Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance

<p>Abstract</p> <p>Background</p> <p>Adverse drug reactions (ADRs) contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone technology to report ADRs following drug exposures were investigated in Sagamu - a peri-urban community in Southwest Nigeria.</p> <p>Methods</p> <p>Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP) and four Patent and Proprietary Medicine Stores (PPMS) in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period.</p> <p>Results and Discussion</p> <p>A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases); of this number, purchases of sulphadoxine-pyrimethamine (SP) and chloroquine (CQ) were highest (39.3 and 25.2% respectiuvely). Other anti-malarials purchased were artesunate monotherapy (AS) - 16.1%, artemether-lumefantrine (AL) 10.0%, amodiaquine (AQ) - 6.6%, quinine (QNN) - 1.9%, halofantrine (HF) - 0.2% and proguanil (PR) - 0.2%. CQ was the cheapest (USD 0.3) and halofantrine the most expensive (USD 7.7). AL was 15.6 times ($4.68) more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1) after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%).</p> <p>Conclusion</p> <p>The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource-poor setting.</p

Inter-relationship of plasma markers of oxidative stress and thyroid hormones in schizophrenics

<p>Abstract</p> <p>Background</p> <p>The relationship of oxidative stress to thyroid hormones has not been studied in the schizophrenics. The present study determined the status and interrelationship of plasma markers of oxidative stress, nitric oxide and thyroid hormones in thirty (17 males and 13 females) newly diagnosed patients with acute schizophrenia before initiation of chemotherapy. Twenty five (13 males and 12 females) mentally healthy individuals served as controls. Patients and controls with history of hard drugs (including alcohol and cigarette), pre-diagnosis medications (e.g. antiparkinsonian/antipsychotic drugs), chronic infections, liver disease and diabetes mellitus were excluded from the study. Plasma levels of total antioxidant potential (TAP), total plasma peroxides (TPP), nitric oxide (NO), malondialdehyde (MDA), thyroxine (T4), tri-iodothyronine (T3) and thyroid stimulating hormone (TSH) were determined in all participants using spectrophotometric and enzyme linked immunosorbent assay (ELISA) methods respectively. Oxidative stress index (OSI) was calculated as the percent ratio of total plasma peroxides and total antioxidant potential.</p> <p>Findings</p> <p>Significantly higher plasma levels of MDA (p < 0.01), TPP (p < 0.01), OSI (p < 0.01), T3 (p < 0.01) and T4 (p < 0.05) were observed in schizophrenics when compared with the controls. The mean levels of TAP, NO and TSH were significantly lower in schizophrenics (p < 0.01) when compared with the controls. The result shows that T3 values correlate significantly with MDA (p < 0.05) and TPP (p < 0.01) in schizophrenics.</p> <p>Conclusions</p> <p>Higher level of TPP may enhance thyroid hormogenesis in schizophrenics. Adjuvant antioxidant therapy may be a novel approach in the treatment of schizophrenic patients.</p

Potential contribution of prescription practices to the emergence and spread of chloroquine resistance in south-west Nigeria: caution in the use of artemisinin combination therapy

Abstract Background Prescription practices have been shown to influence the emergence of anti-malarial drug resistance. Thus efforts in this study were devoted to evaluating the prescribing practices prior to introduction of the artemisinin based combination therapy (ACT) in Nigeria and its potential contribution to emergence of chloroquine resistant malaria in south-west Nigeria, in order to forestall a similar situation with the ACT. Methods A retrospective quantitative study was designed to examine case records of patients treated for malaria in either a government or a private hospital in Ibadan, south-west Nigeria, over a 20-year period, cutting across three phases of resistance to chloroquine in Nigeria: pre-resistance, emerging resistance and dissemination of resistance. Patient prescriptions were examined for use of anti-malarial drugs, sub-therapeutic doses of chloroquine, co-administration of anti-histamines with chloroquine. Descriptive statistics of frequency and percentage were used to describe trends in the parameters assessed using EPI-info. Results Case record files of 2,529 patients were examined. Chloroquine was the main drug used in treatment of malaria throughout the periods studied, with frequency of prescription at both sites ranging from 91.4% to 98.3% during the pre-resistance years. It was administered as standard doses during the pre resistance years. Anti-histamines, especially promethazine, were routinely co-administered with chloroquine at this period too. However, the practice of prescribing sub-therapeutic doses of chloroquine at the private health care facility coincided with the latter phase of emerging resistance and phase of dissemination of resistance. Frequency of prescription of sub-therapeutic doses increased from 6.7% in 1983 (pre-resistance years) to 43.6% in 1997 (dissemination of resistance phase) at the private health care facility. Frequency of co-administration of anti-histamines with chloroquine also reduced during the period of dissemination of resistance. Conclusion The results from this study describe a lack of adherence to national treatment guidelines, especially in the private sector, and a relationship between prescription practices and dissemination of drug resistant falciparum malaria. As Nigeria adopts the use of ACT, there is an urgent need to improve malaria treatment practices in Nigeria in order to prolong the clinical shelf-life of the combination.</p

Abstinence sexuelle du postpartum et les types d&apos;allaitement a Shagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.Il s&apos;agit d&apos;une étude prospective concernant 371 mères. L&apos;âge moyen de ces mères était de 27,5 (.3,5) ans ainsi qu&apos;un âge moyen à l&apos;école (des années scolaires) de 11,3 (2,9) ans. Toutes les mères ont allaité au moins un de leurs enfants pendant six mois alors que les mères ont aussi allaité leur dernier enfant pendant un moyen de 10,3 (4 mois). Le moyen global des naissance vivantes précédentes était de 1,9 (0,8). En ce qui concerne le postpartum du premier mois, 84,6% des mères se sont abstenues des rapports sexuels mais vers les 4ème et 5ème mois, le chiffre a chuté jusqu&apos; à 18,1%, mais il n&apos;y avait que 2,1% de la population étudiée qui se sont abstenues des rapports sexuels au cours de la période de 11 - 15 mois du postpartum. Quarante - sept (13,5%) 30 (8,6%) et 3 (0,9%) mères appartenant aux clases sociales 2,3 et 1 respectivement ont repris les rapports sexuels après 4-5 mois, alors que (12 (3,4%) et 4 (1, 1%) dans les classes sociales 2 et 3 respectivement ont continué les rapports sexuels après 11 - 15 mois. Il y a eu encore des mères qui ont repris les rapports sexuels à partir d&apos;un mois jusqu&apos;à 15 mois du postpartum quand elles ont allaité pour 6 - 10 minutes et 11 - 15 minutes plus que celles qui ont allaité pour 1 - 5 minutes 16 - 20 minutes et 21 - 25 minutes. Il y avait plus des femmes du groupe d&apos;âge de 25 - 29 ans qui avaient repris les rapports sexuels à partir du premier mois jusqu&apos;au quinzième mois du postpartum que les mères dans d&apos;autres groupes d&apos;âge

Contribution of indigenous health care givers to the herbal managament of febrile illnesses in Rivers state, South-south, Nigeria

This study was carried out in two rural communities: Kaani and Boue, in Khana Local Government Area (LGA) and, in one urban community, Eleme, in Eleme LGA, all in Rivers State, South-South Nigeria. The investigations involved in-depth interviews conducted with 104 health care givers comprising indigenous healers: herbalists, sellers of herbal remedies and community elders. Information was obtained on types of fevers (febrile illnesses) treated, symptoms and methods of establishing illnesses, and traditional herbs used in the prevention and treatment of febrile illnesses. On types of febrile illnesses treated, respondents presented the following: malaria (78.8%), typhoid (23.1%), yellow fever (21.2%), high fever (19.2 %), convulsion (15.4%), and pregnancy fever (2.9%). Other illnesses treated were yellow eyes (4.8%) headache (11.5%), waist pain (14.4%), and joint pains, (8.7%). Respondents determined whether a person had fever by the following: physical examination (85.4 %), listening to patients' complaints (9.4 %), through divination and inspiration (9.4 %), while others (0.2 %) were not quite explicit on their methods of diagnoses. On the treatment of febrile illnesses, respondents used herb teas (88.5%), herb powders (42.3%), incantation (3.3 %), and performance of sacrifice (4.8%) or use of special fluids (27.9%). Majority of the respondents, in describing the best herbal medicines for the treatment of febrile illnesses, 62.5 % said that dogonyaro (Azadiracta indica) was the best medicine. Other responses were: lemon grass (Cymbopogon citratys, 51.9 %), mango (Mangifera indica) bark (29.8 %); lime (Citrus limetta) juice (30.0 %), paw paw (Carica papaya) leaf/fruit (20.2 %); guava (Psidium guajava) leaf (18.3 %), akpagbogoro (Salacia nitida), 7.7 %, plantain (Musa sapientum) sucker (6.7 %), Lipton tea (3.8 %) and scent leaf (Ocimum gratissimum), 1.9%. Keywords: Malaria, fever, febrile illness, herbal remedies, NigeriaWest African Journal of Pharmacology and Drug Research Vol. 21 (1&2) 2005: pp. 48-5