists, Herbal formulations/Phytopharmaceuticals, Knowledge base, Pharmacology> Tropical Journal of Pharmaceutical Research Vol. 5 (2) 2006: pp. 619-62

COVID-19 Mutual Disabilities in Edo State Gubernatorial Electoral Process

The conduct of elections in Nigeria is generally associated with manipulation, which has often undermined the credibility and fairness of the process since the country gained its independence. COVID-19 poses a very serious challenge to the electoral process, considering the nature of the disease, which has led to the promotion of limited physical interaction as an approach to mitigate its transmission and safeguard the health of the people while at the same time impacting negatively on state's electoral justice. While elections remain a key factor to the attainment of political positions in a democratic setting globally, several scholars and media reports have made attempts to assess the political intrigues in the state of Edo as a result of the tense atmosphere created by political gladiators. The use of the pandemic and various forms of propaganda to destabilise the camp of perceived opponents with the aim of winning public support are notable strategies employed by the main contending political parties and their candidates as the election approaches. Therefore, this article evaluates the impediments and political manoeuvrings in the electoral process in the state of Edo, considering the increasing number of corona-virus infections, the country's frail electoral system, and the desire to maintain credible democratic consolidation in the country

Knowledge, perception and practice of medication use review among community pharmacists in southwestern Nigeria

Background: Medication use review (MUR) is an emerging concept in medicine management that has recorded success in many developed countries.Purpose: To evaluate knowledge, perception and practice of MUR among community pharmacists (CP) in southwestern Nigeria.Method: A cross-sectional study was carried out among 100 CP recruited from Oyo and Osun states between January and March, 2015, using a pre-tested  questionnaire. Demographic information and CP’s knowledge, perception and current practice of MUR were evaluated using open-ended, closed-ended and Likert-scale questions. Respondents’ scores for 6-item knowledge test questions and description of specific component of MUR services were categorised as score>3 (good  knowledge) and score≤3 (poor knowledge). Descriptive statistics were used to  summarize data. Ranked variables were evaluated using Kruskal-Wallis test at  p<0.05. Results: Fifty-nine (59.0%) CP from Oyo and 41(41.0%) from Osun state participated. Sixty-five (70.7%) had score>3 indicating “good” knowledge of MUR, while 27 (29.3%) had score≤3 suggesting “poor” knowledge. Forty-two (42.0%)  claimed to provide MUR service; of this, 14 (33.3%) had scores>3 indicating those who gave correct description of specific component of MUR. Lack of adequate time for counselling (49; 49.5%) and lack of specialized training for pharmacists  (45;45.5%) were cited as barriers to MUR practice. Majority (51; 51.5%) agreed that MUR service should be incorporated into community pharmacy practice.Conclusion: Knowledge of MUR concept among community pharmacists in Oyo and Osun states is considerable, but description of specific component of MUR services by respondents was poor. There is therefore a need for continuous training on emerging concepts among pharmacists, so as to stimulate interest in patient-oriented service.Keywords: Medication use review, Community pharmacist, Knowledge, Perceptio

Community Pharmacists’ Perception of the Relevance of Drug Package Insert as Source of Drug Information in Southwestern Nigeria

Purpose: To evaluate the opinions of community pharmacists on the usefulness and reliability of drug package inserts (DPI) as drug information source, and necessary modifications needed to improve theircontents.Methods: A prospective cross-sectional study using a pretested questionnaire was administered to sixty-one superintendent community pharmacists (CP) across two cities in southwestern Nigeria. Descriptive statistics was used to summarize the data and evaluate respondents’ opinion. Kruskal-Wallis test was used to evaluate the rank variables with p < 0.05 considered significant.Results: A majority of CP believed that information from DPI was precise and may be helpful in achieving therapeutic success (n = 42; 72.8 %). CP believed there is need for the modification of DPI content with respect to patient-related information (n = 52; 92.8 %) and health provider-relatedinformation (n = 52; 94.5%), non-uniformity of information on the same generic medicines (n = 31; 50.8 %), and ambiguity of content (n = 29; 47.5 %). Years of experience in practice significantly influenced respondents’ perception of precision and satisfaction with DPI as source of information.Conclusions: Community pharmacists in southwestern Nigeria believed that a properly modified drug package insert could be a useful and reliable source of drug information in daily practice.Keywords: Community pharmacist, Drug information, Drug package inser

Use of antibiotics among non-medical students in a Nigerian university

Background: Antibiotic misuse is a major contributory factor to treatment failure, antibiotic resistance and high healthcare costs.Objectives: To evaluate level of self-reported antibiotic misuse among non-medical undergraduate students of a Nigerian university.Methods: Respondents’ knowledge of antibiotics and disposal system for left-over antibiotics were explored using a structured questionnaire. Data were summarized with descriptive statistics. Chi square was used to evaluate relationship between specific categorical variables and respondents’ opinions with p<0.05.Results: More than half the respondents obtained their antibiotics through doctor’s prescriptions (273; 68.3%). The study revealed gross antibiotic misuse with majority, (298;74.5%) either by keeping left-over antibiotics for future use or throwing it away with refuse. Respondents (289; 72.3%) sometimes forgot to take the antibiotics. Financial constraints (73; 18.3%), long duration of treatment (70; 17.5%), side effects experienced (60;15.0%), polypharmacy (56;14.0%), tablet size (45;11.3%), and perceived low level of confidence in the prescriber (11; 2.8%) were major reasons for non-adherence. Course of study of respondents had no significant effect on respondents’ knowledge or adherence (p>0.05).Conclusion: Misuse of antibiotics among non-medical undergraduate students in a Nigerian university setting is pervasive suggesting an urgent need for enlightenment on rational use and disposal of antibiotics.Keywords: Antibiotic misuse, University Students, NigeriaAfrican Health Sciences 2013; 13(4): 1149 - 115

Evaluasi Kesesuaian Penulisan Resep pada Kasus ISPA Non Pneumonia di Poli MTBS Puskesmas Kecamatan Cengkareng

Acute respiratory infections (ARI) is one of the major health problems in Indonesia. There are three classifications of cases of ARI, consist of pneumonia, severe pneumonia and non pneumonia. This study aimed to find an overview of the use of antibiotics and the evaluation of suitability prescriptions performed in cases of non pneumonia Acute Respiratory Infections (ARI) in IMCI Polyclinic, Cengkareng District Community Health Centre (Puskesmas Cengkareng), West Jakarta. Evaluation for the prescription suitability was useful to find the percentage of the suitability of prescribing on the existing management. This activity was done using retrospective method with data of 100 children patients suffered from non pneumonia cough obtained from registration book on IMCI Polyclinic during February 2016. The existing data was then matched to the patient's status and prescription books that went into the dispensary unit at second floor. Furthermore, we evaluated the suitability of the reference book titled Integrated Management Scheme for Toddler Patients/Bagan Manajemen Terpadu Balita Sakit (MTBS), issued by the Ministry of Health of the Republic of Indonesia in 2011. The results showed that the percentage of antibiotic use in the sample was 59.6%, which the most frequent antibiotic used was amoxicillin. Therefore we concluded that the prescription compliance with IMCI guidelines in Puskesmas Cengkareng at February 2016 was inadequate yet

Perception and Use of Herbal Medicines Among Clients Visiting Selected Community Pharmacies in Ibadan, Nigeria

Globally, there is an increasing trend in the use of herbal medicines. Despite, the benefit of its use, herbal medicines are not completely harmless. This study aims to evaluate the perception and use of herbal medicines among clients who visited selected community pharmacies in Ibadan metropolis, Nigeria. A cross-sectional survey was carried out among clients who patronized the selected community pharmacies, using a self-administered questionnaire. Demographic information, as well as perception and use of herbal medicines were evaluated. Data were summarized with descriptive statistics while K-W test was used for ranked variables at P<0.05. The response rate was 90.7 %. Malaria 113 (58.9 %) was cited as the most common illness treated with herbal medicines. A total of 232 (76.8 %) had score 50.0 % indicating “good” perception on the use of herbal medicine. The level of education of the clients significantly influenced some of their perception towards herbal medicine. This include statement such as herbs can cure all diseases (K-W p=0.011), combination of the conventional drugs and herbs have no side effects (K-W p=0.002), and that side effect of synthetic drugs can be minimized with combination with herbs (K-W p=0.044). Most of the respondents had good perception about herbal medicine use. However, it was notable that the level of education significantly influenced the perception about the use of herbal medicines of some respondents. Public sensitization programme, and health education about the safety of herbal medicines, may be a useful means of improving the use of herbal medicine and reduce potential health risk

Evidence of Gender Role in Soybean Production: Case Study from Agrarian Communities in Benue state, Nigeria

The main purpose of this study was to investigate role of gender in soybean production activities in Benue State, Nigeria. Two (2) Local Government Areas (LGAs) were purposively selected from each of the Eastern and Northern Agricultural Zones of the State. Two (2) rural communities were selected from each LGA and finally ten (10) farmers were selected from each community to make a total of eighty (80) farmers that were interviewed. Data were analyzed using simple descriptive statistics such as frequency counts, percentages and mean. Findings revealed that 67.5% of the respondents were between 30 and 49 years old and 70% had family size of between 5 and 7 members. Majority had formal education, but was relatively new in soybean production. Women are mostly involved in the tedious farm activities in soybean production such as bush/land clearing, stumping, and tilling. The production needs of men and women were the same in areas like credit/loan facility, supply of improved variety, subsidized farm inputs, availability of land, and pest and disease control. The results of this study provide a strong advocacy for more extension services to be directed towards women farmers so as to encourage their participation in agricultural development programmes in Nigeria.Key words: Gender Role; Soybean Production; Agrarian Communities; Benue State; Nigeri