Editorial: The challenging roles of pharmacists in hospital and community pharmacy practice in Nigeria

No abstract available Trop J Pharm Res, December 2003; 2(2): 195-19

Prescribing practices in two health care facilities in Warri, Southern Nigeria: A comparative study

Purpose: Inappropriate prescribing has been identified in many health facilities in developing countries. The purpose of this study was to evaluate the prescribing practices in two health care facilities in Warri located in south-south geopolitical region of Nigeria and identify factors influencing the practices. Method: WHO Prescribing Indicators were applied to evaluate 2000 prescription records, retrospectively, from a private and a public hospital in Warri. Factors influencing the prescribing practices in the facilities were identified through informal interviews of 10 prescribers in the facilities. Using a self-administered questionnaire administered to 40 prescribers in the facilities, we also evaluated the order of importance of the factors affecting drug prescribing. Results: Average number of drugs per encounter in the health facilities is 3.4 (3.9 in the public hospital and 2.8 in the private hospital). Generic prescribing was generally low (54% in the public hospital and 16% in the private hospital) while the percentage of encounters with antibiotics prescribed was high (75% in the public hospital and 55% in the private hospital). Antimalarials, antihypertensives, antidiarrhoeals and analgesics accounted for 47.4%, 7.5%, 1.0% and 18.2%, respectively. The overuse of drugs and generic prescribing were significantly lower in the private hospital than in the public hospital. Major factors influencing prescribing practices included drug availability, clinician\'s level of training, cost of drugs, feedback from patients and socio-economic status of patients. Conclusion: Polypharmacy, overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability, clinician\'s level of training, cost of drugs, feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities. Keywords: Drug prescribing, Indicators, Practices, Southern Nigeria Tropical Journal of Pharmaceutical Research 2003; 2(1): 175-18

Plasmodium falciparum malaria resistance to chloroquine in five communities in Southern Nigeria

Chloroquine is still a first-line antimalarial drug in uncomplicated falciparum malaria. Increasing resistance to chloroquine has been reported in many parts of Nigeria. Clinical and parasitological responses and classes of resistance to chloroquine in falciparum malaria in five communities in Delta region, southern Nigeria were assessed. Chloroquine was administered to 218 patients with uncomplicated P. falciparum malaria. The levels of parasitemia, clinical response and classes of resistance were monitored for 7 days. High levels of therapeutic failures of chloroquine in P. falciparum malaria were recorded in the region. The frequencies of clinical and parasitological failure of chloroquine were 25.7% and 55%, respectively. These frequencies were significantly lower in children below 5 years than older people. R2 and R3 resistance occurred in 37.2% and 17.4% of the patients, respectively. The therapeutic failure of chloroquine was not gender dependent. We conclude that chloroquine is still effective in the treatment of uncomplicated P. falciparum malaria in some communities in Delta region of Nigeria. However, resistance to chloroquine is likely. These results may be used as an important indicator of the significant level of therapeutic failure of uncomplicated P. falciparum malaria to chloroquine in Nigeria. Keywords: Chloroquine, falciparum malaria, resistance, clinical failure, parasitological failure. African Journal of Biotechnology Vol.2(10) 2003: 384-38

Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria

Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS).Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions.Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure.Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.Keywords: Antibiotics; national health insurance scheme; Nigeria; poly-pharmacy; prescription

Response of Tripanosoma brucei brucei–induced anaemia to a commercial herbal preparation

Jubi Formula® is a herbal preparation made from three medicinal herbs (Parquetina nigrescens, Sorghum bicolor and Harungana madagascariensis). It has been reported to have been successfully used in the treatment of anaemia in humans. A study was therefore carried out to determine the effect of the preparation on packed cell volume (PCV) and haemoglobin (Hb) concentrations in anaemic rabbits. The PCV and Hb concentrations of healthy rabbits infected with Trypanosoma brucei brucei were monitored for 49 days. T. b. brucei produced a significant reduction in PCV and Hb concentrations in all infected rabbits when compared with the controls (

Medication Adherence and Health Status in HIV Positive Patients in Akwa Ibom State, Nigeria

Purpose: To assess medication adherence and health status in ambulatory HIV positive patients in Akwa Ibom State, Nigeria.Methods: The 7-item Adherence to Refills and Medication Scale (ARMS-7) was used to assess medication adherence among 500 HIV positive patients in three secondary health facilities in Akwa Ibom State, Nigeria. A single-item question (measuring self-rated health) and depression (CESD-R) questionnaire were also used to evaluate the patients. Recent CD4 count and viral load were obtained from the patients’ folders. The association between independent and dependent variables was evaluated using logistic regression analysis.Results: Only 56 (11.7%) respondents reported 100% adherence to their medications; 190 (39.7%) rated their health as being ‘very good’ and 51 (10.7%) reported being depressed. Respondents who were single were more likely to be nonadherent (aOR = 2.665, 95% CI = 1.336 - 5.318; p = 0.005), and the nonadherent patients were more likely to have lower CD4 cell counts (aOR = 0.998, CI = 0.996 – 0.999; p = 0.007). Those who rated their health as ‘fair’ or ‘poor’ were more likely to be nonadherent (aOR= 11.380, CI = 1.527 – 84.785; p=0.018) and depressed (aOR = 2.748, CI = 1.469 – 5.141; p = 0.002). Patients who were unemployed were more likely to rate their health as fair/poor (aOR = 1.890, CI = 1.197 – 2.985; p=0.006).Conclusion: This work has shown that even though most of the HIV positive patients perceive their health as being very good, their adherence to medications was poor which is directly related to their unemployment status. Intervention to improve adherence directed at socio-economic status of the individual patient is recommended. Keywords: Medication adherence; Depression; Self-rated health; Nigeri

Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria

Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS). Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions. Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 \ub1 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure. Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure

Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: a qualitative study

Background: Antiretroviral therapy (ART) is the primary mode of treatment for Human Immunodeficiency Virus (HIV). It slows disease progression and reduces the spread of infection. HIV treatment is also known to require a high level of adherence of over 90% to achieve good treatment outcomes and viral load suppression. In Sierra Leone, about 70% of People Living with HIV (PLHIV) are non-adherent in their first year of treatment. Understanding the reasons behind this high rate of non-adherence from the perspectives of both PLHIV and health workers is critical for developing strategies to improve adherence. This qualitative study is rooted in the field of public health services. It identifies the barriers and facilitators influencing adherence to antiretroviral treatment in Sierra Leone. Methods: A qualitative study design using in-depth interviews of four healthcare workers and 16 PLHIV in two districts in Sierra Leone– Freetown and Bo. The interviews were analyzed using a grounded theory approach to identify emerging themes from the data. Results: The study identified several facilitators and barriers to ART adherence at the personal, community, and health system levels. The facilitators included perceived benefits of ART, family support, having an informal caregiver, receiving free ART medicines, and belonging to peer support groups. The identified barriers were stigma and discrimination, frequency of medication, use of traditional medicine, lack of money for food and transport, work barriers, inadequate medicines and test kits, limited health workers, and long distances to clinics. Conclusions: Our study emphasized the need for implementing behavioural change communication programmes and activities to reduce stigma and discrimination in the community. Knowledge of the facilitators and barriers to antiretroviral therapy could provide relevant information for more responsive and equitable programmes supporting adherence implementation in low- and middle-income countries. This study also identifies the vital need for community integration of HIV treatment services

Editorial - Herbal Medicines: Challenges

Herbal medicines are but one component of complementary and alternative medicine, which includes acupuncture, chiropractic manipulation, meditation, homeopathy, and other approaches. Since the introduction of orthodox medicines in Africa, the use of herbal medicine in treating various ailments has existed alongside western medicines. Herbal medicines are playing major roles in the health of thousands of people worldwide. In spite of the vastly improved health and longevity in the United Sates and Europe, millions are turning back to traditional herbal medicines in order to prevent or treat many illnesses, and a reasonable proportion of drugs dispensed in community pharmacies now contain drugs extracted from plants. The high demand for herbal medicines from traditional medical practitioners in Nigeria and elsewhere in Africa is a clear indication of the attitude and beliefs of people about the medicines

The changing roles of pharmacists in hospital and community pharmacy practice in Nigeria

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