Assessment of health-related quality of life and its determinants in the pre-dialysis patients with chronic kidney disease.

PURPOSE: Health-related quality of life (HRQoL) is increasingly being considered as a critical parameter to measure how the disease affects patients' health status, especially for long-term ailments like chronic kidney disease (CKD). This study aimed to assess the HRQoL and its determinants in pre-dialysis patients with CKD. METHODS: This cross-sectional study recruited patients with CKD stages one to four. Data were collected using the HRQoL Questionnaire (15D). Descriptive statistics were used to summarize patients' characteristics. Chi-square test or Fisher's exact test was used to explore the association between independent variables and the HRQoL. Multivariate logistic regression analyses were employed to investigate the determinants of HRQoL. A P value of less than 0.05 was considered statistically significant. RESULTS: Two hundred and twenty patients were enrolled in the study (average age 52.7 ± 12.4 years, 61.8% females, and 69.1% with CKD stage 4). The average multidimensional utility score of the study population was 0.82 ± 0.13, while the single-attribute utility scores ranged from 0.73 to 0.89. The speech, and discomfort and symptoms dimensions had the highest (0.89) and lowest (0.73) single-attribute utility scores, respectively. The patients who were uneducated [Adjusted Odds Ratio (AOR) 0.34, 95% CI (0.12-0.97)] were significantly less likely to have poor HRQoL compared to those with tertiary education level. Additionally, unemployed [AOR 4.69, 95% CI (1.69-13.02)], and self-employed patients [AOR 4.25, 95% CI (1.26-14.38)] were significantly more likely to have poor HRQoL compared to the retirees CONCLUSIONS: This study shows that the overall HRQoL of the participants was high, though a considerable proportion of them had poor HRQoL, while the discomfort and symptoms dimension was the most impacted. Being educated, unemployed, and self-employed were significantly and independently associated with poor overall HRQoL.

Patients' Satisfaction With Pharmaceutical Care Services in Asthma: An Intervention Study in 2 Nigerian Hospitals.

Quality in health care is commonly measured by patient satisfaction. This study assessed asthmatic patients' satisfaction with the pharmaceutical care services rendered in 2 Nigerian tertiary hospitals. This 3-arm intervention study was single-blinded, prospective, and randomized. The 3 arms were Usual Care, Individual Intervention, and Caregiver-assisted Intervention. Intervention arms received education for 6 months, whereas the Usual Care arm received no education. The Patient Satisfaction with Pharmaceutical Services questionnaire was utilized. Data were analyzed using the IBM SPSS Version 25.0 with statistical significance set as P < .05. Seventy-eight asthma patients participated in the 3-arm study. The majority of the patients (82.1%) were happy with the services provided by the pharmacists. More of the patients who received Individualized Intervention were highly satisfied, compared to those in the Caregiver-assisted Intervention arm and Usual Care arm (52.6% vs 44.7% vs 2.6%, χ2 = 32.124, P < .001). The Individualized Intervention satisfied patients better than the Caregiver-assisted Intervention. Pharmacists should strive to have direct communication with their patients despite the involvement of caregivers.

How do patients prefer specialized clinical pharmacy service to other prevention of mother-to-child transmission of human immunodeficiency virus services? An evaluation of their willingness to pay and willingness to accept choices and ratios.

WHAT IS KNOWN AND OBJECTIVE: Donor agencies provide most of the funds for HIV services in developing countries. Due to the global economic downturn, there has been a reduction in funding for HIV-related services in Nigeria. This study compared the willingness to pay (WTP)-willingness to accept (WTA) ratios for prevention of mother-to-child transmission (PMTCT) services to specialized clinical pharmacy services among patients of two Nigerian hospitals. METHODS: This was a cross-sectional survey using contingent valuation method at Ahmadu Bello University Teaching Hospital (ABUTH) and University of Nigeria Teaching Hospital (UNTH). WTP and WTA were elicited using an interviewer-administered questionnaire and a payment card. The responses to the WTP and WTA questions were reported as frequencies and percentages, while the amounts were determined as mean. All costs were obtained in Nigerian Naira (N360 = $1). RESULTS AND DISCUSSION: Of the 219 mothers who participated in the study, 172 (78.5%) had no health insurance. Primary prevention of HIV (PPV) had the highest "yes" WTP response of 152 (69.4%) and the highest mean WTP amount of N6067.20. It also had the least "no" WTA response of 162 (74.0%) and the least WTA amount of N232.09. Specialized clinical pharmacy service (SCPS) had the highest WTA/WTP ratio of 4.0826 in ABUTH and 9.3750 at UNTH. Its income effect was -3.0826. A 1% increase in income led to 0.0550 (95% CI: -0.3068 to 0.1968) decreased odds to pay for PPV. WHAT IS NEW AND CONCLUSION: Most patients assessed in this study were willing to pay for PPV than other services. Majority of them were also willing to forgo PMTCT Drugs Only. SCPS had the highest value for the patients, but they did not want to pay a high amount for it. Employment status, health insurance status, educational level and age were predictors of patients' WTP and WTA.

Knowledge and practice of the Global Initiative for Asthma report among community pharmacists in a Nigerian State.

INTRODUCTION: few studies have been conducted to evaluate pharmacists´ knowledge and practice of the asthma guidelines. The Global Initiative for Asthma (GINA) report was developed to reduce practice variability and to improve the quality of asthma care. This study aimed to assess the knowledge and practice of the GINA report among community pharmacists in a Nigerian State. METHODS: this cross-sectional survey was conducted among community pharmacists in Enugu State, Nigeria (May to July, 2018). Data were collected with a 39-item structured self-administered questionnaire and analyzed using the IBM SPSS Version 21.0. Descriptive statistics were used to summarize data. Inferential statistics utilized the Pearson Chi-Square test where applicable, with statistical significance set at P < 0.05. RESULTS: a total of 89 community pharmacists in Enugu State participated in the study (76.7% participation rate). More than half of them were less than 40 years old (60.7%), male (59.6%) and only had the Bachelor of Pharmacy (B.Pharm) degree (83.1%). About a tenth of the community pharmacists (10.1%) reported that they stock the peak flow meter. Few of them (2.2%) utilized the Asthma Control Test™ in their practice. After categorization, less than half of the community pharmacists had good knowledge of asthma (34.8%) and demonstrated good practice of the GINA report (11.2%). CONCLUSION: the community pharmacists had poor knowledge of asthma and demonstrated poor practice of the GINA report. With adequate knowledge of the guidelines, community pharmacists can assist patients with making informed decisions and proffer appropriate recommendations to physicians.

Evaluation of medication adherence and predictors of sub-optimal adherence among pre-dialysis patients with chronic kidney disease.

Background: Multiple medications are required to effectively manage chronic kidney disease (CKD) and associated complications, posing the risk of poor medication adherence. Objectives: To measure medication adherence levels and to investigate the potential predictors of sub-optimal medication adherence in pre-dialysis patients with CKD. Methods: A prospective study was conducted in the medical and nephrology outpatients' clinics in Maiduguri. Non-dialysis patients with CKD stages 1-4 aged 18 years and above were recruited through their physicians. The level of medication adherence was determined using Morisky Medication Adherence Scale. Descriptive statistics were used to summarize patients' background characteristics. Multivariate binary logistic regression analyses were performed to investigate the significantly potential predictors of sub-optimal medication adherence at a p < 0.05. Results: There were 107 participants (48.6%) who had high medication adherence, while 97 (44.1%), and 16 (7.3%) of them had moderate adherence, and low adherence, respectively. The univariate analysis revealed that medication adherence level differed significantly with the number of medications taken daily by patients (p < 0.05). Multivariate logistic regression analyses did not reveal a significant independent predictor of sub-optimal medication adherence. Conclusion: A majority of the participants reported sub-optimal medication adherence. The independent variables considered did not significantly predict sub-optimal medication adherence in the study population. Nevertheless, the study findings highlight the importance of clinical pharmacists' CKD management supportive care to help improve medication adherence.

Kidney Disease Knowledge and Its Determinants Among Patients With Chronic Kidney Disease.

The alarming rise in the incidence of end-stage renal disease in Nigeria is likely to continue if patients with chronic kidney disease (CKD) lack knowledge of this disease, its management, and practices to support effective self-management. The study aimed to assess CKD knowledge and to investigate its predictors. A cross-sectional survey was conducted using a paper-based questionnaire at the medical and nephrology outpatients' clinics of a secondary and tertiary hospital in Maiduguri. The study enrolled 220 patients with CKD stages 1 to 4. Sixty-five percent of the participants had poor CKD knowledge. The patients who had a tertiary level of education were significantly more likely to have higher CKD knowledge compared to those with no formal education (adjusted odds ratio: 2.62, 95% CI: 1.20-5.72). The study shows that the majority of the participants had poor CKD knowledge. Tertiary educational level was the only significant independent predictor of higher CKD knowledge. Therefore, targeted educational interventions are needed among patients with no or low formal education to be able to support them with self-management behaviors.

Assessment of the steps taken towards avoidance of medication errors among hypertensive outpatients attending a tertiary health care facility in Nigeria: a cross-sectional study.

INTRODUCTION: Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits. METHODS: A cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The IBM SPSS Version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant. RESULTS: A total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001). CONCLUSION: Patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.

Willingness-to-Accept and Willingness-to-Pay Ratios of Prevention of Mother-to-Child Transmission Services in a Nigerian Hospital: A Cross-Sectional Contingent Valuation Study.

BACKGROUND: In Nigeria, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome treatment and care services, prevention of mother-to-child transmission (PMTCT) inclusive , are accessed free of charge by patients due to finanacial support from donor agencies. This trend may not be sustainable in the future due to the present global economic realities. Hence, there is the need to ascertain the readiness of PMTCT patients to pay for such services. OBJECTIVES: This contingent valuation study determined the willingness-to-accept (WTA), willingness-to-pay (WTP), and WTA-to-WTP ratios of PMTCT services among clients in a Nigerian tertiary hospital. METHODS: This was a cross-sectional questionnaire-based study. All adult PMTCT patients who had never paid for any component of the services participated in the study. The questionnaire measured their WTP and WTA for the following components of PMTCT: primary prevention of HIV, prevention of unintended pregnancy in HIV-positive women, follow-up treatment and support, and therapeutic interventions around delivery. The WTP and WTA for PMTCT drugs and specialized clinical pharmacy services were also measured. The WTA-to-WTP ratios, income effects, and income elasticity were determined for all services. Questions were posed using Naira (N) ($1 = N250, at the time of the study). RESULTS: Respondents aged 25 to 34 years comprised 80.8% of the population, whereas 80.8% were married. The mean amounts of WTA and WTP for services involving primary prevention of HIV was N543 000 and N18 600, respectively. Its WTA-to-WTP ratio and approximate income effect were 29.19 and -28.19, respectively. These variables were associated with WTP for some services: level of education with PMTCT follow-up treatment and support (P=.046), trimester of pregnancy with primary prevention of HIV (P=.002), correspondent's residence with specialized clinical pharmacy services (P=.003), and time spent to reach facility with primary prevention of HIV (P=.002). CONCLUSIONS: All services had high WTP, WTA-to-WTP ratios, and income effects, with inelastic income elasticity coefficients: patients in the Nigerian hospital attribute high value to all PMTCT services.

Evaluation of the hepatic effect of concomitant administration of ciprofloxacin and some antimalarial drugs in Plasmodium berghei infected mice: An in vivo study.

This study evaluated the hepatotoxic effects of artesunate (AS), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) co-administration with ciprofloxacin (CIP) using animal model. Chloroquine sensitive Plasmodium berghei NK65 strain infected albino mice (120) were utilized for this study, carried out in three phases. Phase 1 comprised eleven groups treated with different doses of either AS, AL, ASAQ or CIP alone. Phase 2 consisted of nine groups treated with 7mg/kg of CIP combined with different doses of AS, AL, ASAQ. Phase 3 comprised ten groups treated with 14mg/kg of CIP (CIP2) with different doses of AS, AL, ASAQ. Seventy-two hours after administration of drugs, toxicity was determined by evaluating the effect of drugs on liver enzymes using spectrophotometer. Statistical analysis revealed that CIP alone significantly (P<0.05) reduced the levels of Aspartate Transaminase (AST) and Serum Alanine Transaminase (ALT) compared to AS, AL and ASAQ alone. Combination of different doses of AS, AL and ASAQ with 7mg/kg CIP significantly increased the level of AST and ALT while combination of AS, AL and ASAQ with 14mg/kg CIP significantly decreased AST and ALT levels. Care should be taken during the co-administration of low dose ciprofloxacin with artesunate, artemether-lumefantrine or artesunate-amodiaquine.