Accessibility of Antimalarials in Secondary Health Care Facilities and Community Pharmacies in Lagos State – A Comparative Study

Background: The attainment of the 6th Millennium Development Goal to halt and reverse the effects of malaria and other diseases by 2015 depends on the accessibility of Artemisinin Combination Therapy (ACT) which is now the first line antimalarial therapy for uncomplicated malaria. The main Objective of this study was to assess the availability and affordability of ACTs in Secondary Health Care (SHC) facilities in Lagos State and community pharmacies located within 200 meters of these facilities.Method:  Two SHC facilities each were randomly selected from four (4) geographical zones and the only one (1) in the fifth zone was selected, making a total of nine (9) facilities which were surveyed. The eleven (11) community pharmacies located within 200 meters of these health care facilities were also used for the study. A modified HAI was used for data collection on medicine price and availability was used for the study.Results:  ACTs (artemisinin/lumefantrine) were prescribed 90% of the time as first line antimalarial. About thirty seven percent (37.5%) of the hospitals did not have the drug in stock at the time of visit and drugs had been out of stock for upward of three weeks. Private partnership pharmacies do not stock antimalarials as a matter of policy, since the drugs are supposed to be obtained free from the hospital. This first line antimalarial cost about six hundred and forty naira (N640) in the private community pharmacies.Conclusion:  ACTs are not always available in the hospitals in Lagos State; patients therefore depend on community pharmacies and patent medicine stores for their ACT supply. Since 93.9% of Nigerians live in subjective poverty, the cost of first line ACT antimalarial remains unaffordable and inaccessible.Keywords: Accessibility; Antim alarial;ACTs;Community Pharmacies; Secondary Health Facilitie

Scholarly publishing depends on peer reviewers

The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre- publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer

Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria

Background: Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea. Objective: To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice. Methods: This study was carried out using two instruments: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria. Results: The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms’ management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits. Conclusions: Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines

Community pharmacists’ views of the use of oral rehydration salt in Nigeria

Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5 years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs’ views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists’ views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists’ views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers’ expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers’ complaints about ORS, by dispensing metronidazole. These barriers appeared to have normalised metronidazole for AWD treatment in this setting. Current facilitators include the caregivers’ improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs’ views showed that caregivers’ expectations for an antimicrobial may be the main barrier to the use of ORS in their practices.</p