Allosteric modulation of α1ß3γ2 GABAA receptors by farnesol through the neurosteroid sites.

In mammalian cells, all-trans farnesol, a 15-carbon isoprenol, is a product of the mevalonate pathway. It is the natural substrate of alcohol dehydrogenase and a substrate for CYP2E1, two enzymes implicated in ethanol metabolism. Studies have shown that farnesol is present in the human brain and inhibits voltage-gated Ca2+ channels at much lower concentrations than ethanol. Here we show that farnesol modulates the activity of γ-aminobutyric acid type A receptors (GABAARs), some of which also mediate the sedative activity of ethanol. Electrophysiology experiments performed in HEK cells expressing human α1ß3γ2 or α6ß3γ2 GABAARs revealed that farnesol increased chloride currents through positive allosteric modulation of these receptors and showed dependence on both the alcoholic functional group of farnesol and the length of the alkyl chain for activity. In silico studies using long-timescale unbiased all-atom molecular dynamics (MD) simulations of the human α1ß3γ2 GABAA receptors revealed that farnesol modulates the channel by directly binding to the transmembrane neurosteroid-binding site, after partitioning into the surrounding membrane and reaching the receptor by lateral diffusion. Channel activation by farnesol was further characterized by several structural and dynamic variables, such as global twisting of the receptor's extracellular domain, tilting of the transmembrane M2 helices, radius, cross-sectional area, hydration status, and electrostatic potential of the channel pore. Our results expand the pharmacological activities of farnesol to yet another class of ion channels implicated in neurotransmission, thus providing a novel path for understanding and treatment of diseases involving GABAA receptor dysfunction.

Attitudes towards COVID-19 vaccination: A cross sectional study in the Federal Capital Territory, Nigeria.

Vaccine acceptance is complex and context-specific, varying across time, place and perceived behavioural nature of the community involved. A high vaccine acceptance rate is important to achieve herd immunity, however, vaccine hesitancy is a possible barrier to this. This study aimed to assess attitudes towards COVID-19 vaccination and associated factors. A cross-sectional survey was undertaken to investigate the attitudes of Federal Capital Territory residents towards COVID-19 vaccine uptake in Nigeria. Data were collected using questionnaires which were administered to respondents physically and online through random and snowball sampling strategies respectively. Data received were then analysed using Statistical Package for Social Sciences (SPSS). A total of 1767 responses were received with males representing 57.8% of the sample. More than half (54.9%) of the respondents were between the ages of 18-30 years. A third (35.4%) of the study participants indicated that a vaccine was not necessary for COVID-19, and 56.5% indicated willingness to accept COVID-19 vaccination. The majority of the sample (56.9%) indicated that the government decision-making was in their best interest, whilst close to two-thirds of the respondents (61%) were of the view that COVID-19 vaccination should not be made compulsory. Older respondents as represented by those over 60 years were more likely to accept COVID-19 vaccination (p = 0.039). This study however revealed negative attitudes towards COVID-19 vaccination, indicating the urgent need for government, policymakers, and other stakeholders to prioritise the development of strategies that can appropriately address vaccine hesitancy in the study setting. Contextual interventions indicated include strategic public enlightenment campaigns targeting populations with less favourable dispositions towards being vaccinated.

The role of government in the achievement of medicines' security: A preliminary exploration of stakeholders' views and experience.

Medicines are essential commodities that form the cornerstone in majority of processes and interventions aimed at assuring optimal healthcare and wellbeing for any population. Apart from being saddled with the responsibility of providing medications for this purpose, the pharmaceutical industry has the potential to catalyse socioeconomic development such as job creation and revenue generation. This study aimed at assessing government's role in driving development in Nigeria's pharmaceutical sector. Questionnaires were administered to healthcare practitioners that participated in an event targeted at developing Nigerian pharmaceutical sector. Data collected were analysed using Statistical Package for Social Sciences. A total of 76 respondents participated in the study. Two-thirds of the study participants (69.7%) were males, slightly above a third of the study participants (38.2%) were aged 51 and above, and close to a quarter of the participants (21.1%) were doctorate degree holders. About half of the study participants (51.4%) indicated that Nigerian pharmaceutical sector was not adequately regulated, whilst almost all (97.4%) indicated that engaging the legislature was critical for the development of the sector. A strong majority of the study participants (87.5%) indicated that existing drug laws should be reviewed so as to protect the pharmaceutical sector. Also, majority of the participants (56.3%) were not satisfied with government's efforts in developing the pharmaceutical industry. Although this study explored a small cohort, its findings have revealed novel insights regarding factors limiting the requisite prioritisation of the Nigerian pharmaceutical sector. The emergent evidence can begin to underpin proactive policy and practice reforms aimed at achieving medicines' security in Nigeria. Further studies can build on these preliminary findings to enable robust and comprehensive sectoral interventions that improve access to healthcare, whilst also catalysing socioeconomic development.

Application of Generative Artificial Intelligence in Predicting Membrane Partitioning of Drugs: Combining Denoising Diffusion Probabilistic Models and MD Simulations Reduces the Computational Cost to One-Third.

The optimal interaction of drugs with plasma membranes and membranes of subcellular organelles is a prerequisite for desirable pharmacology. Importantly, for drugs targeting the transmembrane lipid-facing sites of integral membrane proteins, the relative affinity of a drug to the bilayer lipids compared to the surrounding aqueous phase affects the partitioning, access, and binding of the drug to the target site. Molecular dynamics (MD) simulations, including enhanced sampling techniques such as steered MD, umbrella sampling (US), and metadynamics, offer valuable insights into the interactions of drugs with the membrane lipids and water in atomistic detail. However, these methods are computationally prohibitive for the high-throughput screening of drug candidates. This study shows that applying denoising diffusion probabilistic models (DDPMs), a generative AI method, to US simulation data reduces the computational cost significantly. Specifically, the models used only partial (one-third) data from the US simulations and reproduced the complete potential of mean force (PMF) profiles for three FDA-approved drugs (ß2-adrenergic agonists) and ∼20 biologically relevant chemicals with known experimentally characterized bilayer locations. Intriguingly, the model can predict the solvation-free energies for partitioning and crossing the bilayer, preferred bilayer locations (low-energy well), and orientations of the ligands with high accuracy. The results indicate that DDPMs can be used to characterize the complete membrane partitioning profile of drug molecules using fewer umbrella sampling simulations at select positions along the bilayer normal (z-axis), irrespective of their amphiphilic-lipophilic-cephalophilic characteristics.

Access to healthcare for people with sickle cell disease: Views of healthcare professionals on policies and practices.

INTRODUCTION: Sickle cell disease is a genetic disorder with its highest prevalence in Nigeria. The condition causes red blood cells to turn rigid, and consequently, results to several complications including organ damage. This study aimed at assessing views of health practitioners in Nigeria on policies and practices in the area of access to healthcare services for sickle cell disease. METHODS: A cross-sectional study was undertaken amongst healthcare professionals in Nigeria. Data were collected using a self-administered questionnaire, and analyses were undertaken using Statistical Package for Social Sciences software. RESULTS: A significant proportion of the participants (42.8%) disagreed that relevant legislative framework exists to facilitate optimal access to high-quality healthcare services for persons with sickle cell disorder in Nigeria. Two-thirds of the study cohort were of the opinion that public health surveillance towards sickle cell disease was suboptimal (61.2%). Also, more than three-quarters of the respondents (78.7%) indicated that the cost of managing sickle cell disease was not affordable to majority of affected Nigerians. CONCLUSION: This study provides critical insights into access to healthcare services for sickle cell disease. As such, challenges preventing access to healthcare services for sickle cell patients which have been identified in this study can underpin the development of contextual policies to address them.

Policies and practices in Nigeria's pharmaceutical sector: A mixed methods exploration of stakeholders' perspectives on strategic reforms.

Background: Policies and practices are key factors that determine development in any sector. In the Nigerian setting however, there is lack of evidence that the pharmaceutical sector is embedded with contextual policies and practices that can expedite development in the system. This inadvertently has an impact as regards access to medicines for the citizenry. This study therefore aimed at adopting a bottom-up approach in gathering insights into stakeholders' perspectives on policies and practices in Nigeria's pharmaceutical sector, and how they influence Medicines' Security and consequent access to healthcare. Methods: Data were collected using a self completion questionnaire which was administered to stakeholders present during an event held in Abuja, the capital of Nigeria, which focused on improving the Nigerian pharmaceutical sector. A total number of 82 questionnaires were administered to participants. Following retrieval of questionnaires, quantitative data were subjected to descriptive and inferential analyses, whilst textual data were analysed using thematic analysis approach. Results: Of the 82 questionnaires administered, response rate was 92.68%. Two-thirds of the participants were males (69.7%). A quarter of the study participants were between the ages of 41 and 50 years, whilst those above 50 years represented the most populous proportion of the sample (38.2%). A considerable proportion (48%) of the study participants indicated that current policy ecosystem was hostile for pharmaceutical sector growth and development. Also, majority (97.3%) of the study participants indicated that increased investment in health research could stimulate the development of the pharmaceutical sector. Majority of the study participants indicated the need for collaboration between pharmaceutical companies, research institutes and the petrochemical industry. Conclusion: This study consequently identified several critical factors that could stimulate development in the sector, including increased funding of research; stringent implementation of existing policies; and prioritisation of pharmaceutical sector by government and other key stakeholders.

The role of pharmacists in eliminating counterfeit medicines in Nigeria.

Introduction: Over the years, counterfeit pharmaceuticals have posed immense concerns for global health and patient safety. This menace encompasses various classes of medications. Given the criticality of pharmacists' interventions in drug distribution and supply, this study aimed at exploring their role in the prevention and control of counterfeit pharmaceutical products in Nigeria. Methods: A cross-sectional study was undertaken, using questionnaires to collect data from pharmacists across various sectors of pharmacy practice in Nigeria. Face and content validity was undertaken on the study tool prior to data collection. Ethical approval was obtained from the National Institute for Pharmaceutical Research and Development Health Research Ethics Committee, and confidentiality was strictly maintained during data collection process. Data were analyzed using Statistical Package for Social Sciences. Descriptive statistical analysis was undertaken and chi square was used to determine association between socio-demographic characteristics and variables. Results: The responses comprised 205 (52.6%) female and 185 (47.4%) male participants. Almost all the participants (98.4%) agreed that strict enforcement of drug laws can contribute to adequate control of counterfeit medicines in Nigeria, and majority of the study sample (64.7%) indicated that the poor implementation of these laws was a major factor influencing the preponderance of counterfeit medicines in the country. Two-thirds (63.5%) of the participants supported the need for pharmacists to provide adequate education to patients on strategies to identify counterfeit medicines, and a similar proportion (68.0%) were of the opinion that it was the responsibility of pharmacists to ensure that drugs are purchased from credible sources. Conclusion: Findings from this study, in addition to confirming pharmacists' instrumentality in the fight against counterfeit medicines, identified certain context specific factors that can strengthen the regulation, policy and the entire healthcare system. Government and relevant stakeholders can therefore begin to articulate strategic reforms for contextual policy intervention that address medicines' counterfeiting, whilst prioritising pharmacists' role in other critical areas in the healthcare system.

Impact of Sickle Cell Disease on Affected Individuals in Nigeria: A Critical Review.

Sickle cell disease is an autosomal recessive disorder of the beta-globin gene, with resultant deformation of the red blood cells and variable clinical outcomes. Nigeria is recognised as the country with the highest burden of sickle cell disease globally. This study aimed at critically reviewing available literature on impact of sickle cell disease in Nigeria. A literature search was carried out on four databases, and a total of 116 articles that met the inclusion criteria were included in the critical review. It was observed that majority of the studies were carried out in South-Western part of Nigeria (47.4%), whilst the North-East had the least number of studies undertaken in this area, more than a quarter of the studies (27.6%) were related to hematologic and serologic screening. Major themes that emerged from this review were morbidity and mortality; prevalence of sickle cell disease; issues relating to blood transfusion; psychosocial impact; and anatomical dysfunction in sickle cell disease. Intervention programs from both government and non-governmental organizations aimed at reducing the burden of sickle cell disease and its socio-economic impact were identified as key to strategies aimed at overcoming challenges associated with the disease. Findings from this study also revealed that education and awareness interventions were central to reducing the prevalence of sickle cell disease in this setting.

Preventing and Mitigating Inter-Professional Conflict Among Healthcare Professionals in Nigeria.

Introduction: The primary obligation of healthcare professionals is the well-being of patients. Inter-professional conflict can prevent the achievement of this goal, thereby potentially putting patients in peril. This study aimed at articulating contextual strategies to mitigate and prevent inter-professional conflict among healthcare workers in Nigeria. Methods: A cross sectional study was undertaken in various health facilities in Nigeria. Questionnaires were administered to healthcare professionals. Completed questionnaires were analysed using Statistical Package for Social Sciences. Descriptive and inferential statistical analyses were undertaken. Results: A total of 2207 valid responses were included for analysis. Findings revealed that almost all the respondents (92.9%) indicated that the Ministry of Health has a key role in resolving conflict in the healthcare sector. Close to three quarters (70.4%) of the study participants disagreed that leadership of hospitals and health agencies be limited to a particular profession. Almost all the participants (90.15%) indicated that cognate administrative expertise and experience are critical for leadership. A strong majority of the sample (93.5%) opined that reforms are required in the leadership selection process of hospital and other healthcare agencies. Conclusion: Due to the criticality of this issue to patients' access to healthcare, findings from this study can underpin a proactive evidence based strategy that can comprehensively address inter-professional conflict among healthcare workers in Nigeria.

A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa.

Sickle cell disease is caused by an abnormality of the ß-globin gene and is characterised by sickling of the red blood cells. Globally, sub-Saharan African countries share the highest burden of the disease. This study aimed at critically reviewing studies focusing on challenges of sickle cell anaemia in sub-Saharan Africa. A literature search was carried out in five major databases. Articles that met the inclusion criteria were included in the bibliometric review and critical analysis. A majority of the studies were undertaken in the West African region (85.5%), followed by Central Africa (9.1%). Very few studies had been undertaken in East Africa (3.6%), whilst the Southern African region had the fewest studies (1.8%). Distribution in relation to country revealed that three quarters of the studies were carried out in Nigeria (74.5%), followed by the Democratic Republic of the Congo (9.1%). According to healthcare settings, a strong majority of the studies were undertaken in tertiary health care facilities (92.7%). Major themes that emerged from the review include interventions, cost of treatment, and knowledge about sickle cell disease. Public health awareness and promotion as well as improving the quality of sickle cell centers for prompt management of patients with sickle cell disorder was identified as a critical strategy towards reducing the burden of the disease in sub-Saharan Africa. To achieve this, governments in countries located in this region need to adopt a proactive strategy in addressing gaps that have been identified in this study, as well as instituting other relevant measures, such as continuous media engagement and public health interventions relating to genetic counselling. Reforms in other areas that can help reduce the disease burden, include training of practitioners and equipping sickle cell disease treatment centers according to World Health Organization specifications.

Exploring the matrix: knowledge, perceptions and prospects of artificial intelligence and machine learning in Nigerian healthcare.

Background: Artificial intelligence technology can be applied in several aspects of healthcare delivery and its integration into the Nigerian healthcare value chain is expected to bring about new opportunities. This study aimed at assessing the knowledge and perception of healthcare professionals in Nigeria regarding the application of artificial intelligence and machine learning in the health sector. Methods: A cross-sectional study was undertaken amongst healthcare professionals in Nigeria with the use of a questionnaire. Data were collected across the six geopolitical zones in the Country using a stratified multistage sampling method. Descriptive and inferential statistical analyses were undertaken for the data obtained. Results: Female participants (55.7%) were slightly higher in proportion compared to the male respondents (44.3%). Pharmacists accounted for 27.7% of the participants, and this was closely followed by medical doctors (24.5%) and nurses (19.3%). The majority of the respondents (57.2%) reported good knowledge regarding artificial intelligence and machine learning, about a third of the participants (32.2%) were of average knowledge, and 10.6% of the sample had poor knowledge. More than half of the respondents (57.8%) disagreed with the notion that the adoption of artificial intelligence in the Nigerian healthcare sector could result in job losses. Two-thirds of the participants (66.7%) were of the view that the integration of artificial intelligence in healthcare will augment human intelligence. Three-quarters (77%) of the respondents agreed that the use of machine learning in Nigerian healthcare could facilitate efficient service delivery. Conclusion: This study provides novel insights regarding healthcare professionals' knowledge and perception with respect to the application of artificial intelligence and machine learning in healthcare. The emergent findings from this study can guide government and policymakers in decision-making as regards deployment of artificial intelligence and machine learning for healthcare delivery.

Molecular basis for the recognition of 24-(S)-hydroxycholesterol by integrin αvß3.

A growing body of evidence suggests that oxysterols such as 25-hydroxycholesterol (25HC) are biologically active and involved in many physiological and pathological processes. Our previous study demonstrated that 25HC induces an innate immune response during viral infections by activating the integrin-focal adhesion kinase (FAK) pathway. 25HC produced the proinflammatory response by binding directly to integrins at a novel binding site (site II) and triggering the production of proinflammatory mediators such as tumor necrosis factor-α (TNF) and interleukin-6 (IL-6). 24-(S)-hydroxycholesterol (24HC), a structural isomer of 25HC, plays a critical role in cholesterol homeostasis in the human brain and is implicated in multiple inflammatory conditions, including Alzheimer's disease. However, whether 24HC can induce a proinflammatory response like 25HC in non-neuronal cells has not been studied and remains unknown. The aim of this study was to examine whether 24HC produces such an immune response using in silico and in vitro experiments. Our results indicate that despite being a structural isomer of 25HC, 24HC binds at site II in a distinct binding mode, engages in varied residue interactions, and produces significant conformational changes in the specificity-determining loop (SDL). In addition, our surface plasmon resonance (SPR) study reveals that 24HC could directly bind to integrin αvß3, with a binding affinity three-fold lower than 25HC. Furthermore, our in vitro studies with macrophages support the involvement of FAK and NFκB signaling pathways in triggering 24HC-mediated production of TNF. Thus, we have identified 24HC as another oxysterol that binds to integrin αvß3 and promotes a proinflammatory response via the integrin-FAK-NFκB pathway.

Membrane Lipids Are an Integral Part of Transmembrane Allosteric Sites in GPCRs: A Case Study of Cannabinoid CB1 Receptor Bound to a Negative Allosteric Modulator, ORG27569, and Analogs.

A growing number of G-protein-coupled receptor (GPCR) structures reveal novel transmembrane lipid-exposed allosteric sites. Ligands must first partition into the surrounding membrane and take lipid paths to these sites. Remarkably, a significant part of the bound ligands appears exposed to the membrane lipids. The experimental structures do not usually account for the surrounding lipids, and their apparent contribution to ligand access and binding is often overlooked and poorly understood. Using classical and enhanced molecular dynamics simulations, we show that membrane lipids are critical in the access and binding of ORG27569 and its analogs at the transmembrane site of cannabinoid CB1 receptor. The observed differences in the binding affinity and cooperativity arise from the functional groups that interact primarily with lipids. Our results demonstrate the significance of incorporating membrane lipids as an integral component of transmembrane sites for accurate characterization, binding-affinity calculations, and lead optimization in drug discovery.

Knowledge and awareness of sickle cell disease: a cross sectional study amongst unmarried adults in Nigeria's capital city.

Sickle cell disease is a genetic disorder characterised by the tendency of haemoglobin to polymerise and deform red blood cells to a sickle or crescent shape; this consequently results in vaso-occlusive condition. A better knowledge and awareness about sickle cell disease amongst the population can help reduce its prevalence. This study aimed at assessing awareness and knowledge of unmarried adults in Nigeria's capital. A cross sectional survey was undertaken amongst unmarried individuals residing in the Federal Capital Territory. Questionnaires were administered to participants using convenience sampling strategy. Data were analysed using Statistical Package for Social Sciences version 25. Descriptive and inferential statistical analyses were carried out. A total of 1423 questionnaires were completed and returned, response rate was 83.71%, male participants were in the majority as indicated by 52% of the sample, and the dominant age group was 21 to 30 years (47.90%). Almost all the study participants (92.50%), have heard about sickle cell disease. Knowledge about sickle cell disease was average, as mean score for all the participants was 9.01 ± 3.18, with a range of 0 to 17. Some misconceptions were observed, for instance some participants believed that bacterial or viral infections could cause sickle cell disease. Male participants had a higher knowledge score compared to females (p < 0.001), and older participants were more knowledgeable about sickle cell disease (p < 0.001). This study identified that knowledge gaps exist about sickle cell disease. Emergent findings can underpin government, policymakers' and stakeholders' contextual strategies to prevent sickle cell through public health enlightenment and other relevant means.

The role of patent waivers and compulsory licensing in facilitating access to COVID-19 vaccines: Findings from a survey among healthcare practitioners in Nigeria.

The roll out of COVID-19 vaccines has again revealed the gap between high income countries and developing nations in terms of access to healthcare commodities and services. With the slow vaccination roll out in many low income countries and the emergence of more contagious variants of COVID-19, many persons are at risk of contracting the disease in settings with low immunisation coverage. This study aimed at exploring the views of healthcare practitioners on the role of patent waivers and compulsory licensing in facilitating access to vaccines. A cross-sectional study was undertaken among practitioners in the health sector, which comprised private, public, and development agencies. A well structured and validated questionnaire was administered to the study participants using both physical and online methods of administration in Nigerian setting. A total of 526 respondents participated in the study, majority of them were males (54.4%). A third of the study participants (31.1%) had postgraduate degrees. A strong majority of the respondents (81.2%) agreed that the role of patent is to promote innovation, whilst 70.6% of them indicated that intellectual property waivers can improve access to COVID-19 vaccines. Slightly above half of the respondents (56.0%) indicated that patent waivers can reduce innovation in the pharmaceutical sector, they however indicated that such challenge can be mitigated by granting incentives to innovators whose intellectual property rights had been waived. This study has revealed that there is a need for intellectual property rights waiver and compulsory licensing of all novel COVID-19 commodities including vaccines, as this is an important strategy that can improve access to relevant products in developing countries.

Attitudes and practices of unmarried adults towards sickle cell disease: emergent factors from a cross sectional study in Nigeria's capital.

INTRODUCTION: Sickle cell disease is a genetic autosomal blood disorder that causes red blood cells to turn rigid and crescent shaped. The condition ultimately results to several complications leading to organ damage. This study aimed at assessing attitudes and practices of unmarried adults towards sickle cell disease. METHODS: A cross sectional study was undertaken in the Nigerian Federal Capital Territory. Data were collected using a well-structured questionnaire. Descriptive and inferential statistics were undertaken. RESULTS: Male and female participants were of a similar proportion as represented by 52% and 48%. The overall mean score for attitude towards sickle disease was 6.60 ± 2.583 (range; 0-11). A higher attitude score was observed among female participants (p = 0.012), older participants reported a better attitude towards sickle cell disease (p < 0.001), and level of education also influenced perception towards the disease (p < 0.001). Three-quarters of the participants (73.4%) supported the need for contextual legislation to prohibit marriage between two sickle cell carriers. More than one-tenth of the sample (14.4%) indicated that they would marry someone with sickle cell disease irrespective of their own genotype. Whilst two-thirds of the study participants (67.1%) indicated that they would prioritise sickle cell screening in their relationships, a third of them (33.3%) expressed a contrary standpoint. CONCLUSION: Findings emanating from this research can guide Government and other critical Stakeholders in developing contextual policies and practices that will reduce the burden of sickle cell disorder.

International training of pharmacists and fitness to practice in Nigeria: Emergent issues and novel insights.

INTRODUCTION: Pharmacy education and practice vary significantly in different parts of the world. Research into higher education has long concentrated on determining standards and defining the quality of teaching. This study aimed at assessing the suitability of foreign trained pharmacy graduates to practice pharmacy in Nigeria. METHODS: Paper-based self-completion questionnaires were administered to participants that registered for a certification programme organised for foreign-trained pharmacy graduates. Descriptive and inferential statistical analyses were undertaking using Statistical Package for Social Sciences version 25. RESULTS: A total of 83 respondents participated in the study. More than half (53.0%) were females and two-thirds (66.3%) of the study participants were aged 21 to 25. A little above one-third (37.3%) of the study participants studied in Asia, and about three-quarters (73%) had a bachelor of pharmacy qualification. Also, approximately one-quarter (23.21%) of the study participants indicated that pharmacovigilance was not included in their respective curricula, and a similar proportion (23.8%) were of the opinion that there were gaps in their respective curricula. Other aspects of pharmacy where respondents lacked knowledge included clinical pharmacy and dispensing. Similarly, some of the study participants indicated that they had little or no training and experience with respect to issues relating to tropical diseases. CONCLUSIONS: This study has provided some insights into gaps that exist in foreign training of pharmacists, especially as it pertains to fitness of purpose to practice in Nigeria. Although further research is indicated, these findings provide emergent evidence which can underpin reforms by relevant regulatory and policy entities.

Healthcare professionals' views on access to vaccines in Nigeria: A cross sectional study.

Vaccines are important public health interventions that are critical in preventing the spread of infectious diseases. Sustainable access to these products is therefore critical in articulating contextual policies and strategies. This study aimed at exploring the views of healthcare professionals regarding perceived challenges and strategies that influence access to vaccines in Nigeria. A cross sectional study was undertaken amongst healthcare practitioners that attended a conference targeted at improving access to vaccines. A questionnaire was used for data collection, and analysis was undertaken using Statistical Package for Social Sciences version 25. Questionnaires were administered to a total of 604 participants, response rate was 87.1%, with male participants (54.4%) being slightly better represented than females (45.6%). A tenth of the participants (10.6%) were educated up to doctorate degree level, and a considerable proportion of the participants (43.6%) worked in the government sector. Slightly above three quarters (78.3%) of the participants were of the view that lack of local production capacity was an obstacle preventing access to vaccines, whilst above two thirds of the respondents (70.5%) were of the opinion that the current funding for research and development towards vaccines was sub-optimal. A total of 70.1% of the sample disagreed that the current policy environment was favourable to development of vaccines, whilst more than half of the participants (56%) perceived a lack of support by philanthropists and relevant foundations, for vaccines development in Nigeria. A majority of the participants (73.7%) indicated that sustainable access to vaccines in Nigeria could be achieved by harnessing local research capacity. This study identified critical challenges limiting access to vaccines in Nigeria and can consequently underpin relevant policy and practice reforms that aim to improve access to this public health tool.

Challenges Associated with Addressing Counterfeit Medicines in Nigeria: An Exploration of Pharmacists' Knowledge, Practices, and Perceptions.

Introduction: Counterfeit medicines are substandard pharmaceutical products that are produced and sold with the intent to deceptively represent their authenticity, origin, or effectiveness. The risk of the existence of such products in healthcare provision remains a significant threat to public health. Pharmacists represent the most critical stakeholders in the supply, manufacture, purchase, and dispensing of pharmaceutical products, and as such can play critical roles in detecting and reducing the circulation of fake medicines. This study aimed to assess the knowledge and practices of pharmacists in Nigeria in relation to counterfeit medicines as well as the challenges associated with preventing and mitigating this menace in the country. Methods: A cross-sectional study was undertaken to administer questionnaires to pharmacists across various sectors of practice in Nigeria. Data were analysed using Statistical Package for Social Sciences. Results: A total of 390 valid responses were received. The respondents indicated that online drug commerce (72.68%), inadequate inspection (90.93%), inadequate legislation (88.83%), poor collaboration (89.94%), and poor cross-border enforcement (90.43%) were primary challenges to the mitigation of fake medicines circulation in the country. Whilst pharmacists were knowledgeable about counterfeit drugs, gaps were observed in their practices towards detection of these products, as about one-third (30.7%) of the sample indicated that their current knowledge and skills were inadequate to detect counterfeit medicines. Age, years of practice, and area of practice significantly influenced the abilities of the participants to detect counterfeit medicines. Conclusion: Evidence from the study revealed that pharmacists had good knowledge of medicine counterfeiting in Nigeria. However, factors such as poor collaboration among regulatory agencies, inadequate inspection and legislation on the regulation of the pharmaceutical sector and online sales of medicines have contributed to the circulation of counterfeit medicines, and this has in turn affected healthcare services in the country.

Understanding the Nature and Sources of Conflict Among Healthcare Professionals in Nigeria: A Qualitative Study.

Introduction: Inter-professional conflict in the Nigerian health sector is a concept that is as old as modern medical practice and has resulted in disruption of health care delivery, with the overall impact bearing down on patients. Purpose: This study aimed to provide an in-depth understanding and a clearer insight into the causes of conflict in the Nigerian health sector. Methods: A qualitative strategy was employed using a semi-structured interview approach. Data were obtained from health practitioners from diverse backgrounds in various healthcare facilities. Results: The phenomenon of conflict was reported as a long existent and trans-generational strain on inter-professional relationships occurring in all sectors of health practice, primarily between the physicians and other health care professionals. Inter-professional conflict was reported to emanate primarily from lapses in leadership, remuneration structure, role description, communication and emotional intelligence. This has affected the effectiveness of the Nigerian healthcare system and has contributed to hindrance in the provision of high-quality care in the country. Conclusion: Evidence from this study can help in developing contextual policy in addressing inter-professional conflict in the health sector, and this will consequently improve health care delivery in the country.