Prescription Patterns and Patient Care Practices in Two Tertiary Hospitals in South-South Nigeria

BACKGROUND

Inappropriate use of medicines still characterize all levels of healthcare, with important public health implications. Available evidence indicate that irrational use of medicines can lead to poor therapeutic outcomes, adverse drug reactions, and thus increase morbidity and mortality rates. This study assessed the prescription pattern, patient and health care facility indicators in two tertiary health facilities in Nigeria.

METHODS

A cross-sectional survey of 1800 prescriptions and 600 patients' encounters was conducted at the General Outpatient Departments of the University of Benin and Delta State University Teaching Hospitals using the WHO drug use indicators. Data from 12-month prescription sheets as well as patient interviews were entered into standard indicator forms and analyzed according to WHO guidelines.

RESULTS

Overall, the average number of drugs per encounter was 2.8 ± 1.6. The percentage of generic prescription was 49.6%, while percentage of encounters with antibiotics, antimalarial and injections were 27.4%, 23.2% and 12.4% respectively. Prescription of medicines listed in the Essential Medicines List was 66.6%, even though no copy was available at the consulting rooms. Average consulting and dispensing time were 15.3 minutes and 136 seconds respectively. Percentage of medicines actually dispensed was 86.2% while 98.7% of medicines were adequately labelled.

CONCLUSION

Gaps still exist in the rational use of medicines in Nigeria. There needs to be sustained interventional schemes with capacity for monitoring and evaluation to detect inappropriate drug use patterns and prevent the undesirable consequences of irrational use of medicines.

Prospects and Challenges of Propulsion Technologies of Unmanned Aerial Vehicles: A Review

This review paper discussed the different types of propulsion technologies for unmanned aerial vehicles (UAVs). In it, several UAV propulsion systems were investigated, with particular emphasis on internal combustion engine (ICEs)-powered propulsion systems and electrically powered propulsion systems. The characteristics and working principles of these propulsion systems and challenges were discussed in this paper. Also, the methods in which future generations of UAVs can perform better have been discussed particularly with regards to endurance characteristics, power-to-weight ratios, and environmental wise. Similarly, the relevance of future UAV propulsion systems, which is a hybrid of the two major propulsion systems (ICEs and electric systems), giving a yield for high endurance, long-range, and durability, is discussed.

Barriers and solutions to effective mentorship in health research and training institutions in Nigeria: Mentors, mentees, and organizational perspectives

Aims and Background

Mentoring relationships and programs have become a subject of global interest and their relevance is high in the ever-evolving health system. In Nigeria, informal system of mentoring is largely practiced. To be able to institutionalize mentoring program, there is need to explore the various challenges of mentoring process and suggest potential approaches for effective mentor-mentee relationship in health research institutions in Nigeria.

Subjects and Methods

The study was designed to explore the barriers and solutions to mentoring process from the perspectives of the mentor, mentee, and organization in health research and training institutions in Nigeria. A cross-sectional descriptive design was employed and the study was conducted among 21 health researchers drawn from 24 health research institutions across the 6 regions of Nigeria. The nominal group technique was adopted in the data collection process.

Results

The most frequently reported mentor challenges were "lack of understanding of mentorship process" (84.2%) and "lack of capacity for mentoring" (78.9%), while those of mentee were "mentor preference" (73.7%) and "lack of freedom of expression" (47.4%). "Culture of selfishness/individualism" (84.2%) and "lack of formal relationship" (63.2%) were the most mentioned systemic challenges. Training on mentoring process and relationship was mentioned as the most frequent approach to overcoming challenges for the three perspectives.

Conclusion

Significant mentorship challenges exist in the Nigerian health, academic and research institution. Systematic approaches to finding and implementing the appropriate solutions are needed to circumvent these bottlenecks.

Baseline assessment of pharmacovigilance activities in four sub-Saharan African countries: a perspective on tuberculosis

Background

New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs.

We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB.

Methods

Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs.

Results

Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration is much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness among DR-TB healthcare providers.

Conclusion

aDSM has created awareness about the importance of pharmacovigilance among NTPs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07043-6.

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria

AIMS AND OBJECTIVES

The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population.

PATIENTS AND METHODS

This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur.

RESULTS

A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000.

CONCLUSIONS

Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

Safety of Artemisinin-Based Combination Therapies in Nigeria: A Cohort Event Monitoring Study

BACKGROUND

A pilot programme of Cohort Event Monitoring (CEM) was conducted across the six geopolitical zones of Nigeria on patients treated for uncomplicated malaria with artemisinin-based combination therapy (ACT). The emergence and spread of malaria parasites resistant to commonly available antimalarial drugs necessitated a shift in policy for malaria treatment by the Federal Government from the use of chloroquine and sulphadoxine-pyrimethamine (SP) as first-line treatments to ACTs. Initial reports following deployment of ACTs in clinical settings raised safety concerns regarding their use. Although artemisinin and its derivatives are generally thought to be safe, there are currently few or no data on their safety among populations in Nigeria.

OBJECTIVES

The main objectives of the CEM programme were to proactively determine the adverse event (AE) profile of artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) in real-life settings and to find out the factors predisposing to AEs.

METHODS

The CEM study was observational, longitudinal, prospective, and inceptional. Patients were observed in real-life situations. It was conducted in six public health facilities in Nigeria on patients with a clinical diagnosis of uncomplicated malaria treated with ACTs. Patients were prescribed one of the ACTs on an alternate basis as they enrolled into the programme. Follow-up reviews were undertaken on days 3 and 7 following commencement of ACT treatment. At follow-up, patients were evaluated for any clinical event that they might have experienced following the use of the ACTs. We report the result of this initial pilot in which 3,010 patients treated for uncomplicated malaria with AA or AL were enrolled.

RESULTS

The seven most common AEs seen were general body weakness 25.0/36.6% (AL/AA); dizziness 11.9/17.2% (AL/AA); vomiting 8.0/10.2% (AL/AA); abdominal pain 8.5/7.2% (AL/AA); insomnia 6.3/5.9% (AL/AA); body pains 3.4/5.2 (AL/AA) %; anorexia 8.5/4.6% (AL/AA). Most adverse events occurred from day 1 and peaked by day 2 and 3 of medication with the mean duration of events being 3 days. By the end of the follow-up visit on day 7, the AEs had resolved in the majority of patients. Adverse events were more common in the AA group than AL revealing a better safety profile for AL (p < 0.001). Both ACTs demonstrated good ability to resolve the clinical symptoms of uncomplicated malaria.

CONCLUSION

In conclusion, this pilot CEM programme suggests that adverse events with ACTs were common. However, serious life-threatening events were not common. It appears that ACTs have a tolerable safety profile among Nigerians.