Factors affecting the development & implementation of the structural aspects of the Nigeria building code among the stakeholder's within the house building construction sector in the Lokoja municipality

The failure of the Nigeria Building Code (BC) development and implementation for the structural house building construction process in the Lokoja Municipality to protect the buildings, occupants and the environment as a result of vested stakeholder interests reverberates with significant impacts on house building failures leading to fatalities. There have been 742 recorded deaths, 96 injuries and 63 building failures: three cases from 1976–1978, 19 cases from 1982–1995, and 42 cases from 2000 to 16 September 2014 in Nigeria. These cause investors to lose confidence and allow the entry of non-professionals into the industry. This paper identifies and examines the key factors that affect the development and implementation of structural aspects of house BCs, drawing on contextual analysis and international experience. This paper represents part of a large Ph.D. research project, focusing on the key internal and external factors affecting the development and implementation of structural aspects of a BC. This paper has identified a multitude of inter-locking key factors that affect BC implementation in Lokoja including legislation, absence of approved standards, lack of good leadership, lack of political interest or will, inadequate implementation processes, lack of code awareness, high poverty level, high professional fees and insufficient public dialogue. There are also causal factors involved, which impact risks associated with the non-implementation of the code on consumers and the development of industry and professional practice. These include corruption, professional rivalry, professional vested interest, inadequate capacity building, absence of professional involvement in decision making, lack of respect for the poor and public opinion, abuse of human rights and unemployment

Discriminatory Attitudes of Pharmacy Students and Pharmacists against People Living with HIV/AIDS

Purpose: To evaluate the level and predictors of discriminatory attitudes of pharmacy students and pharmacists towards people living with HIV/AIDS (PLWHA).Methods: A cross-sectional survey of pharmacy students and pharmacists (n = 523) to assess discriminatory attitudes towards PLWHA was conducted using a self completed questionnaire. Correlation and regression analyses were conducted.Results: Pharmacists were more knowledgeable and had less negative perceptions than students towards PLWHA. Level of professional training (p < 0.0001), knowledge status (p < 0.0001) and five negative perception items, namely, (a) people who got HIV through sex deserve it (p = 0.003), (b) PLWHA would make their colleagues apprehensive (p < 0.0001), (c) PLWHA have poor hygiene (r = 0.082, p = 0.032), (d) PLWHA should feel ashamed of themselves (p < 0.0001), and (e) people who behave promiscuously should be blamed for AIDS (p = 0.031), were all significantly associated with higher discrimination. However, being a student and having negative perceptions such as “PLWHA should feel ashamed of themselves and “PLWHA would make their colleagues apprehensive” were independent predictors of discrimination.Conclusions: Discriminatory attitudes against PLWHA among pharmacy students and pharmacists who participated in this study were high and level of training and their perceptions were contributory.Keywords: Discrimination, HIV/AIDS, Pharmacists, Perception, Professionalism, Stigmatization

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.Key words: Artemether; Nigerian children; Paediatric; Quinine; Severe 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.Keywords: Diabetes self-care knowledge, DSCKQ-30, Knowledge instrument, Nigeria

Therapeutic efficacy of artemether-lumefantrine for treatment of uncomplicated plasmodium falciparum malaria in Enugu, Nigeria

Purpose: To review current therapeutic efficacy of artemether-lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria in patients in Enugu State, Nigeria.Methods: One hundred and fifty four malaria patients from three different Local Government Areas (LGA) of Enugu State, southeastern Nigeria, that fulfilled the inclusion criteria were recruited through rapid diagnostic testing and blood film microscopy. The patients received a 3-day complete dose of AL treatment; they were monitored and 3 mL of blood in EDTA bottle was sampled on days 0, 3, 7, 14 and 28. The samples were  evaluated by real-time polymerase chain reaction (RT-PCR) for  identification and quantification of Plasmodium falciparum. Clinical and parasitological responses were recorded and analyzed statistically.Results: There was significant decrease (p > 0.002) in patient’s  temperature (from 40 to 37 ºC) from day 0 to day 28. There was significant decrease (p < 0.001) between parasite mean density on day 0 and the values on days 3,7,14 and 28, with high prevalence of delayed parasite clearance. There was no early treatment failure, while 4 (3.4 %), 30 (25.4 %), and 84 (75.1 %) had late clinical failure, late parasitological response and adequate clinical and parasitological response, respectively.Conclusion: Artemether – lumefantrine combination therapy reduced fever in malaria patients but failed to totally clear parasitemia density, indicating its reduced therapeutic efficacy in Enugu State, Nigeria

Self-reported adherence to HAART in South-Eastern Nigeria is related to patients’ use of pill box

The aim of this study was to assess levels of adherence and predictors of adherence to HAART in South-Eastern Nigeria. Selfreported adherence to HAART was assessed at 4-week intervals for a period of 3 months. A 10-item questionnaire was used to assess hypothesised factors in adherence to HAART. The average adherence score for the 3 months of follow-up was correlated with 10-item hypothesised factors and patient demographic variables. Linear regression was used to model the relationship between self-reported adherence and factors found to be correlated with adherence. The average adherence level of subjects that took part in the study was86.1% ± 30.1%. Use of an adherence aid (pill box) was correlated with adherence (r=0.22,

PRESCRIPTION PATTERN OF CARDIOVASCULAR AND/OR ANTIDIABETIC DRUGS IN ABUJA DISTRICT HOSPITALS

Objective: The study aimed to describe the prescription pattern of cardiovascular and/or anti-diabetic drugs and adherence to the World Health Organization (WHO) prescribing indicators in Abuja District Hospitals. Methods: This descriptive retrospective study was carried out in Asokoro and Maitama District Hospitals Abuja. One thousand and nine prescriptions that contained a cardiovascular drug (CVD) and/or anti-diabetic drug issued between June 2017 and May 2018 from the Medical Outpatient Department were analyzed. Data were collected from the pharmacy electronic database, prescription pattern and adherence to WHO prescribing indicators were assessed. The analysis was done using descriptive statistics. Results were presented as percentages, means, and standard deviations. Results: The frequency of treatment was higher among women (58.8%) and the age group of 41–60 (54.8%). The average number of drugs prescribed was 3.3±1.6: the percentage of drugs prescribed in generic was (64%) and (78.8%) were from the Essential Drug List (EDL). Calcium Channel Blockers (CCB, 71.7%) and Biguanides (B, 92.4%) were the most prescribed CVD and anti-diabetic drug. The majority of the CVD (74.5%) and diabetes (63.6%) patients were on combination therapy. The most frequent CVD combination was CCB plus Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (29.7%). Compared to men, the proportion of females taking one or more CVD (61.3%) or antidiabetic (56.4%) was higher. Conclusion: The prescribing indicators are not optimal in Abuja district hospitals. Women received more treatment for cardiovascular and diabetes diseases than men while the age range of 41-60 was more treated than other age groups

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

EFFECT OF A PHARMACIST INTERVENTION ON SELF MANAGEMENT PRACTICES AMONG HYPERTENSIVE-DIABETIC PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital. Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups. Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p<0.001); physical activity (t=-15.081, p<0.001); weight management practices (t=-5.479, p<0.0010, and alcohol consumption 9t=-11.550, p<0.001). Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients

Community Pharmacists' Competence for Educating Asthmatic Patients on the Use of Inhalers and the Peak Flow Meter.

Community pharmacists are readily accessible to patients for counselling services on their disease state, medications and medical devices. Previous studies have reported asthma patients’ poor inhaler techniques. This study evaluated community pharmacists’ competence for educating asthmatic patients on the use of asthma devices. The cross-sectional study was conducted with community pharmacists in Enugu State, Nigeria (May 2017 – July 2017). A 29-item structured self-administered questionnaire assessing information on stock, action plan for pharmacists, interventions with asthma patients and factors influencing these interventions was utilized. Validated checklists assessed inhaler techniques and peak flow meter use, from participants’ demonstrations. Dummy inhalers and peak flow meters were used to teach correct techniques. Of the 116 registered community pharmacists, 62 completed and returned their questionnaires (53.4% participation rate). More than half of the participants were less than 40 years old (63%), male (71.0%), had community pharmacy experience less than 10 years (67.7%). Few of the community pharmacists (3.2%) stocked spacers or peak flow meters. More than half (71%) of the participants claimed to educate patients on correct inhaler techniques but a quarter (24.2%) agreed that they lacked competence to educate on inhaler techniques. Less than half of them (46.8%) were willing to intervene with asthma patients. Summarily, the demonstrated good techniques were: pMDI (35.5%), Accuhaler (29.0%), Turbuhaler (14.5%), pMDI plus spacer (9.7%), peak flow meter (4.8%). The community pharmacists demonstrated poor inhaler techniques and were deficient in the knowledge of peak flow meter use which limited their roles in asthma management