Appraisal of Institutional Antimicrobial Stewardship in Selected Public Health Facilities in Nigeria

The misuse of antimicrobials (AM) constitutes a huge problem in developing countries, including Nigeria, posing severe public health threats to the populace’s health. Misuse contributes to the high consumption of AM, driving the emergence and spread of antimicrobial resistance (AMR). Establishing functional antimicrobial stewardship (AMS) programs at the health facility levels is recognized as an effective and efficient strategies to tackle AMR. Literature is replete with evidence of poor prescription practices, but few studies assessing the factors contributing to inappropriate use of AM in Nigeria exist. The purpose of this study was to improve the understanding of AMS practice at the three-tiered level of care to promote rational use of AM. The theoretical framework is the theory of planned behavior. A qualitative case study was used with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. Emergent themes include lack of AMS programs, no guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, limited access to quality-assured and affordable medicines, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. The recommendation is to strengthen AMS programs’ policy and governance framework at the national and health facility levels. Strengthening process governance aligned with the aims and structure of the AMS program would contribute to positive social change through rational AM use. Rational AM use would preserve universal access to quality-assured, effective, and affordable AM for those seeking care in Nigeria

The hidden costs of installing xpert machines in a tuberculosis high-burden country: experiences from Nigeria

Introduction Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology. Objective: We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria. Methods We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values. Results Costs were often identified after initiating installation for many reasons. Installation varied widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00. Conclusion Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure

The hidden costs of installing xpert machines in a tuberculosis high-burden country: experiences from Nigeria

Introduction: Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology.Objective: We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria.Methods: We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values.Results: Costs were often identified after initiating installation for many reasons. Installation varied  widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00.Conclusion: Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure.Key words: Tuberculosis, Xpert-Installation, low resource –settings, hidden cost, operational researc

LEPROSY ELIMINATION: PROGRESS AND CHALLENGES IN NIGERIA; KADUNA STATE TB AND LEPROSY CONTROL PROGRAMME AS A CASE STUDY

The study aims at describing the achievements and challenges of Leprosy control in Kaduna State using appropriate indicators. The study was a five year (2004-2008) retrospective review of the Leprosy records and annual reports of all the twenty three LGAs in Kaduna State. Various Leprosy indicators were calculated and presented in different graphic presentations. Focus group discussions were organised with the aim of identifying current challenges of Leprosy control in the State. There was a decline in the new Leprosy cases detected annually from 226 cases in 2004 to 140 cases in 2008. The prevalence rate ranged between 0.3-0.4 per 10,000 population within the five year period. The proportion of children among new cases dropped from 12% in 2004 to 5% in 2007 and increased to 9% in 2008. Grade 2 disability among new cases was very high (between 21%-27%) within the same period. Leprosy elimination target has been achieved in Kaduna State, but new cases with high proportion of children and WHO grade 2 disability were still been reporte

Baseline characteristics of MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013 (N = 482).

<p>Baseline characteristics of MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013 (N = 482).</p

Pharmacovigilance Form (Yellow Form).

<p>Pharmacovigilance Form (Yellow Form).</p

Duration of ADRs among MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013.

<p>Duration of ADRs among MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013.</p

Number and severity of adverse events among MDR-TB patients in Nigeria, 2012–2013 (N = 482).

<p>Number and severity of adverse events among MDR-TB patients in Nigeria, 2012–2013 (N = 482).</p

Association between AEs, sex, age and body weight among MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013.

<p>* <i>Adjusted Odds Ratio and p-value (Wald’s test) based on multivariate logistic regression using a stepwise backward elimination approach</i>.</p><p><i>Note</i>: <i>Treatment centers</i>: <i>DL HMH = Dr</i>. <i>Lawrence Henshaw Memorial Hospital</i>, <i>Calabar; GCH = General Chest Hospital</i>, <i>Ibadan; IDH = Infectious Disease Hospital</i>, <i>Kano; JUTH = Jos University Teaching Hospital</i>, <i>Jos; MHY = Mainland Hospital</i>, <i>Yaba; NTBLCT = National Tuberculosis and Leprosy Training Center; UCH = University College Hospital</i>, <i>Ibadan; UPTH = University of Port Harcourt Teaching Hospital; UUTH = University of Uyo Teaching Hospital</i>, <i>Uyo</i>.</p><p>Association between AEs, sex, age and body weight among MDR-TB patients admitted to in-patient care, Nigeria, 2012–2013.</p

Categorizing of adverse events based on signs and symptoms.

<p>Categorizing of adverse events based on signs and symptoms.</p