Clinicians-related determinants of anticoagulation therapy and prophylaxis in Nigeria.

BACKGROUND: Thromboembolic and hypercoagulable diseases are common life-threatening but treatable problems in hospital practice. Fortunately, anticoagulation is an efficacious management practice indicated for arterial, venous, and intracardiac thromboembolism. Clinicians in developing countries may have gaps in their knowledge of anticoagulation therapy/prophylaxis which could affect their clinical decision. OBJECTIVES: The study examined the knowledge and attitude of clinicians to anticoagulation therapy/prophylaxis in some tertiary hospitals in Nigeria. METHODOLOGY: The study was a multicenter survey. A pretested questionnaire was administered to clinicians in six tertiary hospitals in Southeast Nigeria. RESULTS: A total of 528 questionnaires were returned by 419 (79.4%) residents and 109 (20.6%) consultants. We observed significant abysmal knowledge and lack of awareness of direct oral anticoagulants (DOACs) among most respondents irrespective of their job grades (P = 0.02, odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.90). Their knowledge of anti-Xa assay as laboratory monitoring tool was also significantly inadequate (P = 0.001, OR 0.23, 95% CI 0.10-0.51). On statement analysis on their attitude to anticoagulation therapy/prophylaxis, "Do you think anticoagulation therapy/prophylaxis is clinically relevant" had the highest mean of 4.60, P = 0.01, and a high degree of agreement; while "Should hospital inpatient with > 3 days admission routinely receive anticoagulation/prophylaxis?" had the lowest mean of 2.27, P = 0.02, and a low degree of agreement. CONCLUSION: There is the need to upscale knowledge of anticoagulation agents and an attitude change to anticoagulation therapy/prophylaxis, especially on the DOACs through continuing medical education activities in emerging countries such as Nigeria.

Sexual dysfunction in female hypertensives.

PURPOSE: Hypertension and its treatment are known to produce sexual dysfunction in males. In our culture, women are not free to discuss issues of sexuality with their doctors. Hence, this phenomenon has not been explored in them. Notwithstanding this, cases occur in practice where noncompliance with dire consequences result from sexual dysfunction. This study was done to determine if any dysfunction existed among women as is commonly reported in males. METHODOLOGY: As part of a larger study on serum uric acid and lipid profile of adult Nigerian hypertensives, we sought information on sexual function in females. One group was newly diagnosed and treatment naïve, while the other was made up of known hypertensives on thiazides. The third group consisted of normotensive age-matched controls. FINDINGS: Six out of 44 (13.6%) in the first group, five out of 29 (17.2%) in the second group and two out of 43 (4.7%) in the control group reported sexual dysfunction. The commonest aspect encountered was reduced desire for intercourse. CONCLUSION: There was a tendency for hypertensive women to have more sexual dysfunction even before treatment than did controls. Larger studies should be undertaken and clinicians should probe this subject if poor compliance is suspected.