DRUG USE INDICATORS IN PATIENTS WITH TYPE 2 DIABETES IN A TERIARY HEALTHCARE FACILITY IN NIGERIA

Objective: The study analyzed the utilization pattern of antidiabetic drugs at the outpatient clinic of a teaching hospital in Nigeria to document information for enhancing the rational use of drugs in type 2 diabetes. Methods: A retrospective analysis of prescription records of patients with type2 diabetes, seen between the months of May and October, 2013 was carried out; adapting the World Health Organization's (WHO) recommended drug use indicators. Data was analyzed for drug use indicators, concurrent illnesses and co-prescribed medications. Results: A total of 286 prescriptions of T2DM were collected and analyzed. Mean age of patients was 61(±11.8) years. The number of drugs per prescription averaged 4(±1.6), with majority of prescriptions, 70% containing between 3 and 5 drugs each. Metformin (55.8%) was the most commonly prescribed antidiabetic drug followed by glibenclamide (35.1%). Antibiotics were prescribed in 11% of encounters. The percentage of drugs prescribed by generic name was 58%. Hypertension was identified in 42.2% of the diabetic patients as the most co-existing condition. Conclusion: The study suggests a significant compliance to T2DM treatment guidelines but with scope for improved rational use of drug to reduce the risk of drug therapy problems and enhance patients' quality of life. It provides a baseline data for further studies on institutional drug use in diabetes

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Evaluating a capacity development intervention in health economics among producers and users of evidence in Nigeria: A case study in Getting Research Into Policy and Practice (GRIPP) in Anambra State

Background: The use of research evidence to inform policy and practice cannot be overemphasized especially in low and middle-income countries (LMICs). To promote the use of research evidence in the provision of health services for enhanced effective control of communicable diseases in developing countries, the World Health Organization (WHO) in collaboration with the Health Policy Research Group (HPRG) commissioned a capacity development workshop in health economics among producers and users of research evidence in the healthcare system of Anambra state, south east Nigeria. This study was aimed to evaluate the impact of the workshop training on selected stakeholders on the use of health economics evidence to inform health policy and practice in the state. Methods: Participants were purposively selected based either as producers and users of evidence at various levels of healthcare decision making in Anambra state, comprising mostly senior managers and executives from the ministry of health, the academic and health institutions in the state. A two-day capacity development workshop was conducted to train the participants on the use of economic evidence to inform health policy and practice. Pre-post test approach and group exercises were used to assess the knowledge and impact of the training exercises on the participants regarding the use of health economics evidence. Analysis was based on the framework of process-output-outcome-impact approach using the pre-post test and scores technique to assess the impact of the training programme. Results: Pretest average scores varied from 39.7% to 60.5% while posttest scores varied from 47.6% to 65.7%, showing big differences in individual scores among participants, between the producers and users of evidence both prior to and after the training. The significant differences between the test scores indicated success in increasing the knowledge of participants on the use of health economics evidence. Results corroborated participants' perceptions that the workshop impacted positively on their ability to apply the knowledge of health economic evidence to inform decision making in their respective practices. Conclusion: Findings underscored the need for regular upgrade of stakeholders in the health system for enhanced uptake and sustainability of the programme to achieve the desired goal of getting research into policy and practice in the state applicable to other settings

Evaluating the Treatment Costs for Uncomplicated Malaria at a Public Healthcare Facility in Nigeria and the Implications

Background: Accurate information on the facility costs of treatment is essential to enhance decision making and funding for malaria control. Objective: To estimate the costs of providing treatment for uncomplicated malaria through a public health facility in Nigeria. Methods: Hospital costs were estimated from a provider perspective, applying a standard costing procedure. Capital and recurrent expenditures were estimated using an ingredient approach combined with step-down methodology. Costs attributable to malaria treatment were calculated based on the proportion of malaria cases to total outpatient visits. The costs were calculated in local currency, and converted to the US Dollars at the 2013 exchange rate. Results: Total annual costs of N28.723 million (US$182,953.65), was spent by the facility for the treatment of uncomplicated malaria, at the rate of US$31.49 per case, representing approximately 25% of the hospital total expenditure in the study year. Personnel accounted for over 82.5% of total expenditure, followed by antimalarial medicines at 6.6%. Over 45% of outpatients visits were for uncomplicated malaria. Changes in personnel costs, drug prices and malaria prevalence significantly impacted on the study results, indicating the need for improved efficiency in the use of hospital resources. Conclusion: Malaria treatment currently consumes a considerable amount of resources in the facility, driven mainly by personnel cost and a high proportion of malaria cases. There is scope for enhanced efficiency to prevent waste and reduce costs to the provider and ultimately the consumer

Detection, Distribution and Health Risk Assessment of Toxic Heavy Metals/Metalloids, Arsenic, Cadmium, and Lead in Goat Carcasses Processed for Human Consumption in South-Eastern Nigeria

Notwithstanding the increased toxic heavy metals/metalloids (THMs) accumulation in (edible) organs owed to goat′s feeding habit and anthropogenic activities, the chevon remains increasingly relished as a special delicacy in Nigeria. Specific to the South-Eastern region, however, there is paucity of relevant data regarding the prevalence of THMs in goat carcasses processed for human consumption. This work was, therefore, aimed to investigate the detection, distribution and health risk assessment of THMs in goat carcass processed for human consumption in South-Eastern Nigeria. To achieve this, a total of 450 meat samples (kidney, liver and muscle) were evaluated from 150 randomly selected goat carcasses processed in two major slaughterhouses in Enugu State. The detection, distribution, as well as health risk assessment parameters followed standard procedures. Results revealed that at least one THM was detected in 56% of the carcasses. Mean concentrations of arsenic (As) were 0.53 ± 0.10 mg/kg, 0.57 ± 0.09 mg/kg and 0.45 ± 0.08 mg/kg, lead (Pb) were 0.48 ± 0.38 mg/kg, 0.45 ± 0.24 mg/kg and 0.82 ± 0.39 mg/kg, cadmium (Cd) was 0.06 ± 0.32 mg/kg, 0.02 ± 0.00 mg/kg, and 0.02 ± 0.00 mg/kg for kidney, liver and muscle tissues, respectively. The estimated daily intakes (EDI) for all THMs were above the recommended safe limits. The target hazard quotient (THQ) and hazard index (HI) computed for all As, Cd and Pb fell below unity in all the studied organs, which indicated no non-carcinogenic risks. Curtailing the anthropogenic activities that aid the THM-contamination in goat production/processing lines is recommended. Screening for THM-contamination in Nigerian slaughterhouses is imperative, so as to ascertain the toxicological safety of meats intended for human consumption