A qualitative study of patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment in Nigeria.

OBJECTIVE: We explored patients' and carers' perspectives on factors influencing access to hypertension care and compliance with treatment. METHODS: This was a qualitative study using in-depth interviews with hypertensive patients and/or family carers receiving care at a government-owned hospital in north-central Nigeria. Eligible participants were patients who had hypertension, receiving care in the study setting, were aged 55 years and over and had given their written/thumbprint consent to participate in the study. An interview topic guide was developed from the literature and through pretesting. All the interviews were held face-to-face by a member of the research team. This study was conducted between December 2019 and February 2020. NVivo version 12 was used to analyse the data. RESULTS: A total of 25 patients and 13 family carers participated in this study. To understand the barriers to compliance with hypertension self-management practices, three themes were explored, namely: personal factors, family/societal factors and clinic/organization factors. Support was the key enabling factor for self-management practices, which were categorized to emerge from three sources namely: family members, community and government. Participants reported that they do not receive lifestyle management advice from healthcare professionals, and do not know the importance of eating low-salt diets/engaging in physical activities. CONCLUSION: Our findings show that study participants had little or no awareness of hypertension self-management practices. Providing financial support, free educational seminars, free blood pressure checks, and free medical care for the elderly could improve hypertension self-management practices among patients living with hypertension.

Health-Related Quality of Life of HIV Positive Patients with Hypertension: Is There an Association with Blood Pressure Control?

INTRODUCTION: The presence of comorbidities could affect the health-related quality of life (HRQoL) of people living with HIV (PLHIV). AIM: To assess the HRQoL of PLHIV and Hypertension, as well as its association with blood pressure (BP) control. METHODS: This cross-sectional study was conducted in the HIV clinic of the University of Uyo Teaching Hospial in Akwa Ibom State, Nigeria, between August and October 2018. The EQ-5D-5L was administered to 201 eligible outpatients in the waiting area of the clinic before consulting the physician. Patients' socio-demographic and clinical data were obtained from the medical records. Blood pressure was measured using an automatic BP monitor. Data were analyzed with SPSS version 20.0. RESULTS: Majority (58.6%) of the respondents were females; mean age was 49.59 ± 8.97 years; mean systolic and diastolic BP were 152.77 ± 19.38 mmHg and 90.28 ± 11.33 mmHg, respectively. EQ-VAS and EQ-5D index scores were 80.99 ± 15.97 and 0.86 ± 0.05, respectively. There were no significant differences in EQ-VAS score (z = - 0.113,  p = 0.910) or EQ-5D utility (z = - 0.523, p = 0.601) between participants with controlled and uncontrolled BP. Duration on antihypertensive drugs was associated with EQ-VAS score (χ2(2) = 6.558, p = 0.038), while employment status was associated with EQ-5D utility (z = - 2.661,  p = 0.008). CONCLUSIONS: PLHIV and hypertension accessing care at a Nigerian hospital reported a high HRQoL, irrespective of BP control status. Nevertheless, there is a need to provide psychological support and employment for this population to maximise their HRQoL.

Effects of pharmaceutical care interventions on humanistic outcomes in hypertensive people living with HIV: results of a randomized controlled trial.

OBJECTIVES: To evaluate the effects of pharmaceutical care (PC) interventions on humanistic outcomes in HIV-positive patients with hypertension. METHODS: This prospective, open-label, parallel randomized controlled trial was conducted in the HIV clinic of the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria, from August 2018 to October 2019. Eligible patients were randomized sequentially and equally into two study arms: the control arm (CA), where participants received the traditional care and the intervention arm (IA), where participants received PC by the research pharmacist. The patient's HIV knowledge questionnaire, the Hypertension Knowledge-Level Scale, the Medical Outcome Study-HIV Health Survey and the Patient Satisfaction with Pharmaceutical Service questionnaire were used to assess participants' HIV-related knowledge, hypertension-related knowledge, health-related quality of life (HRQoL) and satisfaction with PC, respectively. These were self-completed at baseline, 6 months and 12 months. Data were analysed using SPSS (IBM version 25.0). KEY FINDINGS: Out of the 206 participants randomized, 182 completed the 12-month follow-up. After 12 months, there was a significant improvement in HIV-related knowledge (∆ = 11.28%, t(180) = 4.41, P < 0.001) and hypertension-related knowledge (∆ = 5.94%, t(180) = 3.25, P = 0.001) in the IA over and above those observed in the CA. Similarly, PC interventions led to significant improvements in HRQoL (∆ = 6.5%, t(180) = 5.50, P < 0.001) and satisfaction with PC in the IA (∆ = 18.12%, t(180) = 11.85, P < 0.001) at the end of the study. CONCLUSIONS: PC significantly improved humanistic outcomes in HIV-positive patients with hypertension after a 12-month intervention.

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study.

WHAT IS KNOWN AND OBJECTIVE: Pharmaceutical care (PC) has been shown to improve clinical outcomes in hypertensive patients as well as in people living with HIV (PLWHV). The objective of this study was to evaluate the impact of PC on blood pressure (BP) control, viral load and adherence to medications in hypertensive PLWHV. METHODS: This was a prospective, randomized controlled study conducted in the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Eligible ambulatory patients were randomized equally to two study arms. The control arm (CA) received the traditional care offered at the HIV clinic; the intervention arm (IA) received the traditional care in addition to PC by the research pharmacist, which included structured education/counselling. BP and self-reported medication adherence were measured at baseline, 6 months and 12 months. Viral load was obtained at baseline and after 12 months. Data were analysed with spss, version 25.0. RESULTS AND DISCUSSION: Of the 206 participants initially randomized, 182 (91 in each study arm) completed the 12-month follow-up. No significant differences existed in both arms concerning socio-demographic/clinical characteristics of participants at baseline (p > 0.05). After 12 months, BP control was significantly higher in the IA (53.4% vs. 25.2%; p < 0.001, adjusted odds ratio, aOR = 3.20 (95% CI 1.59-6.44). Systolic BP reduced by 0.9 mmHg from baseline in the CA (p = 0.668) and by 16.67 mmHg from baseline value in the IA (p < 0.001). Diastolic BP increased by 1.9 mmHg in the CA (p = 0.444), but reduced by 7.0 mmHg in the IA (p < 0.001). No significant differences were observed in the change from baseline in the proportion with undetectable plasma viral load (UPVL) in both groups (p > 0.05). PC led to an increase in mean adherence to antiretroviral drugs (Δ = 0.55; p = 0.015), and an increase in mean adherence to antihypertensive drugs (Δ = 2.32; p < 0.001) in the IA. WHAT IS NEW AND CONCLUSION: To our knowledge, this is the first prospective randomized controlled study evaluating the impacts of PC on clinical outcomes in hypertensive PLWHV with a 12-month follow-up. Our results show that PC significantly improved BP control and adherence to antiretroviral and antihypertensive medications, but had no significant effect on viral load in HIV positive patients with hypertension. Providers of care for PLWHV should leverage the established HIV treatment successes for promoting adherence to treatment for common comorbidities like hypertension in PLWHV in order to improve clinical outcomes.

Impact of pharmacist-led educational interventions on asthma control and adherence: single-blind, randomised clinical trial.

Background Asthma is an important cause of morbidity and mortality worldwide. Education is a critical component in the management of asthma. Objective This study sought to assess the impact of pharmacist-led educational interventions on asthma control and adherence. Setting Tertiary Hospitals in Nigeria Method This was a single-blind, three-arm, prospective, randomised, controlled, parallel-group study conducted in the Respiratory Units of the University of Nigeria Teaching Hospital, Enugu State and the Lagos University Teaching Hospital, Lagos State between March 2016 and September 2017. The three arms were: Usual Care, Individual Intervention, Caregiver-assisted Intervention (1:1:1 ratio). The Intervention arms received education for 6 months while the Usual Care arm received no education. The Asthma Control Test and the 8-item Morisky Medication Adherence Scale were filled at baseline, 3 months, and 6 months after baseline. Data were analyzed using the IBM SPSS Version 25.0 with statistical significance set as P < 0.05. Main outcome measure Asthma control and adherence. Results Seventy-eight (78) asthma patients participated; thirty-nine (39) per hospital; thirteen (13) in each arm. The Individual Intervention arm possessed significantly better asthma control compared to Usual Care at 3 months (21.42 Vs. 18.85; P = 0.004, t = 3.124, df = 25, 95% confidence interval = 0.88 - 4.28) and 6 months (21.81 Vs. 19.58; P = 0.003, t = 3.259, df = 25, 95% confidence interval = 0.82 - 3.64). The Individual Intervention arm also possessed significantly better adherence compared to Usual Care at 3 months (6.81 Vs. 4.94; P = 0.001, t = 3.706, df = 25, 95% confidence interval = 0.83 - 2.90) and 6 months (7.28 Vs. 5.13; P < 0.001, t = 4.094, df = 25, 95% confidence interval = 1.07 -3.24). The Caregiver-assisted Interventions had no significant improvement in asthma control and adherence. Conclusion The individualized educational interventions produced better improvements in asthma control and adherence.

Development and psychometric evaluation of the patient's HIV knowledge questionnaire (PHKQ).

Background Valid and reliable instruments for measuring knowledge about human immuno-deficiency virus (HIV) among people living with the virus are necessary to identify knowledge gaps and evaluate effectiveness or outcomes of education programmes. However such instruments are scarce, particularly in developing countries. Objective This study aimed to develop and validate a self-administered instrument for measuring HIV-related knowledge among people living with HIV in Nigeria. Setting This study was conducted in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. Methods The Patient's HIV Knowledge Questionnaire (PHKQ) items, designed with response choices of 'yes', 'no' and 'don't know', were developed based on relevant literature and similar published studies. Face and content validity were established. Evidence of construct validity was established by factor analysis and group differences. Factor analysis was done using principal components and varimax rotation with Kaiser Normalization. Estimates of reliability were evaluated using internal consistency approach (with Cronbach's alpha coefficient) as well as the test-retest method for estimating the stability of the PHKQ scores over time (with Pearson's r). Main outcome measure Validity/reliability of the Patient's HIV Knowledge Questionnaire. Result Response rate in this study was 95.0%. Item analysis of the 20-item instrument resulted in the deletion of 5 items; thus the final instrument consists of 15 items. Cronbach's alpha coefficient for the scale was 0.77, while test-retest reliability was 0.80 (p < 0.001). Factor analysis resulted in 3 components-Transmission and Misconceptions, Causes and Treatment Outcomes, and Diet and Immunity-with Cronbach's alpha of 0.70, 0.56 and 0.46 respectively. The Patient's HIV Knowledge Questionnaire differentiated between newly diagnosed (≤ 1 year) individuals and those with at least 10 years since HIV diagnosis, and also between those with only primary education and those who had had up to tertiary education (p < 0.001). Conclusion The Patient's HIV Knowledge Questionnaire appears to be a valid and reliable tool for assessing HIV-related knowledge among people living with HIV in Nigeria. Further studies are needed to explore the instrument's responsiveness to change, and to evaluate its psychometrics in different settings.

Satisfaction of Nigerian patients with health services: a protocol for a systematic review.

BACKGROUND: Patient-based assessment of health services is becoming popular in measuring the standard of care. Both quantitative and qualitative methods are available. Patient satisfaction surveys are commonly used to record the experiences of patients in hospitals, whereas qualitative designs (e.g., interviews and focus group discussions) are used less frequently. To date, there has been no systematic review published devoted to patient satisfaction with health services in Nigeria. We aim to (1) systematically analyze relevant quantitative studies to pinpoint excellent procedures in measuring patient satisfaction with health services, (2) to investigate if a reference method (gold standard method) exists, and (3) to identify relevant topics which are recognized by patients as important for the delivery of a high-quality health service in Nigeria. METHODS: Searches of eight electronic journal databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, AJOL, CDSR, DARE, and HTA will be conducted to identify studies assessing patient satisfaction with health services in Nigeria. The searches will be supported by manual searches in reference lists of relevant primary studies and systematic reviews. The review will be limited to studies published since 2007. After a stepwise screening process by two reviewers, data from included studies will be extracted and reviewed. The COSMIN RoB checklist will be used to critically appraise included studies. We will carry out an extensive data synthesis to answer the review questions. DISCUSSION: The intended systematic review will provide information on how the satisfaction of patients with health services has earlier been described and assessed in Nigerian studies. It will establish if a gold standard method exists and synthesize information on topics which might be of special interest to patients. Review findings will enrich the debate on patient-centered care and overall performance of health quality standards in Nigeria. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018108140.

Prevalence of Low Birth Weight before and after Policy Change to IPTp-SP in Two Selected Hospitals in Southern Nigeria: Eleven-Year Retrospective Analyses.

BACKGROUND: In 2005, Nigeria changed its policy on prevention of malaria in pregnancy to intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP). Indicators of impact of effective prevention and control of malaria on pregnancy (MIP) are low birth weight (LBW) and maternal anaemia by parity. This study determined the prevalence of LBW for different gravidity groups during periods of pre- and postpolicy change to IPTp-SP. METHODS: Eleven-year data were abstracted from the delivery registers of two hospitals. Study outcomes calculated for both pre- (2000-2004) and post-IPTp-SP-policy (2005-2010) years were prevalence of LBW for different gravidity groups and risk of LBW in primigravidae compared to multigravidae. RESULTS: Out of the 11,496 singleton deliveries recorded within the 11-year period, the prevalence of LBW was significantly higher in primigravidae than in multigravidae for both prepolicy (6.3% versus 4%) and postpolicy (8.6% versus 5.1%) years. The risk of LBW in primigravidae compared to multigravidae increased from 1.62 (1.17-2.23) in the prepolicy years to 1.74 (1.436-2.13) during the postpolicy years. CONCLUSION: The study demonstrated that both the prevalence and risk of LBW remained significantly higher in primigravidae even after the change in policy to IPTp-SP.

Comparison of the effectiveness of two-dose versus three-dose sulphadoxine-pyrimethamine in preventing adverse pregnancy outcomes in Nigeria.

BACKGROUND & OBJECTIVES: : Three doses of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as the new recommendation for prevention of malaria in pregnancy. This study evaluated the effectiveness of two-dose versus three-dose of SP for IPTp-SP in the prevention of low birth weight (LBW) and malaria parasitaemia. METHODS: : An open, randomized, controlled, longitudinal trial was conducted in a secondary level hospital in Nsukka region of Enugu State, Nigeria. A sample of 210 pregnant women within gestational ages of 16-24 wk were recruited at antenatal clinics and equally randomized to either a two-dose SP or three-dose SP group. The primary endpoints were LBWs, peripheral, and placental parasitaemia, while the secondary endpoints were maternal anaemia, pre-term birth, clinical malaria and adverse effects of SP. RESULTS: : Among 207 cases followed till delivery, the prevalence of parasitaemia was lower in three-dose group than in two-dose group for both peripheral (9.3% versus 27.8%) and placental (10.6% versus 25.6%) parasitaemia. The adjusted odds ratios (aOR) were 0.15 [95% confidence interval (CI), 0.05 - 0.45] and 0.17 (95% CI, 0.06-0.51), respectively. The prevalence of LBW was also lower in three-dose (3.5%) than in two-dose (12.2%) group (aOR, 0.15; 95% CI, 0.04-0.63); however, the prevalence of maternal anaemia, pre-term births, clinical malaria and SP adverse effects were similar between the two arms of treatment. INTERPRETATION & CONCLUSION: : Addition of a third SP dose to the standard two-dose SP for IPTp led to improved reductions in the risk of some adverse pregnancy outcomes.

In vitro and in vivo cytochrome P450 3A enzyme inhibition by Aframomum melegueta and Denniettia tripetala extracts.

OBJECTIVE: To evaluate the in vitro and in vivo inhibitory effects of two commonly used herbs, Aframomum melegueta (A. melengueta) and Dennettia tripetala (D. tripetala) on CYP 3A enzymes. METHODS: In vitro inhibition of the enzymes were assessed with microsomes extracted from female albino rats using erythromycin-N-demethylation assay (EMND) method while their in vivo effects were measured by estimating simvastatin plasma concentrations in rats. Pharmacokinetic parameters were determined using non-compartmental analysis as implemented in WinNonlin pharmacokinetic program. RESULTS: EMND assay with intestinal microsomes indicated that aqueous extracts of D. tripetala and A. melengueta significantly (P < 0.05) inhibited intestinal CYP 3A activity at both 50 µg and 100 µg concentrations. Petroleum ether extract of D. tripetala and ethanol extracts of A. melengueta inhibited intestinal CYP3A activity at 100 µg but not at 50 µg concentrations. All the extracts showed an in vitro dose dependent CYP 3A inhibition with liver microsomes. In vivo analysis showed that pre-treatment with the extracts enhanced systemic absorption of simvastatin with reductions in metabolizing enzymes activity as indicated in significant increases in maximal concentration, area under curve, area under moment curve and mean resident time of simvastatin (P < 0.05). CONCLUSIONS: Herbal preparations containing these plants' extracts should be used with caution especially in patients on CYP450 3A substrate medications.

Inhibition of cytochrome P450 3A enzyme by Millettia aboensis: its effect on the pharmacokinetic properties of efavirenz and nevirapine

ABSTRACT The chronic and comorbid nature of HIV infection necessitate the use of multiple drugs including herbs to relieve symptoms with a possible increase in herb–drug interaction cases. This study was designed to evaluate the effect of Millettia aboensis (Hook. f.) Baker, Fabaceae, on cytochrome P450 3A isoenzyme and the influence of this effect on the bioavailability of two antiretroviral agents. In vitro effect of ethanol extract of M. aboensis on intestinal and liver microsomes extracted from female rats was assessed using erythromycin-N-demethylation assay method while in vivo effects were determined by estimating simvastatin plasma concentrations in rats. The effect of the extract on pharmacokinetic parameters of orally administered efavirenz (25 mg/kg) and nevirapine (20 mg/kg) was determined in rats divided into groups (n = 5). Plasma drug concentrations were assayed using HPLC and pharmacokinetic parameters determined through a non-compartmental analysis as implemented in WinNonlin pharmacokinetic program. The extract inhibited both intestinal and liver microsomal cytochrome P450 3A isoenzyme activities in vitro and enhanced simvastatin absorption in vivo with possible inhibition of metabolizing enzymes as indicated by significant (p < 0.05) increase in maximal concentration, area under curve and mean resident time of the drug. However, further in vivo interaction studies in animal model did not produce significant (p > 0.05) changes in the pharmacokinetic parameters of efavirenz and nevirapine. HPLC fingerprinting indicated the presence of quercetin and kaempferol in the extract. These findings revealed M. aboensis as an inhibitor of cytochrome P450 3A enzyme but, with no significant effect on the bioavailability of orally administered nevirapine and efavirenz.

Effect of antimalarial prophylaxis with sulphadoxine-pyrimethamine on pregnancy outcomes in Nsukka, Nigeria.

Background: We evaluated the association between the use of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) on pregnancy outcomes among women who delivered at a secondary hospital in Nsukka, Enugu State, Nigeria. Materials and methods: Relevant obstetric data (e.g. IPTp-SP use), matched against pregnancy outcome data such as delivery method, stillbirth, maternal haematocrit test results and babies' birth weights, were collected retrospectively from antenatal care (ANC) case files of women who delivered within a one-year period (2013). Results: The prevalence of adverse pregnancy outcomes recorded out of the 500 ANC case files analysed were: low birth weight (LBW) 3.6% (15), anaemia 54.3% (114), caesarean section 31.6% (156) and stillbirth 3.6% (67). A total of 342 (68.4%) of the women received IPTp-SP during ANC and the receipt of IPTp-SP was significantly associated with reductions in the following events: LBW [OR = 0.26, 95% CI = 0.09 - 0.75], moderate anaemia [OR = 0.33, 95% CI = 0.17 - 0.63], caesarean section [OR = 0.36, 95% CI = 0.24 - 0.53] and stillbirth [OR = 0.10, 95% CI = 0.06 - 0.18]. Conclusion: In this area of high malaria transmission we demonstrated significant reductions in unfavourable maternal and infant health outcomes when using IPT-SP.

Medication adherence in type 2 diabetes patients in Nigeria.

BACKGROUND: Medication adherence is a major universal factor influencing patient health outcomes, particularly in chronic diseases such as diabetes. Poor adherence to antidiabetes medication can cause therapeutic failure, leading to manifestation of diabetes-related complications, such as retinopathy, neuropathy, nephropathy, etc., reduced quality of life, and increased healthcare costs. To forestall these, likely predictors of medication nonadherence should be assessed and addressed appropriately. The purpose of this work was therefore to assess medication adherence among type 2 diabetes patients and to identify patient characteristics and probable factors associated with nonadherence. SUBJECTS AND METHODS: A descriptive, cross-sectional research design was used. The study was conducted on 360 ambulatory type 2 diabetes patients attending an endocrinology clinic between June 2012 and February 2013. The eight-item Modified Morisky Adherence Scale was used to assess medication adherence; sociodemographic information and respondents' opinion on the possible barrier(s) to medication adherence were also obtained. Data were analyzed using SPSS version 14.0 software (SPSS, Inc., Chicago, IL). RESULTS: Of the 303 patients included in the final analysis, 19.8% of respondents were judged to be highly adherent. Medium and low adherers were 30.0% and 50.2%, respectively. The median adherence score was 5.75 (interquartile range, 4.5-7.0). Adherence to medication correlated with low literacy level (P=0.008), forgetfulness (P=0.009), high cost of medication (P=0.014), limited access to care (P=0.001), complexity of regimen (P=0.001), poor patient-provider communication (P=0.000), lack of trust in the provider (P=0.046), and depression (P=0.031). No statistically significant relationship was found between patients' characteristics and medication adherence. CONCLUSIONS: Medication adherence was generally poor among the cohorts studied.

Cognitive Determinants of Academic Performance in Nigerian Pharmacy Schools.

Objective. To evaluate cognitive factors that might influence academic performance of students in Nigerian pharmacy schools. Methods. A cross-sectional, multi-center survey of Nigerian pharmacy students from 7 schools of pharmacy was conducted using 2 validated questionnaires measuring cognitive constructs such as test anxiety, academic competence, test competence, time management, and strategic study habits. Results. Female students and older students scored significantly better on time management skills and study habits, respectively. Test anxiety was negatively associated with academic performance while test competence, academic competence, and time management were positively associated with academic performance. These 4 constructs significantly discriminated between the lower and higher performing students, with the first 2 contributing to the most differences. Conclusion. Test and academic competence, test anxiety, and time management were significant factors associated with low and high academic performance among Nigerian pharmacy students. The study also demonstrated the significant effects of age, gender, and marital status on these constructs.

Knowledge of self-care among type 2 diabetes patients in two states of Nigeria.

OBJECTIVE: To assess the knowledge of self-care practices, as well as factors responsible for such knowledge among type 2 diabetes patients in two states of Nigeria. METHODS: Descriptive, cross sectional survey research design was employed. The study was conducted on type 2 diabetes out-patients attending Endocrinology Clinic at the University of Uyo Teaching Hospital (UUTH) and University of Calabar Teaching Hospital (UCTH) between June 2012 and February 2013. The Diabetes Self-care Knowledge (DSCK-30) was used in evaluating knowledge of self-care practices. Socio-demographic information and respondents' opinion on the possible barrier(s) to knowledge of self-care were also obtained. Data were analysed using Microsoft Excel and SPSS version 14.0. Statistical significance for all analyses was defined as a p value less than 0.05. RESULTS: A total of 303 out of 380 questionnaires distributed were completed and returned (response rate =79.7%). The majority of the study sample (79.5%) had 70% or more overall knowledge level about self-care. Self-care knowledge was associated with level of education (p<0.001), monthly income (p<0.001) and duration of diabetes (p=0.008). Negative attitude to disease condition was the only factor associated with knowledge (chi-square value at one degree of freedom =6.215; p=0.013). CONCLUSION: Diabetes self-care knowledge was generally high among the population studied. Educational status, monthly income, duration of diabetes and negative attitude to disease condition predicted knowledge level.

Cost-Utility Analysis of Pharmaceutical Care Intervention Versus Usual Care in Management of Nigerian Patients with Type 2 Diabetes.

OBJECTIVE: To assess the cost-effectiveness of pharmaceutical care (PC) intervention versus usual care (UC) in the management of type 2 diabetes. METHODS: This study was a randomized, controlled study with a 12-month patient follow-up in two Nigerian tertiary hospitals. One hundred and ten patients were randomly assigned to each of the "intervention" (PC) and the "control" (UC) groups. Patients in the UC group received the usual/conventional care offered by the hospitals. Patients in the PC group received UC and PC in the form of structural self-care education and training for 12 months. The economic evaluation was based on patients' perspective. Costs of management of individual complications were calculated from activities involved in their management by using activity-based costing. The impact of the interventions on quality of life was estimated by using the HUI23S4EN.40Q (Mark index 3) questionnaire. The primary outcomes were incremental cost-utility ratio and net monetary benefit. An intention-to-treat approach was used. Two-sample comparisons were made by using Student's t tests for normally distributed variables data at baseline, 6 months, and 12 months. Comparisons of proportions were done by using the chi-square test. RESULTS: The PC intervention led to incremental cost and effect of Nigerian naira (NGN) 10,623 ($69) and 0.12 quality-adjusted life-year (QALY) gained, respectively, with an associated incremental cost-utility ratio of NGN 88,525 ($571) per QALY gained. In the cost-effectiveness acceptability curve, the probability that PC was more cost-effective than UC was 95% at the NGN 250,000 ($1613) per QALY gained threshold and 52% at the NGN 88,600 ($572) per QALY gained threshold. CONCLUSIONS: The PC intervention was very cost-effective among patients with type 2 diabetes at the NGN 88,525 ($571.13) per QALY gained threshold, although considerable uncertainty surrounds these estimates.

The Impact of Pharmaceutical Care Intervention on the Quality of Life of Nigerian Patients Receiving Treatment for Type 2 Diabetes.

OBJECTIVES: To evaluate the impact of pharmaceutical care (PC) intervention on health-related quality of life (HRQOL) of patients with type 2 diabetes. METHODS: This study was a randomized, controlled study with a 12-month patient follow-up. The study protocol was approved by the Research Ethical Committees of the institutions in which this study was conducted. A total of 110 patients were randomly assigned to each of the "intervention" (PC) and "control" (usual care [UC]) groups. Patients in the UC group received the usual/conventional care offered by the hospitals. Patients in the PC group received UC and additional PC for 12 months. The HUI23S4EN.40Q (developed by HUInc - Mark index 2&3) questionnaire was used to assess the HRQOL of the patients at baseline, 6 months, and 12 months. Two-sample comparisons were made by using Student's t tests for normally distributed variables or Mann-Whitney U tests for nonnormally distributed data at baseline, 6 months, and 12 months. Comparisons of proportions were done by using the chi-square test. RESULTS: The overall HRQOL (0.86 ± 0.12 vs. 0.64 ± 0.10; P < 0.0001) and single attributes except "hearing" functioning of the patients were significantly improved at 12 months in the PC intervention arm when compared with the UC arm. The HRQOL utility score was highly negatively (deficit ≥10%) associated with increasing age (≥52 years), diabetes duration (>4 years), emergency room visits, comorbidity of hypertension, and stroke in both PC and UC groups. CONCLUSION: Addition of PC to UC improved the quality of life in patients with type 2 diabetes.

Increasing use of artemisinin-based combination therapy for treatment of malaria infection in Nigerian hospitals.

OBJECTIVES: This study aimed at describing the pattern of outpatient antimalarial drug prescribing in a secondary and a tertiary hospital, and to assess adherence to the National Antimalarial Treatment Guideline (ATG). METHODS: An audit of antimalarial prescription files from the two health facilities for a period of six months in 2008 was conducted. Semi structured questionnaires were used to collect information from the doctors and pharmacists on their awareness and knowledge of the National Antimalarial Treatment Guideline. RESULTS: Artemisinin-based combination therapies (ACTs) were the most prescribed antimalarials. Overall, 81.4% of the total prescriptions contained ACTs, out of which 56.8% were artemetherlumefantrine. However, adherence to the drugs indicated by national guideline within the DU90% was 38.5% for the tertiary and 66.7 % for the secondary hospital. The standard practice of prescribing with generic name was still not adhered to as evidenced in the understudied hospitals. The percentage of health care providers that were aware of the ATG was 88.2% for doctors and 85.1% for pharmacists. However, 13.3% and 52.2% of doctors and pharmacists respectively could not properly list the drugs specified in the guideline. Amodiaquine was the most commonly preferred option for managing children aged 0 - 3 months with malaria infection against the indicated oral quinine. CONCLUSION: This study showed an increased use of artemisinin-based combination therapy for the treatment of uncomplicated malaria compared previous reports in Nigeria. This study also highlights the need for periodic in-service quality assurance among health professionals with monitoring of adherence to and assessment of knowledge of clinical guidelines to ensure the practice of evidence based medicine.

Assessment of attitudes of University of Nigeria pharmacy students toward pharmaceutical care.

OBJECTIVE: The purpose of this study was to describe the attitude of University of Nigeria pharmacy students towards pharmaceutical care. METHOD: A survey of pharmacy students in their second to fifth year was conducted. A modified 13-item standard Pharmaceutical Care Attitudes Survey (PCAS) was used for the study. Reliability and factorial validity of the modified instrument were assessed. RESULTS: Modification of the instrument did not alter its validity. Students of the University of Nigeria had a positive attitude towards pharmaceutical care as attitude score of all the items were above the midpoint score of 2.5. The mean scale score of second and third year students were significantly lower than that of the fifth year's (Oneway ANOVA, p<0.001). Females had a higher positive attitude score compared to male students (Students t-test, p=0.005). There was no significant difference in the mean scale score among those that had work experience and those without work experience. Marital status did not influence attitude score. CONCLUSION: University of Nigeria pharmacy students had a positive attitude towards pharmaceutical care. However, it is necessary to provide sites were students could acquire practice experience and these sites should be designed to enable students observe the integration of pharmaceutical care activities into pharmacy practice.

Effect of pharmaceutical care programme on blood pressure and quality of life in a Nigerian pharmacy.

OBJECTIVE: The study aimed at evaluating the effect of pharmaceutical care programme on blood pressure and quality of life of patients who visit a Nigerian community pharmacy. METHOD: A non-randomised, single-site, crossover design was used. Patients served as their own control. They underwent 5 months of usual care and another 5 months of pharmaceutical care. MAIN OUTCOME MEASURE: Blood pressure and quality of life measured before implementation of pharmaceutical care and at the end served as main outcome measures. Other end-points assessed at baseline and at the end of investigation included smoking cessation, adherence to therapy, exercise, salt restriction, alcohol moderation and self blood pressure measurement. RESULTS: Twenty four (24) patients out of the 40 recruited completed the study. Mean reductions were significant after pharmaceutical care intervention for systolic BP (14.3+/-14.4 mmHg) and diastolic BP (10.8+/-10.7 mmHg). There was a significant mean increase in number of patients that adhered to salt restriction (-36%), aerobic exercise (-46%), self BP measurement (-46%), alcohol moderation (-33%) and drug adherence (-16.7%). There was a positive increase of -11.4 and -3.2 for physical health and social health domain of quality of life evaluation respectively. CONCLUSION: Pharmaceutical care programme could produce a beneficial effect on hypertensive patients.