Access to age-appropriate essential medicines: a retrospective survey of compounding of medicines for children in hospitals in Nigeria and implications for policy development

Policies to improve access to medicines for children in Nigeria do not include compounding as a source of medicines. Compounding is often applied as a last resort in health institutions to provide age-appropriate formulations usually for oral use in young children; but it bears some risk. Some countries have adopted policies aimed at reducing the risk based on available data. There is not much data for Nigeria. This retrospective study examined compounding records from January to December 2011 in a sample of seven hospitals to describe what medicines for oral use were commonly compounded in Nigeria. It then determined if these medicines were commercially available in forms suitable for use in children in selected countries-the United Kingdom, United States and India. The study found that out of 2845 items compounded, over 65% were medicines for cardiovascular conditions, diarrhoea or tuberculosis. The main reason (96%, n = 2399) for compounding was the unavailability of age-appropriate formulations. Medicines were almost all compounded using simple syrup, vitamin C or vitamin B syrups as suspending vehicles. Final products were all oral liquids. Comprehensive stability testing was not reported for the products. Almost all of the commonly compounded medicines were found to be commercially available in dosage forms suitable for use in children in the selected countries. These medicines were all listed in the World Health Organization Essential Medicines List for children as well as in the current edition of the Essential Medicines List of Nigeria. The fact that they were compounded highlights the need for improved access to age-appropriate dosage forms for children in Nigeria. The study recommends policy expansion through a three-pronged approach to improving access: increased supply through facilitated importation/accelerated product registration, or in-country manufacturing; rational drug use including therapeutic substitution, and establishment of a national formulary for compounding

Evaluation of a Chromogenic Medium for the Detection of ESBL with Comparison to Double Disk Synergy Test

Background: Extended Spectrum Beta Lactamase (ESBL) producing bacterial strains are the major causes of nosocomial and community-acquired infections worldwide. The aim of the study was to evaluate the effectiveness of Brilliance ESBL Agar (BEA) (a chromogenic culture medium) for the detection of ESBL in comparison with Double Disc Synergy Test (DDST) and confirm results from both methods by Single-plex Polymerase Chain Reaction (PCR) as gold standard. Materials and Methods: A total of 75 clinical isolates of Escherichia coli were screened for ESBL production using BEA & DDST from various clinical specimens. The antibiotic susceptibility testing was done by the Kirby-Bauer disc diffusion method using Cefotaxime (30 µg) and Ceftazidime (30 µg) discs on Mueller Hinton agar. ESBL producing strains were detected phenotypically by DDST and BEA at 24 h and 48 h, respectively. Isolates screened by both methods were confirmed using PCR for the detection of blaSHV, blaTEM, blaCTX-M genes. Results: The prevalence of ESBL was 61%. The sensitivity and specificity of DDST at 24 h and 48hours incubation time was 91.3% and 89.5%, respectively. BEA showed an increase in sensitivity and specificity at 48 h with 97.8% and 98.0%, respectively. All ESBL producing strains detected by phenotypic tests were also found harboring ESBL genes (blaSHV, blaTEM, blaCTX-M) by PCR. Conclusion: The use of BEA in the screening of ESBL production was found to give much better results than DDST and can be used where PCR cannot be performed

A survey of caregivers of Nigerian children less than 6 years of age to determine the experience and perception of acceptability of oral solid dosage forms.

OBJECTIVES: The World Health Organization (WHO) recommends flexible solid oral dosage forms such as dispersible tablet as the preferred formulation for (young) children, especially in developing/low- and middle-income countries, LMIC. The aim of this study was to assess experience, perceptions of acceptability, and formulation preferences, among 10 oral dosage forms for young children in a sample of end-users in Nigeria as an exemplar LMIC. METHODS: Using a semi-structured and validated questionnaire, 148 caregivers were surveyed. Acceptability was assessed by level of liking using a 3-point Likert scale and ease of administration. Preference was assessed from participants’ dosage form of choice. Oral dosage forms assessed were those mentioned in the British National Formulary for children, 2013. RESULTS: The formulation perceived as the most acceptable was the chewable/suckable tablet. However, preference was for liquids. Specifically with the dispersible tablet, whilst 89% (n = 111) of caregivers of young children found it easy-to-administer, only 50% of children liked it. CONCLUSION: There is a gap between the proposal of dispersible tablet as the preferred dosage form for young children and caregivers’ perceptions of acceptability and preference. Educational strategies to increase acceptability of dispersible tablets as the preferred formulation for young children would be required

Determinants of Health-Care Seeking Behaviors and Quality of Life in Children with Epilepsy in Nigeria

Epilepsy is the commonest neurological condition affecting every sphere of a child’s life ranging from physical and cognitive performances, and mixed feelings for the affected family. These feelings are worsened by the cultural beliefs, myths, and stigmatization that surround epilepsy with a consequent reduction in the healthcare-seeking behaviors and quality of life of these children. The goal of management is to control seizures with minimal use of antiepileptic medications and to improve the child’s quality of life. This work is aimed to understand the health-seeking behavior of families and children diagnosed with epilepsy in Nigeria, the factors that influence their decisions, and the need to plan a “need-based” comprehensive healthcare program for all stakeholders, particularly the disprivileged groups. Despite some improvement in access to healthcare in Nigeria, there are existing inequalities relative to culture, socioeconomic class, accessibility to universal health insurance, and gender. Knowledge of barriers to optimal healthcare-seeking behavior could help reduce the impact of epilepsy on children’s development and consequently improved quality of life. Efforts should be made to educate children with epilepsy, their caregivers, and other affected stakeholders and periodic trainings organized for the health workers. Subsidizing the cost of care by support groups and government is vital

Ultrasound-guided bursal injections

The native bursa is a structure lined by synovium located adjacent to a joint which may serve to decrease friction between the tendons and overlying bone or skin. This extra-articular structure can become inflamed resulting in bursitis. Steroid injections have proven to be an effective method of treating bursal pathology in various anatomic locations. Performing these procedures requires a thorough understanding of relevant anatomy, proper technique, and expected outcomes. Ultrasound is a useful tool for pre procedure diagnostic evaluation and optimizing needle position during these procedures while avoiding adjacent structures. The purpose of this article is to review core principles of ultrasound-guided musculoskeletal procedures involving bursae throughout the upper and lower extremities

First-in-human controlled inhalation of thin graphene oxide nanosheets to study acute cardiorespiratory responses

Graphene oxide nanomaterials have been developed for wide-ranging applications, but has potential safety concerns for human health. Controlled inhalation exposures in human volunteers have been a vital means to determine the effects and mechanisms of ultrafine particles in air pollution, however, few studies have used this approach to explore the effects of nanomaterials. We conducted a double-blind randomised controlled study to determine whether inhalation of graphene oxide affects pulmonary or cardiovascular function. A high purity graphene oxide was synthesised with a thickness of 1-2 layers in two sizes: ‘small’ (lateral dimensions: 100-1700 nm) and ‘ultrasmall’ (30-500 nm). Graphene oxide particles at 200 µg/m3, or filtered air, were inhaled for 2 hours by 14 young healthy volunteers on repeated visits, with measurement of cardiorespiratory parameters before and across 4 hours after exposure. Graphene oxide exposure was well-tolerated with no adverse effects. Heart rate, blood pressure, lung function and inflammatory markers were unaffected by graphene oxide irrespective of particle size. GO did not change blood biomarkers of coagulation, however, there was a mild increase in thrombus formation in an ex vivo model of arterial injury. Proteomics revealed very few differential plasma proteins. Overall, acute inhalation of graphene oxide was not associated with overt detrimental effects in healthy humans. These findings demonstrate the feasibility of carefully controlled human exposures for risk assessment of graphene nanomaterials