EFFECT OF A PHARMACIST INTERVENTION ON SELF MANAGEMENT PRACTICES AMONG HYPERTENSIVE-DIABETIC PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital. Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups. Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p<0.001); physical activity (t=-15.081, p<0.001); weight management practices (t=-5.479, p<0.0010, and alcohol consumption 9t=-11.550, p<0.001). Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients

Effects of Potassium Iodate Application on the Biomass and Iodine concentration of Selected Indigenous Nigerian Vegetables

Iodine is a trace element in soil and water that is involved in some important metabolic functions in human development. In many areas of the world, the surface soil becomes progressively poorer in iodide through accelerated deforestation, flooding and soil erosion. Hence, the food grown in iodine deficient regions can never provide enough iodine for the people and livestock living there. This study was aimed at increasing the level of iodine in commonly consumed vegetables by iodination of irrigation water with potassium iodate. The results obtained showed that, the increase in iodine concentration in fluted pumpkin ranged from 89.02 ± 0.31 to 140.36 ± 1.08 ìg/100 g in week 4 and 102.86 ± 0.60 to 115.89 ± 0.05 ìg/100g in week 6. The increase in iodine concentration in the vegetable marrows ranged from 60.879 ± 0.32 to 76.786 ± 0.16 ìg/100 g in week 4 and 62.078 ± 0.09 to 107.679 ± 0.24 ìg/100 g in week 6. The increase in iodine concentration in water leaf ranged from 61.59 ± 0.24 to 73.41 ± 0.83 ìg/100 g in week 4 and 62.06 ± 0.09 to 96.25 ± 0.025 ìg/100 g in week 6. From the results, the vegetables treated with 40 ìg/l potassium iodate showed the highest iodine level in week 4. These results from this iodine biofortification studies, suggest that the iodine added to the soil increased iodine uptake by the vegetables. Suggesting that iodination of irrigation water is an advantageous and cost-effective method of supplying iodine, since it requires simple technology.Key words: Fortification, iodine deficiency disorders, iodination, irrigation, potassium iodate

Incarcerated individuals and education programmes in Nigeria: A task for social workers

Much is not known about education programmes for Nigerian incarcerated individuals. Consequently, different correctional institutions worldwide have different forms of correctional education offered to incarcerated individuals. Nigerian incarcerated individuals perceive that there are implementations of education programmes offered to them. However, little or nothing is known about how incarcerated individuals perceive these education programmes. To this end, this study ascertains the incarcerated individuals’ perception of education programmes as well as the expectations of social work profession in ensuring that incarcerated individuals in correctional institutions are provided with quality education. In-depth interviews involving 20 convicted incarcerated individuals from Owerri correctional centre were conducted. Thematic analysis was used in analyzing data generated for the study. Findings show that education programmes are available and essential, but the quality of the programme does not go down well with the incarcerated individuals. It also revealed that incarcerated individuals were not allowed to decide on the type of education programme to be involved in. To this end, their participation in the programme is jeopardized. The findings further revealed that little or nothing is known about social workers in prison education. Therefore, the inclusion of correctional social workers as an integral part of education programmes that aim to reform, rehabilitate and reintegrate incarcerated individuals becomes necessary

The roles and experiences of informal carers providing care to people with advanced cancer in Africa—A systematic review and critical interpretive analysis

There is an increasing prevalence of cancer in Africa with approximately 80% of cancers diagnosed at an advanced stage. High out-of-pocket healthcare costs and overstretched health systems lead to heavy reliance on informal carers for cancer care. This study aims to explore the roles and experiences of informal carers including the impact of cancer care on individuals and communities and support available for carers. We carried out a systematic review following PRISMA reporting guidelines and used critical interpretative synthesis to identify themes and develop an informal carers’ experience framework. We searched nine databases and screened 8,123 articles from which 31 studies were included in the review. Most studies were from Sub-Saharan Africa (29/31, 94%), particularly Uganda (9, 29%). Carers were mostly women, aged 30–40 years, and siblings, spouses, or children. Caring roles included care coordination, fundraising, and emotional support. Caring was time-consuming with some carers reporting 121 hours/week of caring, associated with the inability to pursue paid work and depression. Four themes demonstrated carers’ experiences: 1) intrapersonal factors: strong sense of familial obligation, and grappling with gender roles, 2) interpersonal factors: impact of a cancer diagnosis on households, changing social and sexual relationships, 3) community factors: navigating cultural norms on nature and location of care, and 4) health system influences: barriers to accessing healthcare services, and tensions between traditional and biomedical medicine. These themes aligned with Bronfenbrenner’s social ecological model which aided our development of a framework for understanding informal carers’ experiences’. Our review highlights multifaceted roles and experiences of informal carers in Africa, amidst cultural and community impacts. Carers experience a strong obligation and willingly undertake the role of carer, but at the expense of their social, economic, and psychological wellbeing. Support for carers, including flexible working hours/ carers’ allowance, should be incorporated as part of universal health coverage

Risk perception and hesitancy towards malaria vaccines among hospital pharmacists in southeast Nigeria: a cross-sectional study

This study evaluated the willingness and perceived concerns of hospital pharmacists in allowing and recommending malaria vaccines. This was a cross-sectional-based study. Participants were recruited from two teaching hospitals in southeast Nigeria – the University of Nigeria Nsukka (UNTH) and the Enugu State University Teaching Hospital (ESUTH). Outcomes were acceptability of the malaria vaccine and concerns about the use of malaria vaccine measured using a validated 21-item questionnaire adapted from a similar study. Descriptive statistics were used to characterise and compare data, with chi-test to test the association between variables. A sub-group analysis within the acceptability was done to determine the predictors of ‘probably’ by also dichotomizing the responses. Data were analysed using STATA v17. Out of 250 participants recruited for this study, 187 completed and returned the questionnaire, with UNTH having the highest response rate (n = 137, 73.3%). Ninety-two (54.1%) out of 170 participants agreed that they would allow their children to take the malaria vaccine. Sixty-six (50.4%) out of 131 and 30 (62.5%) out of 48 participants from UNTH and ESUTH, respectively, will likely recommend the vaccine to family members, while 64 (49.6%) out of 129 and 31 (64.6%) out of 48 participants from UNTH and ESUTH, respectively, were likely to recommend the vaccine to their patients. Eighty-three (61.9%) out of 134 and 33 (67.3%) out of 49 participants from UNTH and ESUTH, respectively, had concerns about the adverse effects of taking this vaccine. Education level (p = 0.017) and age (p = 0.014) were significantly associated with the likelihood of recommending this vaccine to patients. Our findings showed that pharmacists are not likely to accept and recommend malaria vaccines to their children and patients. Hospital pharmacists’ demographic characteristics did not predict their acceptability or probability of allowing the malaria vaccine to be administered to their children. Similar findings were also observed for hesitancy towards malaria vaccines. There were concerns about the failure of the vaccine and its adverse effects

A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

BackgroundIntegrated care may improve outcomes for older people living with frailty. We aimed to assess the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life (QoL) of older people living with severe frailty.MethodsA community-based non-randomised controlled study. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at three time points: baseline, 2-4 weeks, and 10-14 weeks. The primary outcome was patient wellbeing (symptoms and other concerns) at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale (IPOS); the secondary outcome was QoL, measured using EQ-5D-5L. To test duration of effect and safety, wellbeing and QoL were also measured at 10-14 weeks. Descriptive statistics were used to characterise and compare intervention and control groups (eligible but had not accessed the new service), with t-test, Chi-Square, or Mann-Whitney U tests (as appropriate) to test differences at each time point. Generalised linear modelling, with propensity score matching, was used for further group comparisons. Data were analysed using STATA v17.Results199 intervention and 54 control participants were recruited. At baseline, intervention and control groups were similar in age, gender, ethnicity, living status, and body mass index, but not functional status or area deprivation score. At 2-4 weeks, wellbeing had improved in the intervention group but worsened in the control (median IPOS -5 versus 2, p<0.001). QoL improved in the intervention group but was unchanged in the control (median EQ-5D-5L 0.12, versus 0.00, p<0.001). After adjusting for age, gender, and living status, the intervention group had an average total IPOS score reduction at 2-4 weeks of 6.34 (95% CI: -9.01: -4.26, p<0.05); this improvement was sustained, with an average total IPOS score reduction at 10-14 weeks of 6.36 (95% CI: -8.91:-3.80, p<0.05). After propensity score matching based on functional status/area deprivation, modelling showed similar results, with a reduction in IPOS score at 2-4 weeks in the intervention group of 7.88 (95% CI: -12.80: -2.96, p<0.001).ConclusionsOur findings suggest that the new, anticipatory, multidisciplinary care service may have improved the overall wellbeing and quality of life of older people living with frailty at 2-4 weeks and the improvement in wellbeing was sustained at three months

Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care

Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change

Predictors of the quality of work life and job satisfaction among serving military healthcare personnel in the Nigerian armed forces

Introduction: Quality of work life and perception affects the productivity of healthcare professionals. The study aimed to determine the quality of work life (QWL) and job satisfaction (JS) of military healthcare professionals in Nigeria. Methods: A cross-sectional study was conducted at three military hospitals, one each for the Army, Navy, and Air Force. The 35-item QWL and five-item JS Index questionnaires were used to record responses from consenting professionals between January–March 2022. Appropriate descriptive and inferential statistical analyses were conducted, with p < 0.05 considered significant. Results: The overall average QWL score for the population was 86.88 ± 23.04, while overall JS had a mean score of 23.2 ± 7.102. Years of experience (β = –0.292, p = 0.018), and previous posting to war areas (β = –0.285, p = 0.022) were significant predictors of QWL, just as years of experience (β=–0281, p = 0.024) and age (β = 0.235, p = 0.097) were for JS. Conclusion: Healthcare professionals serving in the Nigerian Armed Forces have a fair perception of their QWL and JS

Quality of work life and job satisfaction among early-career pharmacists in Africa’s most populous country: A nationwide survey in Nigeria

This study examined the factors affecting the quality of work life and job satisfaction among early-career pharmacists in Nigeria. This was a cross-sectional survey conducted across the six geopolitical zones in Nigeria. We used the database of licensed pharmacists in each selected state to identify eligible participants. Information sheets were sent to all potential participants through email. If interested, they signed the consent form and were sent the survey online to be completed and returned within 24 h. Validated questionnaires were used to evaluate their quality of work life and job satisfaction. Descriptive statistics (frequency, mean, and standard deviation) were used to summarize the data. Of a total of 373 participants; 323 (86.6%) were single, and 245 (65.7%) were working in government-owned hospitals. The findings showed that the quality of work life information affects the job satisfaction of early-career pharmacists. Reasons reported for poor job satisfaction were poor remuneration, increased workload, a lack of employer support, and an unconducive work environment. Suggestions for possible interventions included an increase in remuneration, an accommodating work atmosphere, and flexible working hours. Our findings show a direct relationship between quality of work life and job satisfaction; predictors of job satisfaction were salary, employer assistance, health insurance, and length of leave

Assessing the impact of COVID-19 on prescription patterns and antibiotic use: Insights from three military health facilities

BackgroundThe COVID-19 pandemic disrupted health systems globally and there are suggestions it impacted antibiotics prescribing patterns in clinical practice.ObjectivesThis study aimed to assess the effects of the COVID-19 pandemic on the prescribing patterns in three Nigerian military health facilities and investigate the factors associated with antibiotic prescriptions.MethodsThis was a two-year cross-sectional retrospective study. Three hospitals and a total of 11,590 prescriptions were purposively and conveniently sampled respectively. The World Health Organisation (WHO) and International Network of Rational Use of Drugs (INRUD) prescribing indicators were used to assess for polypharmacy, injection use, use of antibiotics, use of generic drugs and prescriptions from essential drug lists for the periods of the pandemic and before the pandemic. Indicators from both periods were compared for statistical significance using the independent t-test. Generalized linear modelling was applied to assess the factors associated with antibiotic prescriptions. The relationship between the receipt of antibiotics and independent variables was presented using incident risk ratios (IRR).ResultsOur findings showed that all five WHO/INRUD prescribing indicators were above the reference limit for the two-year study period. The study found there was a significant statistical difference between the COVID- and non-COVID-19 periods, with polypharmacy and antibiotic use indicators elevated during the pandemic compared to the latter. COVID-19 (IRR = 1.09), comorbidity (IRR = 1.74), pregnancy (IRR = 0.93), out-of-pocket payments (IRR = 1.10) and the inpatient department (IRR = 1.51) were associated with antibiotic prescriptions.ConclusionsThis provides insight on impact of the pandemic on prescription patterns and advocates for stewardship programs in clinical settings to ensure the rational use of drugs