Prioritizing lectures on end of life care in a Nigerian Medical School: final year medical students' perspectives

No AbstractKeywords: End-of-life Care, Palliative Care, Dying & Death, Medical Students, Nigeri

A 6-month review of medical admissions in a nigerian teaching hospital

Purpose: To provide an overview of morbidity and mortality in the medical wards of a teaching hospital and to generate discussions among staff members with a view to improving patient outcomes and data handling. Methods: A retrospective survey of admissions and mortalities in the medical wards of the University of Benin Teaching Hospital was undertaken from 1st January to 30th June 2006, using ward Record and Change books, and copies of death certificates. Morbidity data were assessed for two medical wards and mortalities for all medical admissions within the period under review were evaluated. Results: Health information was managed entirely manually. Data sources were quite often inaccessible or mutilated, and the utility of available data was limited by incomplete and incorrect documentation. No clinical coding of morbidities or mortalities was available. Human immunodeficiency virus (HIV) infection and its complications accounted for significantly more female than male admissions (26.1% and 16.2% respectively; p=0.005), and for more female than male deaths (34.6% and 29.6% respectively; p< 0.0001). Most deaths occurred between midnight and the start of the working day, with a second peak during prime working hours. Conclusions: Less than optimal health information management was apparent in the health facility studied. Mortality among the patients was highest in HIV-infected patients than other diseases. Capacity building and appropriate infrastructural development is required to improve the management of vitally important health information. Keywords: Health information; Morbidity; Mortality; Medical Wards; Nigeria

Treatment of malaria in health care facilities in Benin city, Nigeria

Malaria is a leading cause of morbidity and mortality in Africa, especially in the sub-Saharan region and an assumption is that medical practitioners in this part of the world should be skilled in prescribing drugs for the treatment of malaria. This study assessed the patterns of prescriptions for antimalarial drugs by doctors. Prescriptions were collected retrospectively from the outpatient clinics of all public hospitals, and 9 randomly selected private hospitals in Benin City, Nigeria from January 2000 to July 2001. Out of the 1,970 prescriptions assessed, 32.1% (633) had antimalarials prescribed. Antimalarial prescriptions showed that the most frequently prescribed drug was chloroquine (54.8%). Other antimalarials prescribed were sulphadoxine/pyrimethamine (20.9%), quinine (12.5%), halofantrine (6.2%), sulphalene/pyri- methamine (2.7%), sulphadoxine/pyrimethamine/mefloquine (1.7%), amodiaquine (0.8%), and artesunate (0.5%). More than half of the prescriptions for chloroquine (52%) were for injections. Oral chloroquine for adults was prescribed in doses ranging from 600mg to 3g for a course of therapy. More than one antimalarial drug was prescribed in 29% of encounters, with quinine plus sulphadoxine/pyrimethamine being the most frequent combination. Co-prescription of analgesics with antimalarials occurred in 517 (82.1%) encounters with paracetamol as the most frequently prescribed analgesic. Almost all (95.8%) of dipyrone prescriptions were for injections. Antibiotics were coprescribed in 48.2% of encounters, and ampicillin/amoxicillin were the most frequently prescribed antibiotics. The values for the WHO Core Prescribing Indicators were: average number of drugs per encounter – 4.4; percentage of drugs prescribed by generic name – 50.2%; percentage of encounters with injections prescribed – 42.2%, and percentage of drugs prescribed from the Essential Drugs List – 96.7%. Vitamin/mineral supplements were co-prescribed in 323 (51.3%) encounters. The findings suggest that there is inappropriate use of parenteral chloroquine, dipyrone and antibiotics in the treatment of malaria. There is also the questionable use of vitamin and mineral supplements alongside antimalarials in the therapeutic settingKeywords: Malaria, antimalarial drugs, prescriptions, WHO indicatorsWest African Journal of Pharmacology and Drug Research Vol. 20(1&2) 2005: 26-3

Impact of an Educational Intervention on the Prescribing of Antimalarials at the University of Benin Teaching Hospital

Purpose: To evaluate the impact of an educational intervention on antimalarial prescribing among internal medicine residents at the University of Benin Teaching Hospital.Methods: A sample of residents was given blank prescription orders to write prescriptions for uncomplicated malaria. This was followed the next day by educational intervention which focused on the World Health Organization&#8217;s &#8216;P Drug Concept&#8217; using malaria as a case study. One week later, the initial survey was repeated. Baseline and post-intervention prescriptions were matched by consensus between the authors and scored. Data were analyzed with SPSS version 16.0 using paired t tests for prescription scores.Results: Forty-six residents participated in the baseline survey and 49 postintervention; 31 pairs of prescriptions matched. Artemisinin-based combination therapies (ACTs) accounted for 81% of antimalarials prescribed at baseline, 75% of which were in brand names. No prescription stated dosage in milligrams at baseline. Generic prescribing improved with less than 50% of prescriptions written in brand names post-intervention (p = 0.001). One resident provided instructions for labelling post-intervention.Conclusion: Focused educational intervention resulted in improved genericprescribing of antimalarials in this experimental setting. Routine academicmeetings should provide opportunities which can be inexpensively used forinterventions to improve the utilization of medicines in Nigerian health carefacilities

Antibiotic use among final year undergraduates in university of Benin, Nigeria

This study was designed to evaluate the use of antibiotics among final year students in a Nigerian university campus, with a view to identifying patterns of use and reasons for adherence or non-adherence to therapy. A cross-sectional survey of randomly selected final year students of the University of Benin was conducted using self-completedquestionnaires which required demographic details (excluding names) and details of antibiotic use in the preceding three months. Data were analyzed using Microsoft Excel software. Two hundred and sixty questionnaires were returned giving a response rate of 99.2%. Of these, two hundred and twenty six respondents (86.9%) had used atleast one antibiotic in the preceding three months, with over 40% having used two or more antibiotics. Self-medication with antibiotics occurred in 35%. Penicillins were the most frequently used prescription antibiotics, as well as for selfmedication. The most frequent reason for adhering to therapy was a determination to get well while a feeling of improvement after initial therapy was the commonest reason for non-adherence. Prescription and non-prescription antibiotics were used by a large proportion of undergraduates. The antibiotics most frequently used (the penicillins) were those against which high levels of resistance have been demonstrated. Interventions to improve utilization ofantibiotics should include those that increase self-motivation to complete antibiotic therapy and also foster behavior change arising from knowledge of the dangers to individuals and communities arising from non-adherence to antibiotic therapy

Letter to EditorPhysician heal thyself

Click on the link to view the letter.Nigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Progress toward elimination of malaria in Nigeria: Uptake of artemisinin.based combination therapies for the treatment of malaria in households in Benin City

Background: The Roll Back Malaria (RBM) Partnership converged in Abuja in 2000. In 2005, Nigeria adopted artemisinin.based combination therapies (ACTs) as first.line therapy for uncomplicated malaria. It was determinedthat by 2010, 80% of persons with malaria would be effectively treated.Objectives: To describe household practices for malaria treatment in Benin City; to explore demographic characteristics that may influence use of ACTs.Materials and Methods: Multistage sampling technique was used to select households from each of the three local government areas in Benin City. Adult respondents were interviewed. Household reference persons (HRPs)were defined by International Labour Organization categories. Data were collected between December 2009 and February 2010 and were analyzed using Statistical Package for the Social Sciences Version 16.0, at a significance level of P &lt; 0.05 (2.tailed).Results: Of the 240 households selected, 217 were accessible, and  respondents from 90% of these recalled the most recent episode (s) of malaria. One.third of malaria episodes had occurred in children younger than 5 years. ACTs were used in 4.9% of households;  sulfadoxine.pyrimethamine was the chief non.ACT antimalarial, followed byartemisinin monotherapies. Patent medicine stores were the most common sources of antimalarial medicines (38.2%), followed by private hospitals (20.3%) and private pharmacies (10.6%). Only 8.3% of households got their medicines from government hospitals. Having a HRP in managerial or professional categories was associated with a 6 times higher odds of using ACTs, compared to other occupational categories [odds ratio (OR) 5.8; confidence interval (CI) 1.470.20.758, P = 0.016]. Fathersf tertiary or higher education was significantly associated with ACT use, but notmothersf (OR 0.054, CI 0.006.0.510; P = 0.011 and OR 0.905, CI 0.195.4.198; P = 0.898, respectively).Conclusion: Ten years after the historic Abuja meeting, only 5% of households in Benin City used ACTs for the treatment of malaria, sourcing medicines chiefly from patent medicine stores and private hospitals. Fathersf level of education was significantly associated with ACT use. Interventions to eliminate malaria from Nigeria should mainstream the men folk and health care providers outside government hospitals, in line with the Nigerian reality.Keywords: Artemisinin.based combination therapy, Benin City, households, malari

A Comparison of Two Instruments for the Assessment of Legibility of Prescriptions in a Developing Country

Purpose: To compare the utility of a rating and visual analogue scale for the assessment of legibility in prescriptions Methods: A sample of fifty randomly selected prescriptions from a tertiary hospital in Benin City, Nigeria was assessed by five independent assessors - three doctors and two pharmacists using a rating scale and a 100 mm visual analogue scale. Rating scores were allocated as: 0 - completely illegible; 1 - barely legible; 2 - moderately legible; 3 - clearly legible, and 4 - print. Visual analogue scores were measured in millimetres. Results: Rating and visual analogue scores were skewed. The median rating score by doctors and pharmacists were 2.0 and 3.0, respectively. Median visual analogue scores were 59.5, 67.0, 55.0, 51.5 and 46.0 mm, respectively. Inter-quartile ranges (rating scores) were 2.0 – 3.0 for both doctors and pharmacists except for one pharmacist whose inter-quartile range was 1.0 – 2.3; inter-quartile ranges (visual analogue scores) were 49.3 – 63.0, 59.8 – 71.0, 31.0 – 65.5, 40.8 – 62.0, 43.0 – 55.5 mm, for the five independent assessors. The pharmacists’ scores using either scale were significantly positively correlated (rs = 0.900; 2-tailed p = 0.05); one doctor’s scores were negatively correlated (rs = -0.308). Conclusion: The findings support the utility of both instruments in the assessment of handwriting but suggest that there may be important differences between doctors and pharmacists using either method

Team Ward Rounds for Quality Improvement in Patient-Centred Care: An 'Acute Care for Elders' Unit Experience

Patient-centred care is a core value in Geriatrics and requires effective  communication between patients and multi disciplinary professionals. Accurate and timely implementations of care plans are also important to achieve desired  outcomes. The Acute Care for Elders (ACE) Unit in University of Benin Teaching  Hospital (UBTH), Nigeria admits older adults with multiple medical morbidities under the care of consultant physicians on call, and a geriatrician who oversees unit activities. Patients and their relatives require support to effectively communicate their healthcare needs to multiple managing teams. Care coordination was alsorequired. In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of lapses in implementation of patient care plans, amongst which documentation andmedication errors were the leading. Our interventions included communication with patients, between members of the multi disciplinary geriatrics team, and with doctors in other managing teams. We conclude that daily multidisciplinary team rounds are feasible in Nigeria and useful for service evaluation and quality improvement in patient care. The rounds enabled the identification of the most pressing targets for quality improvement in patient-centred care: improved documentation and reduction in medication errors.Key words: Ward rounds, Quality improvement, Patient centred care,   Multidisciplinary teams, Geriatrics, Nigeri