Strategies for the prevention and control of cervical cancer in rural communities: a Nigerian perspective

Majority of “most-at-risk” women for cervical cancer disease who reside in rural communities of low and middle income countries (LMIC) do not have access to cervical cancer prevention programmes. This paper reviews epidemiology, recommendations, implementation strategies for prevention and control of cervical cancer, in rural communities of middle and low income countries using Nigeria as a case study.Aim: To describe the current implementation of cervical cancer prevention programme in LMIC such as Nigeria with the view to identify gaps and document best practices for improving screening access to rural women.Method: Literature search was focused on cervical cancer prevention studies, disease prevention programmes, policy implementation guidelines for cervical cancer screening at the rural communities. Cochrane, Medline, PsycINFO and, web sites of Globocon International Agency for Research on Cancer (IARC) i.e. (secondary data) were searched with key words as cervical cancer screening and prevention, HPV vaccination, rural women, Visual inspection with acetic acid (VIA) / Visual inspection with Lugos Iodine (VILI), community, LMIC, and Nigeria.Result & Conclusion: Increasing the knowledge base and competences (skills) of PHC operators and enabling the key stakeholders i.e. rural man and women to undertake screening: integrating low cost cervical cancer prevention programme into routine PHC: and fostering collaboration and community participation are proposed for scaling up cervical cancer prevention programme at the communities.Keywords: Cervical cancer, rural women, empowerment, prevention and control,Nigeri

Off-label prescribing of anticonvulsant drugs

Anticonvulsant drugs are among the 10 top-selling therapeutic drug classes and are frequently used for unapproved indications. The objective of this study was to examine national trends in off-label prescribing of anticonvulsant drugs in ambulatory care from 1993 to 2005, and to explore patient and physician characteristics, and other factors that might be associated with off-label prescribing of anticonvulsant drugs. Physician office and hospital outpatient departmental visits mentioning anticonvulsant drug visits were identified from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Medical Care Survey (NHAMCS) respectively. Anticonvulsants were classified as old anticonvulsant if approved prior to 1990 and new if approved after 1990. On-label visits were defined as visits where any type of convulsion related condition or epilepsy or other approved indications for an anticonvulsant drug was reported as the visit diagnoses or reason for office or hospital visit. Off-label visits were defined as visits at which no approved indications was reported and at least one previously reported off-label use of any of the anticonvulsants was reported. Visits unclassifiable based on these criteria were excluded from the study. Sampling weights were used to provide national estimate. OLS regression was employed in examining the association between patterns of off-label prescribing and variations in promotional activities of drug manufacturers' (free drug sampling, and physician detailing), and the publication of off-label drug use studies. Logistic regression analysis was employed in examining associations between patients, physician and visit characteristics with off-label prescribing. During the 13 years under review, about 62% (95% CI: 59%-64%) of all anticonvulsant drug visits to both physician offices and hospitals' outpatient departments were visits at which at least one anticonvulsant drug was prescribed for an unapproved indication. There was a significant linear growth in the proportion of off-label anticonvulsant drug visits during the study period. Off-label use of new anticonvulsant drugs grew, while the off-label use of old anticonvulsant drugs remained over time, therefore the introductions of the new anticonvulsant drugs had a significant effect on the secular trend in off-label visits. Trends in promotional activities of manufacturers and publication of off-label drug use studies were found to be associated with trends in off-label prescribing of anticonvulsant drugs, though not all association reached statistical significance. Furthermore, certain patient characteristics such age, physician characteristics such as physician specialty and visit characteristics such as number of drugs prescribed were found to be associated with off-label prescribing of anticonvulsant drugs. Anticonvulsant drugs are increasingly used for off-label non-epileptic purposes with the magnitude of growth in off-label prescribing attributable to the new agents. In light of the present political interest in the safe and cost effective use of prescription drugs, there is an urgent need for formulation of policies that will give providers the autonomy to treat patients according to their best knowledge and judgment and at the same time ensure safe and cost effective use of prescription drugs

An assessment of client satisfaction wirh services at a model primary health care centre in Ogun State, Nigeria

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Health claims database study of cyclosporine ophthalmic emulsion treatment patterns in dry eye patients

Karl G Stonecipher,1 Jenny Chia,2 Ahunna Onyenwenyi,2 Linda Villanueva,2 David A Hollander2 1TLC Laser Eye Centers, Greensboro, NC, 2Allergan, Inc., Irvine, CA, USA Background: Dry eye is a multifactorial, symptomatic disease associated with ocular surface inflammation and tear film hyperosmolarity. This study was designed to assess patterns of topical cyclosporine ophthalmic emulsion 0.05% (Restasis®) use in dry eye patients and determine if there were any differences in use based on whether dry eye is physician-coded as a primary or nonprimary diagnosis. Methods: Records for adult patients with a diagnosis of dry eye at an outpatient visit from January 1, 2008 to December 31, 2009 were selected from Truven Health MarketScan® Research Databases. The primary endpoint was percentage of patients with at least one primary versus no primary dry eye diagnosis who filled a topical cyclosporine prescription. Data analyzed included utilization of topical corticosteroids, oral tetracyclines, and punctal plugs. Results: The analysis included 576,416 patients, accounting for 875,692 dry eye outpatient visits: 74.7% were female, 64.2% were ages 40-69 years, and 84.4% had at least one primary dry eye diagnosis. During 2008–2009, 15.9% of dry eye patients with a primary diagnosis versus 6.5% with no primary diagnosis filled at least one cyclosporine prescription. For patients who filled at least one prescription, the mean months’ supply of cyclosporine filled over 12 months was 4.44. Overall, 33.9% of dry eye patients filled a prescription for topical cyclosporine, topical corticosteroid, or oral tetracycline over 2 years. Conclusion: Patients with a primary dry eye diagnosis were more likely to fill a topical cyclosporine prescription. Although inflammation is key to the pathophysiology of dry eye, most patients seeing a physician for dry eye may not receive anti-inflammatory therapies. Keywords: corticosteroids, cyclosporine, dry eye syndromes, inflammation, medication adherenc

Sustainable poverty amelioration through early life education in a peri-urban community of Lagos, Nigeria

Background: Daycare centres/nurseries have become popular because of the need for working mothers to leave young children with caregivers. However, the high poverty level (54% relative and 35% extreme poverty) makes it difficult for disadvantaged parents to pay the high fees charged by the centres. This study describes an attempt to economically empower mothers through the organisation of free early life education in a peri-urban community in Lagos. Objectives: The aim of the study was to examine early life education for under-fives as a means of economic empowerment of mothers and sustainable poverty amelioration. Method: The methodology included a non-randomised selection of 34 disadvantaged mothers by criteria, a prospective intervention utilising community resources to organise early childhood education, an in-depth interview of mothers, and observation of the outcomes over a 5-year period. Results: The result of the study showed that no mother preferred keeping a child older than three years at home. Access to early childhood education gave mothers opportunity to undergo vocational training (1, 2.8%) and take up new/additional jobs (12, 35.3%). All mothers and 32 (80%) of the participating families more than doubled their income, earning up to twenty thousand Naira (approximately $182) per month from the first year of participation. Finally, selection criteria and periodic assessment of immunisation/growth monitoring records of participants’ children improved compliance with primary health care service utilisation. Conclusion: Organisation of early childhood education had the potential for sustainable poverty amelioration through economic empowerment of mothers

A blended curriculum to improve student community health officers’ competencies in newborn infection prevention and control

AbstractBackground Infections contribute significantly to neonatal mortality in Nigeria. Community health officers (CHOs) provide maternal, newborn and child health services at the primary health care level. However, newborn infection prevention and control (NB-IPC) is not included in their current training curriculum, which has little innovation in teaching methods. This study assessed the effectiveness of a blended curriculum on NB-IPC in improving the competencies of student CHOs.Methods This pre- and post-test study was conducted in the CHO training school of Lagos University Teaching Hospital (LUTH), which has 70 students enrolled. We developed and implemented a blended curriculum on NB-IPC using Kern’s six-step framework. Twelve videos were recorded of content experts teaching various aspects of NB-IPC and were watched online or downloaded by students. Two interactive practical sessions were held in class. Pre- and post-course assessment of knowledge was with multiple choice questions, attitude with a Likert scale, and skills with an objective structured clinical examination (OSCE). Course satisfaction was also assessed with a validated scale. Paired t-test was used to determine mean differences at a significance level of 0.05.Results The mean knowledge score of students increased from 10.70 (95% confidence interval (CI): 10.15–11.24) pre-course out of a possible score of 20 to 13.25 (95%CI: 12.65–13.84) post-course (p < 0.001). Mean attitude score increased from 63.99 (95%CI: 62.41–65.56) out of a possible score of 70 to 65.17 (95%CI: 63.68–66.67) (p = 0.222). The mean OSCE score increased from 21.27 (95%CI: 20.20–22.34) out of a possible score of 58.5 to 34.73 (95%CI: 33.37–36.09) (p < 0.001). Mean post-course satisfaction score of students was 127.84 (95%CI: 124.97–130.89) out of a possible score of 147.Conclusion The new curriculum on NB-IPC improved the competencies of student CHOs in LUTH and they were highly satisfied. The blended curriculum may be a feasible addition to learning in CHO schools across Nigeria.Key messageA blended curriculum on NB-IPC involving video teaching is effective in improving the competencies of student CHO

Surveillance and Treatment of Non-Muscle-Invasive Bladder Cancer in the USA

Seventy percent of newly diagnosed bladder cancers are classified as non-muscle-invasive bladder cancer (NMIBC) and are often associated with high rates of recurrence that require lifelong surveillance. Currently available treatment options for NMIBC are associated with toxicities that limit their use, and actual practice patterns vary depending upon physician and patient characteristics. In addition, bladder cancer has a high economic and humanistic burden in the United States (US) population and has been cited as one of the most costly cancers to treat. An unmet need exists for new treatment options associated with fewer complications, better patient compliance, and decreased healthcare costs. Increased prevention of recurrence through greater adherence to evidence-based guidelines and the development of novel therapies could therefore result in substantial savings to the healthcare system