Point Prevalence Survey of Antimicrobial Prescription and Consumption in a Nigerian Tertiary Hospital: A Gateway to the Antimicrobial Stewardship Program.

BACKGROUND: Antimicrobial stewardship is an important action plan for curbing the rising trend of antimicrobial resistance (AMR). Surveillance of antimicrobial use and consumption is needed as baseline data and for monitoring the impact of antimicrobial stewardship interventions. The survey was done to understand the burden of AMR, in view of establishing an antimicrobial stewardship program in our hospital. METHODS: A point prevalence survey (PPS) of antimicrobial use and consumption was conducted on all inpatients admitted before 8.00 am on the days of the survey using a standardized questionnaire. The collected data were entered online into the Global PPS web-based application (www.global-pps.com), for analysis. RESULT: Of the 178 patients admitted during the survey period, 50.6% were on one or more antimicrobial agents. All the patients in adult intensive care units were on antibiotics (100%), followed by neonatal intensive care units (83.3%), with the least being adult medical wards (39.4%). Beta-lactam antibiotics were the most frequently prescribed antimicrobial for various infections, especially skin and soft tissue infections, 41.3%, which were the most common diagnoses treated with antibiotics. The infection was mostly community-acquired (81.6%), of which 94.9% were treated empirically. There was no written guideline in existence. CONCLUSION: The present study revealed a poor prescribing habit because of a high rate of empirical treatment. The need for antimicrobial stewardship cannot be overemphasized as it will help streamline and improve the prescribing pattern.

Adverse reactions from community directed treatment with ivermectin (CDTI ) for onchocerciasis and loiasis in Ondo State, Nigeria

Onchocerciasis is an endemic disease in Ondo state, Nigeria. Community directed distribution of ivermectin is currently on-going in some local government areas of the state. Randomly selected persons (2 331 males and 2 469 females) were interviewed using a modified rapid assessment procedure for Loa loa (RAPLOA) to assess community directed treatment with ivermectin. The retrospective study evaluated the coverage, impacts and adverse reactions to the drug treatment. A questionnaire was administered by house-to-house visit in six local government areas, implementing community directed treatment with ivermectin (CDTI) in this bioclimatic zone. A total of 2,398 respondents were reported to have participated in the treatment. The overall ivermectin coverage of 49.96% was recorded (range 0 - 52% in different communities). Adverse reactions from ivermectin administration were experienced in 38% of individuals. Diverse adverse reactions experienced included predominantly itching (18.50%); oedema, especially of the face and the limbs (8.2%); rashes (3.4%) and body weakness (2.4%). Expulsion of intestinal worms occurred in 0.96% of the respondents. The occurrence of adverse reactions in relation to age categories was statistically significant. Neither fatal nor severe adverse reactions were reported by respondents. Significantly, despite experienced adverse reactions, continued participation, acceptability and compliance to ivermectin treatment was expressed by the various communities. This attitude is in consonance with the African Programme for Onchocerciasis Control (APOC) objectives. Rev. Biol. Trop. 56 (4): 1635-1643. Epub 2008 December 12.

La oncocercosis es endémica en el estado Ondo, Nigeria. Se seleccionaron 4 800 personas al azar para evaluar con encuesta retrospectiva la cobertura, efectos y reacciones al tratamiento farmacológico con ivermectina administrado por la misma comunidad. La cobertura global de ivermectina fue 50 % con reacciones adversas en 38 % de los individuos. Estas fueron comezón picazón (18%), edema, especialmente de la cara y las extremidades (8%), erupciones cutáneas (3%) y debilidad (2%); dependieron de la edad y no hubo reacciones más graves. La expulsión de las lombrices intestinales se produjo en 96% de los encuestados. A pesar de las reacciones adversas, hubo continuidad, aceptación y cumplimiento del tratamiento con ivermectina, en consonancia con los objetivos del Programa Africano para el Control de Oncocercosis (APOC).

Market survey of loiasis: prevalence and adverse reactions to ivermectin using a rapid procedure for loiasis / Encuesta de mercado de loiasis: prevalencia y reacciones adversas a la ivermectina usando un procedimiento rápido para la loiasis

OBJECTIVES: 1. To assess the levels of endemicity of loiasis in a total of 30 selected villages covering an area of 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West and Ifedore local governments in Ondo State, Nigeria, using Rapid Assessment for loiasis technique. 2. To obtain information on adverse reactions which occurred during previous administrations of the drug ivermectin used for the treatment of loiasis and onchocerciasis in the study area. METHODS: Consent was obtained from the chairman of each local government village head and individuals were co-opted into the study. A total of 480 individuals were interviewed, 80 from each of the six local governments, during the regular scheduled community market days. Survey for Loa loa was carried out according to specifications in "Guidelines for rapid Assessment of Loa loa (TDR, 2002). RESULTS: Among the 480 respondents, 80 (16.7%) reported having had a history of loiasis while 11 (2.3%) had recent occurrence of the disease. The local name given to the disease in all the villages studied is "aran oju". Respondents in Ondo East local government had an eyeworm history of 23 (28.8%) and occurrence of loiasis was 02 (2.5%), these were the highest figures recorded. Using the SPSS version 10 package for data analysis, demographic factors of age and gender were not significant determinants of prevalence (> 0.05). Ondo East and Ifedore local governments had significant levels of loiasis prevalence (p < 0.05). Adverse reactions from the retrospective ivermectin administration was 04 (0.83%). This was statistically insignificant (p > 0.05). CONCLUSION: Market surveys in rural communities were considered to be cost effective and rapid in the determination of prevalence of any disease. Since less than 40% of the respondents in the study area reported having had a history of eyeworm, the entire area was classified as "low risk" as regards the administration of ivermectin.

OBJETIVOS: 1. Evaluar los niveles de endemicidad de loiasis en un total de 30 poblados seleccionados, que abarcan un area de 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West y los gobiernos locales de Ifedore in Ondo State, Nigeria, usando una evaluación rápida para técnica de loiasis. 2. Obtener información acerca de las reacciones adversas que ocurrieron durante las administraciones previas del medicamento invermectina usado para el tratamiento de loiasis y onchocerciasis en el área de estudio. MÉTODOS: Se obtuvo el consentimiento del presidente de cada uno de los gobiernos locales de los poblados de cabecera, así como de los individuos cooptados para la realización del estudio. Se entrevistaron un total de 480 individuos, 80 de cada uno de los seis gobiernos locales, durante los días de mercado regularmente programados para la comunidad. Se llevó a cabo una encuesta de Loa loa de acuerdo con las especificaciones de las "Guías para la evaluación rápida de Loa loa". RESULTADOS: De los 480 encuestados, 80 (16.7%) reportaron haber tenido una historia de loiasis, mientras que 11 (2.3%) tuvieron padecimientos recientes de esta enfermedad. El nombre local dado a esta enfermedad en todos los poblados estudiados es "aran oju". Los encuestados en el gobierno local de Ondo East local tenían antecedentes de gusano ocular de 23 (28.8%) y la manifestación de loiasis fue 02 (2.5%). Estas fueron las cifras más altas registradas. Usando el paquete SPSS versión 10 para el análisis de datos, se observó que los factores demográficos de edad y sexo no fueron significativamente determinantes de la prevalencia (> 0.05). Los gobiernos locales de Ondo East y de Ifedore tuvieron niveles significativos de prevalencia de loiasis (p < 0.05). Las reacciones adversas de la administración de ivermectina retrospectiva fue 04 (0.83%). Esto fue estadísticamente significativo (p > 0.05). CONCLUSIÓN: Las encuestas de mercado en las comunidades rurales fueron consideradas costo-efectivas y rápidas en la determinación de la prevalencia de cualquier enfermedad. Puesto que menos del 40% de los encuestados en el área de estudio reportaron haber tenido una historia de gusano ocular, toda el área fue clasificada como de "bajo riesgo" en relación con la administración de la invermectina.

Adverse reactions from community directed treatment with ivermectin (CDTI) for onchocerciasis and loiasis in Ondo State, Nigeria.

Onchocerciasis is an endemic disease in Ondo state, Nigeria. Community directed distribution of ivermectin is currently on-going in some local government areas of the state. Randomly selected persons (2331 males and 2469 females) were interviewed using a modified rapid assessment procedure for Loa loa (RAPLOA) to assess community directed treatment with ivermectin. The retrospective study evaluated the coverage, impacts and adverse reactions to the drug treatment. A questionnaire was administered by house-to-house visit in six local government areas, implementing community directed treatment with ivermectin (CDTI) in this bioclimatic zone. A total of 2,398 respondents were reported to have participated in the treatment. The overall ivermectin coverage of 49.96% was recorded (range 0-52% in different communities). Adverse reactions from ivermectin administration were experienced in 38% of individuals. Diverse adverse reactions experienced included predominantly itching (18.50%); oedema, especially of the face and the limbs (8.2%); rashes (3.4%) and body weakness (2.4%). Expulsion of intestinal worms occurred in 0.96% of the respondents. The occurrence of adverse reactions in relation to age categories was statistically significant. Neither fatal nor severe adverse reactions were reported by respondents. Significantly, despite experienced adverse reactions, continued participation, acceptability and compliance to ivermectin treatment was expressed by the various communities. This attitude is in consonance with the African Programme for Onchocerciasis Control (APOC) objectives. Rev. Biol.

Market survey of loiasis: prevalence and adverse reactions to ivermectin using a rapid procedure for loiasis.

OBJECTIVES: 1. To assess the levels of endemicity of loiasis in a total of 30 selected villages covering an area of 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West and Ifedore local governments in Ondo State, Nigeria, using Rapid Assessment for loiasis technique. 2. To obtain information on adverse reactions which occurred during previous administrations of the drug ivermectin used for the treatment of loiasis and onchocerciasis in the study area. METHODS: Consent was obtained from the chairman of each local government village head and individuals were co-opted into the study. A total of 480 individuals were interviewed, 80 from each of the six local governments, during the regular scheduled community market days. Survey for Loa loa was carried out according to specifications in "Guidelines for rapid Assessment of Loa loa (TDR, 2002). RESULTS: Among the 480 respondents, 80 (16.7%) reported having had a history of loiasis while 11 (2.3%) had recent occurrence of the disease. The local name given to the disease in all the villages studied is "aran oju". Respondents in Ondo East local government had an eyeworm history of 23 (28.8%) and occurrence of loiasis was 02 (2.5%), these were the highest figures recorded. Using the SPSS version 10 package for data analysis, demographic factors of age and gender were not significant determinants of prevalence (> 0.05). Ondo East and Ifedore local governments had significant levels of loiasis prevalence (p < 0.05). Adverse reactions from the retrospective ivermectin administration was 04 (0.83%). This was statistically insignificant (p > 0.05). CONCLUSION: Market surveys in rural communities were considered to be cost effective and rapid in the determination of prevalence of any disease. Since less than 40% of the respondents in the study area reported having had a history of eyeworm, the entire area was classified as "low risk" as regards the administration of ivermectin.