Statin prescribing among hypertensive patients in south-west Nigeria : findings and implications for the future

Statins reduce cardiovascular risk especially in patients with hypertension due to their concomitant blood pressure reducing effects. Prescribing generic statins minimizes cost and improves access. Our aim is to ascertain current prescribing of statins in Nigeria and potential savings from the increased use of generics. Prospective study involving hypertensive patients attending University College Hospital, Ibadan, Nigeria. 228 hypertensive patients received statins. Atorvastatin was the most prescribed statin, followed by simvastatin, rosuvastatin and finally fluvastatin. Prescribed doses were less than 1 defined daily dose in the majority, with high use of originators. Average monthly potential savings from increased prescribing of generics was US$2,635 for atorvastatin and US$10578 for rosuvastatin. A shift towards increased prescribing generics is recommended to minimize cost

Chloroquine-induced Acute Dystonic Reactions after a Standard Therapeutic Dose for Uncomplicated Malaria

Acute dystonic reactions (ADR) are extrapyramidal effects that usually occur after the initiation of a wide variety of drugs or triggering factors besides neuroleptics. We report the case of a 54-year-old man who was admitted with an approximately 10-hour history of muscle twitching around the eyes, face and neck after he took the first dose of oral chloroquine phosphate (1 g [600 mg base]) prescribed for uncomplicated malaria. He was given intravenous diazepam (10 mg statum) followed by 10 mg of oral diazepam 3 times a day. The symptoms improved within 30 minutes of treatment, and he was discharged 14 hours later after a complete recovery

Bronchoscopy in Nigerian Clinical Practice: A Survey of Medical Doctors’ Perception, Use and Associated Challenges

BACKGROUND: Bronchoscopy is a vital diagnostic and therapeutic procedure in pulmonological practice. The aim of this study was to determine the perception, use and challenges encountered by Nigerian medical doctors involved in this procedure.MATERIALS AND METHODS: A cross-sectional study was conducted among 250 medical doctors recruited from three major tertiary institutions in Nigeria between September 2013 and June 2014. A semi-structured questionnaire was self-administered to adult physicians, paediatricians, and surgeons as well as their trainees to obtain their perception, use and associated challenges in the use of bronchoscopy in clinical practice.RESULTS: The majority (91.6%) of the respondents perceived bronchoscopy as a beneficial procedure to respiratory medicine. However, 59.2% of them were not aware of the low mortality rate associated with this procedure. The commonest indications for bronchoscopic use were foreign body aspiration (88.8%) and management of lung tumors (75.6%). Only 21 (8.4%) of the respondents had received formal training in bronchoscopy. Very few procedures (1-5 cases per month) were performed. The respondents identified the lack of formal training in the art of bronchoscopy as the foremost challenge facing its practice in Nigeria. In addition, availability of bronchoscopes, level of awareness, knowledge of the procedure among medical doctors and the cost of the procedure were the challenges faced by the medical doctors.CONCLUSION: There is an urgent need to equip training centers with modern bronchoscopic facilities. In addition,well-structured bronchoscopic training programme is imperative to enhance the trainees’ proficiency for the furtherance of bronchoscopic practice.KEYWORDS: Bronchoscopy, Nigeria, Respiratory medicine, Interventional pulmonology, Trainin

Developing countries subcommittee of the clinical pharmacology division : The medicines utilization research in Africa (MURIA) group and IUOHAR co-organized a workshop in botswana for the promotion of rational use of medicines

The improper use of medicines is a major cause of poor therapeutic effect as well as adverse drug reactions, and has considerable financial consequences (1-4). In the present era of global economic recession, there is a need for the judicious use of resources to benefit all citizens in developing countries. Therefore, the promotion of the Rational Use of Medicines (RUM) should be a healthcare priority in African countries. Still, there is limited information available on how appropriately medicines are prescribed and used in Africa (5)

Prescription audit in a paediatric sickle cell clinic in South-West Nigeria: A cross-sectional retrospective study

Background: Sickle cell disease (SCD) is a genetic haematological disorder that affects millions of people around the world especially people of African heritage. The treatment of the symptoms of SCD includes the use of analgesics, antibiotics, and anti-malarial drugs. Studying the pattern of drug prescription is a veritable tool for establishing the current practice and how it conforms to existing guidelines.Objectives: The main objective of this study was to assess the pattern of drug prescription in children with sickle cell disease (SCD) attending the paediatric outpatients’ clinic of a tertiary care centre in Ado-Ekiti, South-West Nigeria.Methods: This was a cross-sectional retrospective study carried out using the medical records of all patients with SCD who attended the paediatric outpatient clinic of the teaching hospital between January 1 and December 31, 2014. The information retrieved from the case notes included the bio-demographic data, associated co-morbid conditions and the list of prescribed drugs.Results: A total of 202 SCD patients aged below 18 years were seen in the clinic during the study period with males accounting for 61.9% of them. The mean age of all patients was 6.9 ±3.8 yrs. A total of 1015 medications were prescribed during the study period giving a mean of 5.02 ± 1.9. Vitamins/micronutrients, anti-malarial drugs, antibiotics and analgesics accounted for 41.4%, 29.0%, 15.7% and 13.9% of all prescribed drugs respectively. Antibiotics from the penicillin group were the most commonly prescribed followed by macrolides and cephalosporins while Ibuprofen (60.3%) and Acetaminophen (32.6%) were the commonly prescribed analgesics.Conclusion: High rate of antibiotic prescription, low use of opioid analgesics and non- prescription of prophylactic penicillin/ pneumococcal vaccination were the main findings in this study. There is need for the introduction of standard treatment protocols for this group of patients

Initiative to progress research on medicine utilization in Africa : formation of the Medicines Utilization Research in Africa group

This two day meeting brought together drug utilisation researchers from across Africa. The purpose was to share current drug utilisation (DU) research findings to further DU research across Africa including the development of a medicines utilisation research group. This led to the formation of the MURIA (Medicine Utilisation Research in Africa) Group, with a tentative vision and mission as well as the first planned research methodology training course and a symposium in Botswana later in the year. Future research projects were also planned including studies on drug utilisation of ARVs in Botswana and across Africa as well as ways to enhance the appropriate use of antibiotics and increase generic utilisation

Budgetary Resource Allocation and Organizational Survival Strategies: A Revised Simplex Algorithm

Abstract: This paper, which is based on budgetary provisions in Ejigbo Local Government Area of the State of Osun for a period of three years spanning 2011 to 2013, considered allocation of limited resources on expenditure items from which it was discovered that capital expenditure should be given maximum attention during the preparation of budget. Having applied Revised Simplex Method (RSM) on the formulated Linear Programming Problem (LPP), the results revealed that less emphasis should be placed on recurrent expenditure as well as consolidated revenue fund charges with a view to ensuring optimal budgetary allocation by meeting the demands of the citizenry in the local government area considered

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

BACKGROUND: Information regarding the incidence of drug-drug interactions (DDIs) and adverse drug events (ADEs) among paediatric patients in Nigeria is limited. METHODS: Prospective clinical audit among paediatric outpatients in four general hospitals in Nigeria over a 3-month period. Details of ADEs documented in case files was extracted. RESULTS: Among 1233 eligible patients, 208 (16.9%) received prescriptions with at least one potential DDI. Seven drug classes were implicated with antimalarial combination therapies predominating. Exposure mostly to a single potential DDI, commonly involved promethazine, artemether/lumefantrine, ciprofloxacin and artemether/lumefantrine. Exposure mostly to major and serious, and moderate and clinically significant, potential DDIs. Overall exposure similar across all age groups and across genders. A significant association was seen between severity of potential DDIs and age. Only 48 (23.1%) of these patients presented at follow-up clinics with only 15 reporting ADEs. CONCLUSION: There was exposure to potential DDIs in this population. However, potential DDIs were associated with only a few reported ADEs

Identifying patients at high risk for obstructive sleep apnoea syndrome in Nigeria: A multicentre observational study

Background: Obstructive sleep apnoea is associated with significant health consequences. A significant proportion of hospitalized patients at risk for obstructive sleep apnoea were never identified and referred for polysomnography for diagnosis. The objective of this study was to determine the factors associated with high risk for obstructive sleep apnoea and use it to identify patients at risk for the condition in tertiary hospitals in Nigeria.Methods: This was a multicentre observational study of adult patients hospitalized in three selected hospitals from 15th January to 17th March 2015. Berlin questionnaire and Epworth sleepiness scale were used to assess for obstructive sleep apnoea risk and excessive daytime sleepiness respectively. Additional questions on traditional risk factors for obstructive sleep apnoea were also obtained.Results: Nine hundred and twenty-six patients were recruited into the study. Respondents’ mean age was 44.3 years ± 15.2years, 486 (52.5%) were females and 556 (60.0%) had one or more medical co-morbidity and none of the patients had a previous diagnosis of obstructive sleep apnoea. Factors that were independently associated with high risk for obstructive sleep apnoea include systemic hypertension(aOR-10.33;95%: CI 6.42-16.61), obesity(aOR-7.87;95% CI: 4.33-14.29); excessive daytime sleepiness (aOR-3.77;95% CI:2.28-6.22), tobacco smoking (aOR-2.99;95% CI: 1.76-5.07), snoring in a first-degree relative (aOR-1.83;95% CI: 1.19-2.81); and the use of sedative (aOR-1.82;95% CI: 1.06-3.15).Conclusions: This study shows that patients with systemic hypertension, obesity, excessive daytime sleepiness, history of smoking, snoring in a firstdegree relative and use of sedatives are at high risk of obstructive sleep apnoea. None of the patients at high risk had a previous diagnosis of sleep apnoea by a physician, highlighting the diagnostic challenges of this condition. The results of this study will assist health care professionals in early identification of individuals at risk of obstructive sleep apnoea and subsequent referral for a sleep study

The IUPHAR sub-committee on clinical pharmacology in developing countries and the medicines utilization research in Africa (MURIA) group co-organized the third training workshop on drug utilization research in Africa

The IUPHAR Sub-Committee on Clinical Pharmacology in developing countries continues to partner with The Medicines Utilization Research In Africa (MURIA) Group to advance Drug Utilization research (DUR) in Africa and promote sustainable rational uses of medicines (RUM) through training, workshops, networking and cross national research.1-6 The Third Annual MURIA Training Workshop and Symposium took place between 26 and 28 June, 2017 at The University of Windhoek, Namibia, with the theme ‘Medicines Utilization Research in Africa influencing patient care and policy.