Determinants of caregiver's knowledge and practices regarding childhood fever management in a developing setting: a multi-centre cross-sectional assessment.

Introduction: Fever is both a sign of various diseases (chief of which are infectious in nature) and an adverse effect of certain interventions (e.g. vaccines, drugs) in the pediatric population. It elicits anxiety among caregivers and healthcare professionals alike resulting in non-evidence based practices, adverse medication administration events, waste of scarce resources and overutilization of health facilities. The determinants of these practices among caregivers in the domiciliary contexts have not been well characterized in developing settings. Methods: We assessed the knowledge and practices of childhood fever and their determinants among caregivers in domiciliary settings in Northern Nigeria using a 41-item questionnaire between August 2020 and February 2021. Results: The questionnaire is reliable (knowledge: Cronbach's Alpha = 0.689; practice: Cronbach's Alpha = 0.814) and collected data on a total of 2,400 caregiver-child pairs, who participated in the study. Over two-third (68.3%; 1,640) of the caregivers expressed fever phobic tendencies. Paracetamol was the most commonly used medication and constituted 31.3% of medication administration adverse events reported by the caregivers. Only one out of every six knowledgeable caregivers engaged in evidence-based home childhood fever management practices (7% vs. 41.6%) with being a primary caregiver [Knowledge: odd ratio (OR): 2.81, 95% CI: 0.38; 5.68; p value: 0.04; Practice: OR: 1.65, 95% CI: 0.09; 7.33; 0.02] and having a child/children aged ≤3 years (knowledge: OR: 7.03, 95% CI: 4.89; 9.67, p value: 0.003; practice OR: 3.11, 95% CI: 1.27; 8.59, 0.007) determining both the knowledge and practices of childhood fever management in a household. Conclusions: The knowledge and practice of childhood fever management among caregivers were sub-optimal with being a primary caregiver and having a child/children aged ≤3 years being the significant determinants of each domain. These gaps underscore the dire need for targeted strategies aimed at improving childhood fever management by educating caregivers.

Predictors of enablers and barriers to community pharmacists' management of minor ailments in a developing setting: A theory-driven assessment.

BACKGROUND: The clinical and financial burdens associated with minor ailments are well documented, but published evidence suggests that minor ailment services led by community pharmacists have a remarkable positive impact, mainly in developed settings. There is a paucity of evidence on community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments. OBJECTIVES: The objective of the study was to identify community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments as well as their significant predictors. METHODS: A Kurt Lewin's theory-driven cross-sectional survey of 305 community pharmacists was conducted in Qatar using a pretested 25-item structured questionnaire developed with an adapted conceptual framework focused on 4 key areas: education, regulation, practice, and research. Bivariate logistic regression was used to identify significant predictors of community pharmacists' self-perceived enablers and barriers. RESULTS: The response rate was 92.5% (282/305). Most of the respondents (68.1%) were males, who were 31-40 years of age (55.3%) and worked for pharmacy chains (77.3%). Community pharmacists identified a higher proportion of enablers (positive force) (82.4%) relative to only 3 barriers (negative force) (17.6%). The barriers identified included insufficient private or semiprivate space for patient counseling, the paucity of invitations to participate in practice-based research, and lack of feedback regarding the results and recommendations of previous research in which they were participants. The significant predictors of self-perceived enablers and barriers were female gender (odds ratio [OR], 2.21; 95% CI, 1.25-3.91; P = 0.007) and age group of ≤40 years (OR, 4.74; 95% CI, 3.50-7.16; P = 0.006). CONCLUSION: Community pharmacists' perceptions of the factors that enhance their effective management of minor ailments were overwhelmingly positive, as 14 enablers were identified relative to only 3 barriers. Female and young community pharmacists were significantly more likely to perceive enablers than barriers. The insights provided are potentially useful in developing pharmacy-based schemes to improve the effective management of minor ailments.

Community pharmacists' management of minor ailments in developing countries: A systematic review of types, recommendations, information gathering and counselling practices.

AIMS: To conduct a systematic review of the management of minor ailments by community pharmacists in developing countries, and to identify the specific minor ailments encountered, the medications recommended or requested and the information gathering and counselling practices. METHOD: Observational studies from developing countries published in English language from inception to 2019 and report the management of minor ailments by community pharmacists were systematically searched in PubMed, ScienceDirect and Cochrane Library. RESULTS: Thirty full-text studies, out of 7876 retrieved and screened, were included in the systematic review. Minor ailment-induced encounters by patients with community pharmacists are generally pervasive and involve mainly verbal request for specific medicines by name (60%). The most frequent minor ailments reported were respiratory, gastrointestinal and musculoskeletal conditions, and the most common medicines recommended or requested for were cough/cold preparations, antimotility and oral rehydration preparation, and analgesic/antipyretic. Inappropriate recommendation of antibiotics were reported for acute diarrhoea and cough/colds (40%) (10/25). Community pharmacists encountered 11-30 customers with minor ailments per day, with an average of about 4.8 (1.3-20.5) minutes per encounter. None of the studies reported the availability and/or use of a specific protocol to guide the management of minor ailments. There was wide variation in the type and depth of information gathered and used for the management of minor ailments; and the counselling information provided by community pharmacists, and there was no evidence of the documentation activities related to the management of minor ailments. CONCLUSIONS: Community pharmacists' encounter with and management of minor ailments appear extensive in developing countries and probably present an opportunity to contribute significantly to reduce disease burden and enhance public health. However, the management process is currently unstructured, unguided by a specific protocol and vary in the quality of recommendations, information gathering and counselling practices.

Healthcare professionals' knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study.

BACKGROUND: All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. This study was designed to explore the attitude, awareness and knowledge of HCPs toward vaccination for influenza. METHOD: A cross-sectional study was performed during October-November 2016. A total of 405 questionnaires were distributed in 8 major hospitals in Saudi Arabia. A validated questionnaire consisting of 31 questions and 5 sections was administered. Statistical Analysis Software (SAS®) version 9.2 was used to analyze the data. RESULTS: A total of 364 HCPs responded to the study survey, which is a response rate of 90%. A large proportion (61.8%) of participants were female. The majority of the participants were nurses (60.4%). More than half of the respondents (57.7%) were working in government-run hospitals. Among all the participants, approximately 67.6% of HCPs were vaccinated. The majority (84.1%) of HCPs believed that influenza vaccine prevents the flu. Furthermore, approximately 75% of participants believed that HCPs can be more susceptible to influenza infections than other people. The majority of participants (89.6%) knew the proper signs and symptoms of influenza. HCPs' belief that vaccination prevents influenza infection (OR = 3.93, 95% CI = 1.97-7.82), their awareness of the Scientific Committee for Influenza and Pneumococcal Vaccination (SCIPV)'s guidelines (OR = 2. 13, 95% CI = 1.16-3.90) and the presence of the standing orders regarding influenza vaccine (OR = 1.57, 95% CI = 1.01-3.21), were the predictors for receipt of influenza vaccine by HCPs. Many (58.0%) respondents believed that vaccine safety concerns is a major barrier to the vaccination of HCPs. Some misconceptions, such as influenza infection due to vaccination (42.3%) and incorrect perceptions about the symptoms of influenza in adults (50.5%), were found. CONCLUSION: The acceptance of and participation in influenza vaccination by HCPs in Saudi Arabia appears to have markedly increased in the 2016 season. Continuing evaluation of vaccination practices is necessary, and more training programs are needed in the future.

Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study.

OBJECTIVES: The widespread availability and use of vaccines have tremendously reduced morbidity, mortality and health care costs associated with infectious diseases. However, parental beliefs about vaccination are one of the major factors in achieving high vaccination rates. Thus, this study aims to assess the perceptions and attitudes regarding routine childhood immunization among Saudi parents. METHODS: A cross sectional study with a pre-tested 18-item questionnaire was conducted using 467 randomly selected parents from the Hail region of Saudi Arabia in the period between February 1st, 2016, and February 1st, 2017. The validated questionnaire consisted of three sections that collected information on participants' demographics, parents' awareness of vaccine benefits, and parents' practices regarding the immunization of their children. RESULTS: Female and male parents comprised 54.5% (255) and 45.5% (212) of the sample, respectively, and the response and completion rates were 97%. The majority of the respondents had received a formal education (94.1%, 439), were gainfully employed (62.9%, 294) and had a regular monthly income (73.3%). The majority of the respondents were aware of childhood vaccinations (78.9%), completed vaccinations mandated for children up to 5 years (86.2%), encouraged other parents to do so (89.9%), and had easy access to vaccines (90.5%). Sixty to ninety percent of the respondents were knowledgeable regarding the health benefits of vaccinations in children, even though 18.4% of their children had experienced vaccination-related minor adverse effects during or after vaccination of which 23.2% required doctor's visits. Health care professionals were the most frequent source of parents' vaccine-related information (65.2%), and vaccination reminder services provided by the Ministry of Health (MOH) via mobile phones were cited by 57.5% of respondents. CONCLUSIONS: Confidence in and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits and ease of access to immunizations appeared to be quite good among Saudi parents.

Does personalized goal setting and study planning improve academic performance and perception of learning experience in a developing setting?

OBJECTIVE: The learning process for pharmacists must enable the skillful harnessing of metacognition, critical thinking, and effective application of specialized skills. This study assessed the impact of self-developed academic goals and study plans on pharmacy students' academic performance and perception of learning experience in a developing setting. METHODS: A prospective cohort study was conducted at the College of Clinical Pharmacy, King Faisal University, KSA, in a compulsory 4th year course (Pharmacy management). The study group was exposed to goal setting and study planning while the control group had only routine teaching and learning activities planned for the course. Academic performance was determined with quizzes, midterm, and final exams, and the percentage achievement for the course objectives. An end-of-course evaluation, with a pre-tested questionnaire, was used to assess the perception of learning experience. RESULTS: The study group constituted 41.4% (29), while 58.6% (41) were in the control group, with a mean ± SD age of 22.9 (SD = 3.2) and 21.6 (SD = 6.1) years, respectively. The mean ± SD scores for quizzes (8.4 (SD = 2.2), mid-term (21.9 (SD = 3.7), and final exams (42.8 (SD = 5.3), and the percentage achievement for the course objectives A (77%) and B (78%) were significantly higher in the study group (P < 0.001). The end-of-course feedbacks showed key differences in the perception of learning experience between the study and control groups. CONCLUSION: Personalized goal setting and study planning appeared to significantly improve continuous engagement with learning, focus on academic goals, and academic performance.

Does self-reflection and peer-assessment improve Saudi pharmacy students' academic performance and metacognitive skills?

BACKGROUND: The patient-centered focus of clinical pharmacy practice which demands nuanced application of specialized knowledge and skills targeted to meeting patient-specific therapeutic needs warrant that the training strategy used for PharmD graduates must empower with the ability to use the higher level cognitive processes and critical thinking effectively in service delivery. However, the historical disposition to learning in the Middle East and among Saudi students appeared heavily focused on rote memorization and recall of memorized facts. OBJECTIVES: To assess the impact of active pedagogic strategies such as self-reflection and peer assessment on pharmacy students' academic performance and metacognitive skills, and evaluate students' feedback on the impact of these active pedagogic strategies on their overall learning experience. METHOD: An exploratory prospective cohort study was conducted among 4th year students at the College of Clinical Pharmacy, King Faisal University, Saudi Arabia to assess the impact of self-reflection and peer-assessment in a semester-wide assessment tasks in two compulsory first semester 4th year courses (Therapeutics-3 and Pharmacoeconomics). An end-of-course evaluation survey with a pre-tested 5-item open-ended questionnaire was also conducted to evaluate students' feedback on the impact of active pedagogic strategies on their overall learning experience. RESULT: Male students (study group) constituted 40.7% of the cohort while 59.3% were females (control group) with mean ± SD age of 23.2 ± 5.6 and 22.1 ± 4.9 years respectively. The mean ± SD scores for quizzes, mid-term and final exams, and the overall percentage pass were significantly higher in the study group for both courses (P < 0.001). The majority of the students in the study group opined that the exposure to active pedagogic strategies enabled them to improve their use of critical thinking, facilitated deeper engagement with their learning and improved their clinical decision-making and discussion skills. CONCLUSION: The use of active pedagogic strategies such as self-reflection and peer-assessment appeared to significantly improve examination performance, facilitate deep and constructive engagement with learning and fostered students' confidence in the use of critical thinking and clinical decision-making.

Frequency, types and factors associated with potentially harmful drug interactions in ambulatory elderly patients in Nigeria.

OBJECTIVE: To determine the frequency, types and factors associated with potentially harmful drug interactions among ambulatory elderly (≥65 years) patients in Ibadan, Nigeria. METHODS: A 4-week cross-sectional study was conducted among 229 elderly patients who consented and were prescribed two or more medicines within a 4-week study period at a major 256-bed secondary care facility in Ibadan, Nigeria. Chi-square and risk ratio were used to identify the factors associated with the potentially harmful drug-drug interactions. KEY FINDINGS: Potentially harmful drug-drug interactions were identified in about two-thirds (65%, 149/229) of the patients. The risk of occurrence drug interactions was significantly higher among patients who had at least six prescribed medicines (relative risk: 7.8 (95% confidence interval, 6.9 to 9.5) (P < 0.001)), and a significant majority were also females (73.8%) (110) (P < 0.001). The most frequent interacting drug combination was angiotensin-converting enzyme inhibitors and amiloride + hydrochlorothiazide (34.7%). CONCLUSION: Potentially harmful drug interactions that are significantly associated with high multiple prescribing are considerable among elderly patients in Nigeria.

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm.

BACKGROUND: Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardio- and renovascular protection benefits. OBJECTIVE: To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. METHODS: A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. RESULTS: Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p < 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p < 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). CONCLUSIONS: Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.

Perceived medication use challenges and coping strategies among medical outpatients in Nigeria.

BACKGROUND: The use of medicines is an action that involves a change in behaviour and it is a complex construct involving reciprocal interactions between social, environmental and cognitive factors. This is particularly true when a patient uses medicines for asymptomatic chronic conditions, requiring life-long use. OBJECTIVE: To identify patient-perceived medication use challenges, determine the coping strategies used and investigate the relationship between patient-perceived challenges and self-initiation of coping strategies. SETTING: A premier 900-bed tertiary/teaching hospital located in Ibadan, Nigeria. METHOD: Ten pharmacists conducted cross-sectional medication use interviews for a random sample of 324 medical outpatients in 4 weeks (25th October-19th November 2006). MAIN OUTCOME MEASURE: Patient-perceived challenges with prescribed medications, self-initiated coping strategies used and relationship between patient-perceived challenges and self-initiation of coping strategies RESULTS: Eighty-one percent (324) of the random sample of 400 patients consented and completed the interview. Of these, 50.3 % were males while 49.7 % were females with mean age (SD) of 51.5 (17.6) and 52.1 (17.4) years respectively. The most frequent diagnoses were hypertension (53 %) and type-2 diabetes + hypertension (14.5 %). Two hundred and twenty-four patients reported one or more perceived challenges. Of these, 43.8 % were 65 years or older and about half reported at least 3 challenges. The majority (95.6 %) of patients who reported perceived challenges initiated one or more coping strategies without the knowledge of their physicians or pharmacists. Of 100 patients who did not report any perceived challenge, 43 % admitted initiating strategies to maintain perceived "cure" of their medical conditions. Self-initiation and use of coping strategies was far more likely among patients who reported perceived challenges (OR: 28.4, 95 % CI 26.1-30.5). The number of coping strategies reported appeared strongly related to the number of perceived challenges (r = 0.91, p < 0.001). CONCLUSION: Perceived challenges associated with the use of prescribed medications and self-initiation of coping strategies appeared considerable among medical outpatients at a major teaching hospital in Nigeria. The risk of unauthorised initiation and use of varieties of coping strategies without the knowledge of clinicians was very high among patients who reported at least one perceived challenge.

Determinants of self medication practices among pregnant women in Ibadan, Nigeria.

OBJECTIVE: To assess the frequency and evaluate the factors underlining self-medication with orthodox and herbal medicines among pregnant women in Ibadan, Nigeria. Setting Antenatal clinics at the major antenatal care facility in Ibadan, south-western Nigeria. METHODS: A prospective cross-sectional study with a pre-tested 15-item structured questionnaire over a 12 week period among 1,650 pregnant women who attended antenatal clinics at a major antenatal care facility in Ibadan, south-western Nigeria. Data analysis was done with Chi-square, multivariate logistic regression and summary statistics. MAIN OUTCOME MEASURE: Frequency and major factors associated with self-medication in pregnancy. RESULTS: The response and completion rate was 96.6% (1,594) [mean age ± SD 27 ± 5.3 years]. The majority of the respondents were literate (92.6%), self-employed (61.5%) and in the third trimester (49.5%). A significant majority (63.8%) used self-medication (orthodox and herbal medicines) as their first response to perceived ill-health (P < 0.001). Self-medication in pregnancy was strongly associated with self-employment (OR: 3.8 (2.6-4.7), unemployment (OR: 2.6 (1.4-4.2) and third trimester of pregnancy (OR: 4.2 (3.1-5.6). The major over-the-counter medicines and potentially harmful prescription medicines kept at home for self-medication were Paracetamol, vitamins and haematinics; and piroxicam, dipyrone, chloramphenicol and Diazepam respectively. About one-third of the respondents who self-medicated (1,017) used local herbs (31.2%). The most frequent source of the medicines purchased during self-medication was patent medicine stores (55%). Mothers-in-law and relatives (41.3%) were the most frequently cited sources of advice during self-medication. Miscarriage/bleeding (44.3%) was the most frequently cited potential adverse effect that could occur with the use of certain medicines during pregnancy. Only 32% of respondents could identify medicines that are potentially harmful in pregnancy. CONCLUSION: Poorly guided self-medication with prescription, over-the-counter and herbal medicines is pervasive and significantly associated with gestational age and occupational pattern among pregnant women in Ibadan, south-western. A majority lacked the knowledge of potential adverse outcomes associated with the use of certain medicines, and the potentially harmful medicines to avoid during pregnancy.

Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria.

OBJECTIVES: To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria. SETTING: Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria. METHODS: A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index. MAIN OUTCOME MEASURE: Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review. RESULTS: Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P < 0.0001). Two hundred and twenty-six medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the major consequences of non-adherence. Potentially harmful drug-disease interactions were the most frequent medication use-related problems arising from self medication (40.4%). CONCLUSION: Potentially harmful medication use-related problems are frequently encountered among medical outpatients in Nigeria. The institutionalization of medication use review and the devolution of this task to pharmacists may prove beneficial in optimizing outcomes of medication use in Nigeria.

Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided.

OBJECTIVE: To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria. METHODS: Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). RESULTS: Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78•5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local 'Iro and Buba' Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for 'marketers' of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76•8%) ice-breaking opening statement / strategy to gain consumers' attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers' enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contra-indications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. CONCLUSIONS: Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear considerable in Nigeria. Majority of the vendors did not correctly respond to consumers medicine-related enquiries, or provide detailed factual medicines information to guide appropriate use. These misleading promotional activities could potentially encourage inappropriate purchase and probable self-medication by consumers.

Pharmacists' participation in the documentation of medication history in a developing setting: An exploratory assessment with new criteria.

OBJECTIVE: To assess the impact of pharmacists' participation on the frequency and depth of medication history information documented in a developing setting like Nigeria. METHOD: The study consisted of two phases. The first phase was a baseline cross-sectional assessment of the frequency and depth of medication history information documented by physicians in case notes of systematic samples of 900 patients that were stratified over 9 Medical outpatients Units at a premier teaching hospital in south western Nigeria. The second phase was an exploratory study involving 10 pharmacists who conducted cross-sectional medication history interview for 324 randomly selected patients. RESULTS: 49.2% of patients, whose medication history were documented at the baseline, by physicians, were males; while 50.3% of patient interviewed by pharmacists were male. Mean age (SD) of males and females whose medication histories were documented by physicians and pharmacists were 43.2 (SD=18.6), 43.1 (SD=17.9) years and 51.5 (SD=17.6), 52.1 (SD=17.4) years respectively. The frequency of medication history information documented by pharmacists was significantly higher for twelve of the thirteen medication history components (P < 0.0001). These include prescription medicines; over the counter medicines; source of medicines; adverse drug reactions; allergy to drugs, allergy to foods, allergy to chemicals; patient adherence; alcohol use; cigarette smoking; dietary restrictions and herbal medicine use. The depth of medication history information acquired and documented by pharmacist was significantly better for all the thirteen medication history components (P<0.0001). CONCLUSION: Pharmacists' participation resulted in significant increase in frequency and depth of medication history information documented in a developing setting like Nigeria. The new medication history evaluation criteria proved useful in assessing the impact of pharmacists' participation.

Advertising of OTC products in a Nigerian urban setting: content analysis for indications, targets, and advertising appeal.

OBJECTIVE: To identify the indications for which treatments were promoted, the segments of population targeted, and the type and extent of advertising appeal used for over-the-counter (OTC) products in a Nigerian urban setting. METHODS: Using a cross-sectional design, the content of advertisements for OTC products on radio, television, and billboards in a city in southwestern Nigeria were assessed during a 3-month period. Two coders independently assessed 1,492 advertisements for 49 brands of OTC products (interrater reliability [Cohen's kappa] = 0.83 [95% CI 0.80-0.90]). RESULTS: The most frequent indications for OTC products were aches and pain (42.9%), anemia/malnutrition (34.8%), and malaria (22.2%). Of advertisements, 92% were targeted at the primary end user. Use of appeal related to efficacy (100%), psychosocial enhancement (80%), and ease of use (40%) in visual, written, and audio messages was highest in ads on billboards. Efficacy appeal had the highest frequency across the three advertising media (100%); ease-of-use and safety appeal had the lowest frequency (40% and 7.4%, respectively). Nigerian movie stars were used as brand icons in advertisements of OTC products on radio (59.5%), television (52.9%), and billboards (49.6%). CONCLUSION: The majority of advertisements for OTC products in a Nigerian urban setting used advertising appeal related to efficacy and psychosocial enhancement. Promotional efforts by pharmaceutical manufacturers appear to focus on positive emotional appeal to influence drug purchase and use decisions.

What probable factors underlie inadequacy of medication history information recorded in patients' case notes by physicians in a Nigerian teaching hospital?

OBJECTIVE: To identify probable factors underlying inadequacy of medication history information recorded in patients' case notes by physicians in an ambulatory tertiary care setting in Nigeria. METHOD: A cross-sectional survey was conducted, with a pre-tested 25-item questionnaire, of 93 physicians at the nine medical units in the Department of Medicine at University College Hospital, Ibadan, Nigeria. KEY FINDINGS: The overall response rate was 79.6% (74/93), and the usable rate was 75% (70/93). A majority of physicians opined that a detailed medication history is an essential component of optimal and patient-specific care; and they were able to identify correctly the key components of a detailed medication history. However, about 60% of physicians opined that the adequacy of medication history documented by them is affected by heavy workload due to the large number of patients to which they attend. The majority (75%) of physicians also considered detailed documentation of patient medical history to be more important than medication history. CONCLUSIONS: Physicians' heavy workload, due to the large number of patients, and their belief that medical history is more important than medication history, appear to be the probable factors underlining the inadequacy of physician-acquired medication history in a developing sub-Saharan tertiary care setting.

Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria.

OBJECTIVE: To describe the pattern of anti-diabetic drug prescribing; ascertain the level of glycemic control, adherence with prescribed anti-diabetic medications, and diabetes self management practices among patients with type-2 diabetes in a tertiary care setting in Nigeria. SETTING: University College Hospital (UCH); a 900 bed teaching hospital with medical residents located in Ibadan, southwestern Nigeria. METHOD: The study consisted of two phases. A cross-sectional review of randomly selected 200 case notes of type 2 diabetic patients that attended the Endocrinology clinic over 3 month; and crosssectional interviews, with a pre-tested Adherence and Self-Management Monitoring Tool (ASMMT), of 200 consecutive patients that presented their drug prescriptions at the satellite pharmacy unit over a 4 week period at a 900-bed teaching hospital located in Ibadan, South-Western Nigeria. RESULTS: Oral Hypoglycemic Agents (OHA) were prescribed for 86% (171) of cohorts while insulin and OHA was prescribed in 14% (29). About 70.8% (121) of patients on OHA were on combination therapy. The most frequently prescribed OHA combination was glibenclamide and metformin (95.8%). Glibenclamide was prescribed as twice daily regimen in 69% of cohorts. The most frequently documented side effect was hypoglycemia (60.3%). Only 44% (88) of cohorts had adequate glycemic control; of these, 93% (82) were adjudged adherent with prescribed anti-diabetic drugs. Interviews with the structured ASMMT revealed that 59% of patients were non-adherent with the previous anti-diabetic drugs due to lack of finance (51.7%); side effects (34.5%); perceived inefficacy of prescribed anti-diabetic drugs leading to self-medication with local herbs (13.8%). Only 20% of non-adherent patients claimed disclosure to physicians during consultation. The identified factors for non-disclosure were lack of privacy during consultation (58%); and short consultation time (42%). The knowledge and practice of critical components of diabetes self-management behaviours were generally low among the cohort studied. However, it was significantly higher among patient judged adherent with their prescribed anti-diabetic medications (P < 0.05). CONCLUSION: Majority of patients with type 2 diabetes in an ambulatory tertiary care setting in Nigeria are managed with OHA combinations, mainly glibenclamide and metformin. While the current prescribing strategy achieved glycemic control in about one third of patients, majority are still not meeting the recommended blood glucose targets due to poor adherence with prescribed drug regimen, and poor knowledge and practice of successful self-management.

Does a physician's specialty influence the recording of medication history in patients' case notes?

AIMS: To determine the impact of a physician's specialty on the frequency and depth of medication history documented in patient medical records. METHODS: A cross-sectional assessment of the frequency and depth of medication history information documented by 123 physicians for 900 randomly selected patients stratified across Cardiology, Chest, Dermatology, Endocrine, Gastroenterology, Haematology, Neurology, Psychiatry and Renal specialties was carried out at a 900-bed teaching hospital located in Ibadan, Nigeria. RESULTS: Four hundred and forty-three (49.2%) of the cohort were males and 457 (50.8%) were females; with mean ages 43.2 +/- 18.6 and 43.1 +/- 17.9 years respectively. Physicians' specialties significantly influenced the depth of documentation of the medication history information across the nine specialties (P < 0.0001). Post hoc pair-wise comparisons with Tukey's HSD test showed that the mean scores for adverse drug reactions and adherence to medicines was highest in the Cardiology specialty; while the Chest specialty had the highest mean scores for allergy to drugs, food, chemicals and cigarette smoking. Mean scores for the use of alcohol; illicit drugs; dietary restrictions was highest for Gastroenterology, Psychiatry and Endocrine specialties respectively. Physicians' specialties also significantly influenced the frequency of documentation of the medication history across the nine specialties (P < 0.0001). CONCLUSIONS: Physicians appear to document more frequently and in greater depth medication history information that may aid the diagnostic tasks in their specific specialty. Researchers and other users of medication history data documented in patients' medical records by physicians may want to take special cognizance of this phenomenon.

Physicians' prescribing of anti-hypertensive combinations in a tertiary care setting in southwestern Nigeria.

PURPOSE: To evaluate physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria, determine the degree of usage of Angiotensin Converting Enzyme (ACE) inhibitor-based combinations and identify specific points of intervention to improve outcomes of anti-hypertensive combination therapy. METHODS: A cross-sectional retrospective drug use review was conducted between June 1st and August 31st 2002 using randomly selected 200 case notes of patients attending the Hypertension Clinic at a 900-bed tertiary care facility in southwestern Nigeria. 11 case notes were not used due to incompleteness. RESULTS: 73% (138) of the patients were on anti-hypertensive drug combinations, comprising 71.7% (99), 24.4% (34) and 3.6% (5) on combinations of two, three and four drugs respectively. Overall, Thiazide diuretic consisting mainly of fixed dose combination of Amiloride and Hydorchlorothiazide (Moduretic(r)) was the most frequently prescribed drug class in anti-hypertensive combination therapy (83.3%). ACE inhibitor, Lisinopril (Zestril(r)), was prescribed in combination with Moduretic(r), Calcium channel blocker and beta-blocker in 6.5%, 8.5% and 0.7% respectively. Blood pressure control was adequate in only 29% (40) of patients, though adherence with therapy was documented as adequate in 77.5% (107). Type-2 diabetes mellitus (32.7%) and osteoarthritis (21.8%) were the most frequent co-morbidities. Potentially harmful drug-drug interactions in the study sample were identified in 17.5% (46) of patients. Physician documentation of adverse drug reactions among patients was done in only 10.9% of cases. There appear to be no institutionalised system in place to monitor, detect and document adverse drug reactions among patients on anti-hypertensive drug therapy. CONCLUSION: Physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria is considerable. However, this practice does not appear to have positively impacted on blood pressure control among hypertensive patients nor being modulated by an Institutionalised standard guide.