Evaluation of drug therapy problems among renal patients receiving care in some tertiary hospitals in Nigeria

Purpose: To determine the prevalence of drug therapy problems (DTPs), identify the types of DTPs and assess outcomes of DTP interventions among renal patients receiving care in three Nigerian tertiary hospitals.Methods: This prospective descriptive study was conducted in nephrology units of three tertiary hospitals in Nigeria, based on recommendations of working conference of the Pharmaceutical Care Network Europe, version 6.2 while the reviews,  classification of DTPs and principles of drug use in chronic kidney diseases (CKD) were based on evidence-based clinical guidelines and standards of practice (Kidney Disease: Improving Global Outcomes (KDIGO).Results: Out of 234 DTPs identified, 90 (38.46%) had drug choice problem, 86 (36.75%), had problems of drug interactions; 47(20.09%), had dosing problem, while 11 (4.70%) had drug use problem. Clinical interventions (459) were  undertaken at prescriber level (78; 16.99%); patient/carer level (211, 46.00 %) and drug level (170, 30.04 %). Pharmacists recommended 376 of the interventions for approval, out of which 310 (67.54%) were approved. Amongst the DTPs indentified, 47.86 % were successfully resolved.Conclusion: Drug therapy problems among renal patients were high. Inappropriate drug selection and drug interactions were the commonest drug therapy problems. The acceptance of pharmacists’ interventions by prescribers was appreciable.Keywords: Drug therapy problems, Renal patients, Therapy, Intervention, Outcome

Health-related quality of life of HIV-infected patients taking different antiretroviral regimens at a tertiary healthcare facility in northern Nigeria

Purpose: To evaluate the health-related quality of life (HRQoL) of patients taking different antiretroviral regimens.Methods: A cross-sectional descriptive design was used to evaluate HRQoL of patients on Highly Active Antiretroviral Therapy (HAART) at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Data were collected using HIV/AIDS-Targeted Quality of Life instrument between May and November, 2015 from 872 adult outpatients who had been on their regimen for at least 6 months. Data were statistically analysed.Results: The overall HRQoL score of the patients was 59.40 ± 18.66. Among  patients on the first-line regimens, those on TDF + FTC + EFZ (60.52 ± 19.17) and those on TDF + 3TC + EFZ (64.41 ± 18.04) reported the best HRQoL scores. The difference between the scores of patients on the two most utilised regimens; AZT + 3TC + NVP (58.14 ± 18.53) and TDF + 3TC + EFZ (64.41 ± 18.04) was significant (p < 0.05). Among patients on second-line regimens, those on TDF + FTC + LPVr (67.58 ± 14.80) reported the highest HRQoL score.Conclusion: Patients in this facility had a moderate HRQoL. TDF + 3TC + EFZ, TDF + FTC + EFZ and TDF + FTC + LPVr were the regimens with the best HRQoL  outcomes. The use of these regimens should be encouraged for better patient well-being.Keywords: HIV, Health-related quality of life, Antiretroviral therapy, First-line  antiretroviral regimen, Second-line antiretroviral regime

Health state utilities of a population of Nigerian hypertensive patients

<p>Abstract</p> <p>Background</p> <p>Establishment of the health impact of hypertension on quality of life of Nigerians is a step towards controlling the disease. The study aimed to provide a Nigerian specific reference list of utility scores of hypertensive patients with various interacting conditions.</p> <p>Findings</p> <p>An interviewer-based, cross-sectional study was conducted using hypertensive patients in two purposively selected tertiary hospitals located in South-Eastern Nigeria. Health Utility Index Mark 3 (HUI3) was used.</p> <p>A total of 384 participants with either hypertension alone or with hypertension-associated complications were interviewed in the two tertiary hospitals.</p> <p>The overall mean utility score was 0.35 +/- 0.42. Patients with hypertension alone had the highest overall mean utility score (0.57 +/- 0.29) while hypertensive patients with stroke had the lowest overall mean score (0.04 +/- 0.36). Being a male, increase in age and mean arterial blood pressure, emergency visit and loss of work due to illness were associated with significant decrease in overall utility scores.</p> <p>Conclusions</p> <p>This study presented a reference for health state utilities of a population of Nigerian hypertensive patients.</p

A Comparative Study of Quinine and Artemether in the Treatment of Severe Malaria in Nigerian Children

Purpose: Nigeria has adopted quinine as the drug of first choice in the treatment of severe malaria and artemether as an alternative therapy. The purpose of this study was to ascertain whether artemether is a comparable alternative to quinine in the management of severe malaria in Nigerian children. Methods: We conducted a randomized prospective study comparing quinine and artemether therapies in 90 Nigerian children with severe malaria. Results: Mortality was lower in quinine group (13.0 %) than artemether (15.9 %), Odds Ratio (OR) = 0.446 (95 % Confidence Interval (CI), 0.124 to 1.603, p = 0.249 ). The parasitaemia clearance on day 3 by quinine and artemether was 96.8 and 99.0 % (p = 0.422), respectively, while on day 14 it was 100 % for both medicines. Fever clearance by quinine and artemether was 87.7 and 90 % (p = 0.753), respectively, on day 3 but it increased to 100 and 96.42 % (p = 0.072), respectively, on day 14. For the quinine group, 71.74 % of the patients spent less than one week in the hospital versus 61.76 % for the artemether group (p = 0.829, OR = 0.883, 95 %CI = 0.284 to 2.742). Conclusion: Artemether is a comparable alternative to quinine in the treatment of severe paediatric malaria

The Construct Validity of an Instrument for Measuring Type 2 Diabetes Self-Care Knowledge in Nigeria

Purpose: To develop an instrument (DSCKQ-30) for measuring type 2 diabetic patients’ knowledge of self-care practices. Methods: A 30-item questionnaire (DSCKQ-30) consisting of close ended questions was developed for this study. DSCKQ-30 was self administered to a cross-section of randomly selected 400 ambulatory adult diabetic patients (≥ 18 years), who were attending endocrinology clinics at the hospitals included in this study. The sex distribution for female and male was 56.7 and 43.3% respectively. Factor analysis and item analysis were performed to test the construct validity and reliability of the instrument. Item performance was measured by item discrimination (item-to-total correlation) and percent correctness (%C). Results: The response rate was 78.5%. Factor analysis identified three scales of knowledge of self-care management. Chronbach’s alpha of the 30 questionnaire items was found to be 0.89. The item-to-total correlation coefficients and ranges for component 1 - 3 were 0.36 (0.25 - 0.48), 0.28 (0.23 - 0.35), and 0.34 (0.23 - 0.41), respectively, with overall average of 0.33 (0.23 - 0.48). Items percent correctness (%C) ranged from 16.7 to 86.7 % with an overall average of 55.6 %. Item factor loadings averaged 0.62 for the total items; averages of the three scales ranged from 0.59 to 0.68. Conclusion: The DSCKQ-30 provided a quantitative measure of patient's knowledge of self-care practices

Comparison of the effectiveness of two-dose versus three-dose sulphadoxine-pyrimethamine in preventing adverse pregnancy outcomes in Nigeria

Background & objectives: Three doses of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as the new recommendation for prevention of malaria in pregnancy. This study evaluated the effectiveness of two-dose versus three-dose of SP for IPTp-SP in the prevention of low birth weight (LBW) and malaria parasitaemia. Methods: An open, randomized, controlled, longitudinal trial was conducted in a secondary level hospital in Nsukka region of Enugu State, Nigeria. A sample of 210 pregnant women within gestational ages of 16–24 wk were recruited at antenatal clinics and equally randomized to either a two-dose SP or three-dose SP group. The primary endpoints were LBWs, peripheral, and placental parasitaemia, while the secondary endpoints were maternal anaemia, pre-term birth, clinical malaria and adverse effects of SP. Results: Among 207 cases followed till delivery, the prevalence of parasitaemia was lower in three-dose group than in two-dose group for both peripheral (9.3% versus 27.8%) and placental (10.6% versus 25.6%) parasitaemia. The adjusted odds ratios (aOR) were 0.15 [95% confidence interval (CI), 0.05 – 0.45] and 0.17 (95% CI, 0.06–0.51), respectively. The prevalence of LBW was also lower in three-dose (3.5%) than in two-dose (12.2%) group (aOR, 0.15; 95% CI, 0.04–0.63); however, the prevalence of maternal anaemia, pre-term births, clinical malaria and SP adverse effects were similar between the two arms of treatment. Interpretation & conclusion: Addition of a third SP dose to the standard two-dose SP for IPTp led to improved reductions in the risk of some adverse pregnancy outcomes

Prevalence of Low Birth Weight before and after Policy Change to IPTp-SP in Two Selected Hospitals in Southern Nigeria: Eleven-Year Retrospective Analyses

Background. In 2005, Nigeria changed its policy on prevention of malaria in pregnancy to intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP). Indicators of impact of effective prevention and control of malaria on pregnancy (MIP) are low birth weight (LBW) and maternal anaemia by parity. This study determined the prevalence of LBW for different gravidity groups during periods of pre- and postpolicy change to IPTp-SP. Methods. Eleven-year data were abstracted from the delivery registers of two hospitals. Study outcomes calculated for both pre- (2000–2004) and post-IPTp-SP-policy (2005–2010) years were prevalence of LBW for different gravidity groups and risk of LBW in primigravidae compared to multigravidae. Results. Out of the 11,496 singleton deliveries recorded within the 11-year period, the prevalence of LBW was significantly higher in primigravidae than in multigravidae for both prepolicy (6.3% versus 4%) and postpolicy (8.6% versus 5.1%) years. The risk of LBW in primigravidae compared to multigravidae increased from 1.62 (1.17–2.23) in the prepolicy years to 1.74 (1.436–2.13) during the postpolicy years. Conclusion. The study demonstrated that both the prevalence and risk of LBW remained significantly higher in primigravidae even after the change in policy to IPTp-SP

Knowledge of self-care among type 2 diabetes patients in two states of Nigeria

Objective: To assess the knowledge of self-care practices, as well as factors responsible for such knowledge among type 2 diabetes patients in two states of Nigeria.Methods: Descriptive, cross sectional survey research design was employed. The study was conducted on type 2 diabetes out-patients attending Endocrinology Clinic at the University of Uyo Teaching Hospital (UUTH) and University of Calabar Teaching Hospital (UCTH) between June 2012 and February 2013. The Diabetes Self-care Knowledge (DSCK-30) was used in evaluating knowledge of self-care practices. Socio-demographic information and respondents’ opinion on the possible barrier(s) to knowledge of self-care were also obtained. Data were analysed using Microsoft Excel and SPSS version 14.0. Statistical significance for all analyses was defined as a p value less than 0.05.Results: A total of 303 out of 380 questionnaires distributed were completed and returned (response rate =79.7%). The majority of the study sample (79.5%) had 70% or more overall knowledge level about self-care. Self-care knowledge was associated with level of education (p<0.001), monthly income (p<0.001) and duration of diabetes (p=0.008). Negative attitude to disease condition was the only factor associated with knowledge (chi-square value at one degree of freedom =6.215; p=0.013).Conclusion: Diabetes self-care knowledge was generally high among the population studied. Educational status, monthly income, duration of diabetes and negative attitude to disease condition predicted knowledge level