Medication history documentation in referral letters of children presenting at the emergency unit of a teaching hospital in Lagos, Nigeria

Background: Medical literature has demonstrated that referral hospitals often receive inadequate information about the care and medications their patients received from referring hospitals.Objectives: This study aimed to assess the completeness of referral letters, especially the medication history, for patient presenting at the children emergency room of a teaching hospital in Lagos, Nigeria.Methods: A pro forma form was developed to obtain from the referral letters the demographic information of children referred to the emergency room of the Lagos University Teaching Hospital (LUTH), Idiaraba, over a period of three months. The nature of the referring centre, tentative diagnoses made at the referring centre, duration of illness prior to referral, vital signs and  hysical examination findings, investigation results, and treatment given were also extracted from the letters. In addition, we extracted from the letters the name, dosage, frequency and duration of use of medicines administered at the referring centres. Parents were also interviewed about the details of medicines used prior to presentation of their child at the referring centres.Results: Among those referred with a letter, 100 patients met the inclusion criteria and constituted those evaluated in this study. Most of the patients were referred from general hospitals (31%), another tertiary hospital (29%), and private hospitals/clinics (24%). Gender (30%) and tentative diagnoses (12%) were omitted in the referral letters. However, information about the weight (82%), vital signs (57%), physical examination findings (44%), treatment given (92%), and medication history (71%) were much more omitted in the referral letters.Conclusion: Medication history as well as many other data points is infrequently reported in referral letters to a tertiary care hospital in Lagos, Nigeria. Standard referral guidelines may be useful to improve documentation of medication history.Keywords: Medication, History, Referral letters, Children, Emergency unit, Tertiary hospita

Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria

Background: Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teaching hospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour. Methods: A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics. Results: Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs. Conclusion: Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs. Since this study was based on self-report, the influence of drug information resources reported by the respondents on their prescribing behaviour may have been underestimated. Measures should be taken to minimize interactions between PSRs and the respondents.Key words: Drug, prescription, information source, promotion, pharmaceutical company, influence, doctors, Nigeri

Evaluation Of The Anti-Arthritic Activity Of The Hydroethanolic Leaf Extract Of Alchornea Cordifolia In Rats

Background: Different decoctions of Alchornea cordifolia leaves are used by Yoruba herbalists (Southwest Nigeria) for the local treatment of ulcers, rheumatic pains, febrile convulsions, and for enhancing physical performance.Materials and methods: In this study, the anti-arthritic effect of 100 – 400 mg/kg/day of the hydroethanolic leaf extract of Alchornea cordifolia (HEAC) was investigated in Complete Freund’s Adjuvant (CFA)-induced arthritic rats as a way of evaluating its efficacy in the local management of arthritis. In addition, the effects of HEAC on liver and renal function parameters as well as its effect on the antioxidant enzyme system were investigated. Arthritis was induced using 0.1 ml of 10 mg/ml of Complete Freund’s Adjuvant (CFA) following 1 h oral pretreatment and 8th day postarthritic induction with 100, 200 and 400 mg/kg/day of HEAC and 3 mg/kg/day of celecoxib as the reference drug. The anti-arthritic activity of HEAC was assessed based on the ability of HEAC to alter the paw edema diameter, body weight, full blood count, renal and liver function markers, glycoprotein, lysosomal enzymes and possible antioxidant potential in the arthritic rats.Results: Oral pretreatment with 100, 200, and 400 mg/kg/day of HEAC produced significant (p<0.001, p<0.05 and p<0.01) reductions in the paw edema diameter in a non-dose dependent fashion in ACF-induced arthritic rats with the 100 mg/kg/day of HEAC producing the most significant antiarthritic effect. Similarly, HEAC increased hepatic GSH levels, CAT and SOD activities suggesting possible antioxidant mechanism for its antiarthritic effect.Conclusion: Overall, results of this study lend credence to the folkloric use of water decoction of Alchornea cordifolia leaves against rheumatoid arthritis. However, further pharmacological investigations would be required at isolating and determining the active anti-arthritic molecule(s) in HEAC in the nearest future.Key words: Complete Freund’s Adjuvant, Arthritis, Hydroethanolic leaf extract, Alchornea cordifolia, Rat

Evaluation of hypoglycemic activities of hydroethanolic leaf extract of Nicotiana tabacum (Solanaceae)

The aim of this study was to evaluate the hypoglycemic activities of hydroethanolic leaf extract of Nicotiana tabacum. Acute toxicity was evaluated in Swiss albino mice using graded oral doses of the extract. Hypoglycemic properties of Nicotiana tabacum was assessed using oral glucose tolerance test and on normoglycemic rats that received single doses of the extract at 40 and 80 mg/kg body weight and blood glucose levels estimated at 2, 4 and 6 hours (single dose study). Phytochemical screening of the extract for the presence of secondary metabolites was performed with standard methods. Acute toxicity study revealed a median lethal dose (LD50) of 5.82g/Kg. the single-dose study showed that 40mg/Kg and 80mg/Kg body weight of the extract significantly (p<0.05) reduced blood glucose levels at 2h compared to control (27.35% and 28.37% respectively), while 80mg/kg body weight of the extract significantly (p<0.05) reduced blood glucose level at 6h compared to control (75.40%). The oral glucose tolerance test results also showed a significant reduction (p<0.05) in blood glucose levels. These findings suggest that the extract of Nicotiana tabacum has hypoglycemic properties which may be accounted for by the presence of secondary metabolites in the extracts -flavonoids, alkaloids, phenols and terpenoids.Key words: Nicotiana tabacum, Diabetes mellitus, Hypoglycemia, Oral glucose toleranc

Knowledge of malaria amongst caregivers of young children in rural and urban communities in Southwest Nigeria

Purpose: To compare the awareness and treatment knowledge of malaria amongst caregivers of young children in urban and rural areas of Ado-Odo/Ota Local Government Area in Ogun State. Method: Structured questionnaires were administered to caregivers of children under the age of five years in 1472 households using a multistage random sampling technique. Results: Many respondents (65%) attributed the cause of malaria to mosquito bite. The knowledge of malaria treatment (particularly the knowledge of pediatric doses) was generally poor. Caregivers in urban areas had better understanding of the dosage regimen for both adult and pediatric doses (

The Knowledge and Attitude towards Childhood Immunization amongst Mothers Attending Antenatal Clinic in Lagos University Teaching Hospital

Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with infectious diseases. Over two million deaths are delayed through immunization each year worldwide. Childhood immunization is an act of inducing immunity to a child by applying a vaccine that almost guarantees protection from many major diseases. This present study aims to assess the knowledge and attitude of mothers attending antenatal clinic in Lagos University Teaching Hospital (LUTH) towards childhood immunization as the findings obtained may serve as the basis for effective intervention. This study is a descriptive cross-sectional survey of the knowledge and attitude of 274 mothers attending antenatal clinics in LUTH towards childhood immunization between April and June, 2009. The results showed that almost all the respondents were aware of immunization and that immunization could prevent childhood illness (93.8%; 98.1%) respectively. However, some of the respondents (28.8%) felt immunization will make their children brilliant. A large percentage of the respondents (45.5%) thought that polio vaccines ought to be given five (5) times while only 8.6% knew it should be given four (4) times. There were significant (P<0.05) relationships between age of respondents; ethnicity; level of education; occupation and attitude to immunization. However, there was no significant (P>0.05) relationship between religion and attitude to immunization. Although majority of the mothers were aware of immunization services, their knowledge of immunization schedule as well as of vaccine preventable diseases is poor. A better understanding of routine immunization schedule is important in the design and implementation of immunization programmes. Educating mothers about the vaccines and vaccine preventable diseases, and improving their performance are recommended

SERVICE MARKETING IMPERATIVES, LEADERSHIP COMPETENCIES AND SUSTAINABLE MARKET PERFORMANCE OF SELECTED HOTELS IN LAGOS, NIGERIA

The increasing importance of service in today’s business environment has dominated most economies around the world. The hotel industry is on the fast rise to becoming one of the contributors to GDP; it is overwhelmed with innovation, technology and service environment, which has affected customers’ decision to repeat the purchase of service rendered to them in the hotel. These, however, have obliged service managers to be equipped with relevant leadership competencies that would enable them to facilitate service operations from the initial stage of internal marketing to the ultimate goal of sustainable market performance. The main objective of this study is to examine the moderating effect of leadership competencies on service marketing imperatives and sustainable market performance. The study adopted a mixed-method using a structured questionnaire and semi-structured interview. A total of 541 copies of the questionnaire to both customer-contact employees and managers in eight (8) hotels in Lagos, Nigeria, was administered. At the same time, the researcher interviewed 28 managers involved in the service encounter. The study adopted multiple sampling techniques: stratified and purposive sampling techniques to select the respondents. The data were analysed using PLS-SEM and Thematic Analysis. The quantitative findings revealed that internal marketing has a statistical significance on marketing innovation (β = 0.566, t = 16.241, p-value = 0.00); interactive marketing has a significant effect on revenue growth (β = 0.559, t = 15.003, p-value= 0.00); external marketing has a statistical effect on profitability (β = 0.547, t = 13.191, p-value= 0.00); service marketing imperatives has a statistical significance in predicting sustainable market performance (β = 0.726, t = 26.897, p-value = 0.00) and leadership competencies could moderate the relationship between service marketing and sustainable market performance (β = -0.132, t = 4.178, p-value = 0.00). The qualitative findings revealed the following themes; employee management, customer experience, interpersonal relationships and hotel manager competencies; they are important contributors to service marketing, leadership competencies and sustainable market performance. The study recommends that appropriate marketing strategies to build customer loyalty should be implemented to promote and enhance profitability. It also recommends that hotel managers should train, develop and orientate the customer-contact employees with the necessary knowledge and skills. Furthermore, it recommends that hotel managers should be people-oriented to encourage teamwork and facilitate training

Antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) in Rodents: possible mechanism of actions

Summary: The leaves of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) is used in Traditional African medicine for the treatment of various ailments including arthritis. The present study sought to investigate the antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (HeCA). HeCA (100, 200 or 400 mg/kg, p.o.) was administered 1 h before intraplantar injection of formalin 1%v/v in saline to evaluate antinociceptive effect. Moreover, its possible mechanism of antinociceptive action was investigated through pretreatment of mice with antagonists of receptors implicated in nociception. Anti¬inflammatory effect of the extract was investigated using the carrageenan-induced paw oedema and complete Freund's adjuvant (CFA)-induced arthritis models in rats. HeCA (400 mg/kg) treatment significantly reduced the duration of paw licking/biting during both in the early (42.12%) and late (75.79%) phases of formalin-induced nociception. However, the antinociceptive effect elicited by HeCA was reverse by pretreatment of mice with naloxone, prazosin, yohimbine, ketanserin, L-arginine, and parachlorophenylalanine (PCPA). HeCA produced dose-dependent and time course decrease in carrageenan-induced paw oedema. Pre- and post-treatment of rats with HeCA ameliorated CFA-induced arthritis evidenced in the significant decrease in arthritic index comparatively similar to the effect of celecoxib. CFA- induced oxidative and nitrosative stress were attenuated by subchronic treatment with HeCA. Findings from this study shows that C. anisata possesses antinociceptive activity through possible interaction with opioidergic, noradrenergic, L-arginine-nitric oxide and serotonergic pathways as well as anti-arthritic property which could be attributed to its ability to prevent the release of inflammatory mediators and oxidative stress.Keywords: Complete Freund's adjuvant; L-arginine-nitric oxide; nociception; antioxidant; rheumatoid arthritis; serotonergic

Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria

Objective: Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated.Design: A retrospective 5 year open cohort studySetting: The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEPFAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection.Main outcome measures: Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between  adherence and therapeutic outcomeResults: A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (÷2 = 115.60, p<0.0001).Conclusions: Zidovudine + lamivudine + nevirapine was the most  frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugsand improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.Keywords: Pharmacoepidemiology, antiretroviral drugs, drug adherence, adverse event