Outcome of cardiovascular risk assessment among rural community dwellers in ezionum, Nigeria-implications for public health.

BACKGROUND: Cardiovascular disease is a major cause of mortality worldwide. Risk assessment has been shown to reduce cardiovascular morbidity and mortality. In view of their proximity and accessibility, community pharmacies could be a suitable site for cardiovascular risk assessment and other preventive health activities especially in rural underserved populations. The objective of this study was to assess outcome of cardiovascular risk assessment among rural community dwellers. MATERIALS AND METHODS: Five hundred and five community dwellers aged 40 to 80 years were recruited for the study. Cardiovascular risk assessment was performed using the region specific WHO/ISH risk assessment charts. Blood pressure, diabetes status, total non- fasting cholesterol, and age were used to estimate risk category. Demographic variables and clinical characteristics were expressed as frequency and percentage. Regression analysis was done to identify predictors of high risk category. RESULTS: More than 30% of subjects were hypertensive. Nearly 30% were overweight and had abnormal cholesterol levels. The proportion of subjects in the high risk category was 8.9%. Systolic blood pressure, random blood sugar and advancing age were the highest predictors of high risk category. CONCLUSION: Accessibility, proximity and availability are unique characteristics of community pharmacies that could be exploited to support community based screening services.

Limitations to the dynamics of pharmaceutical care practice among community pharmacists in Enugu urban, southeast Nigeria.

BACKGROUND: The introduction of pharmaceutical care in Nigeria has been faced with many challenges in addition to limited information regarding the practice. OBJECTIVE: This study aimed to determine the barriers encountered by community pharmacists in Nigeria in the provision of pharmaceutical care. METHODS: A cross-sectional descriptive survey was carried out in Enugu urban, southeast Nigeria. Data were collected using pretested and structured 5-point Likert scale questionnaires that were self-administered to the respondents. Data were analyzed using descriptive statistics. RESULTS: The 78 community pharmacists comprised 62 males and 16 females. Out of the 78 respondents, 69 (88.5%) had the basic Bachelor of Pharmacy degree while three (3.9%) had Fellowship, Master's, and Doctor of Pharmacy degrees respectively. The mean number of years of practice was 8.2 (±0.6). The key limitations to the implementation of pharmaceutical care were: pharmacists' attitude and lack of pharmaceutical care skills, as well as resource and system-related constraints. Others challenges were interprofessional and academic obstacles like lack of collaboration (66.6%) and lack of role models (42.1%). Most of the respondents (81%) were strongly willing to adopt and implement pharmaceutical care, while 19.2% were not strongly willing to practice pharmaceutical care. CONCLUSION: Despite limitations to practice, community pharmacists in the area are very inclined to implement pharmaceutical care in the private sector to improve patients' quality of life.

A Systematic Review of Community Pharmacists' Interventions in Reducing Major Risk Factors for Cardiovascular Disease.

OBJECTIVES: To conduct a systematic literature review and assess the effectiveness of community pharmacists' interventions in reducing major risk factors for cardiovascular diseases. METHODS: A comprehensive literature search from 2000 onwards was performed using MEDLINE (1946 to June 4, 2013), EMBASE (1947 to present), CINAHL, and Cochrane Library. The gray literature was also searched. Studies were classified as diabetes, hypertension, dyslipidemia, and tobacco dependence. Data abstracted from the articles included study design/participants, study duration, key components of intervention, primary outcome, and key findings. Study quality was assessed using a checklist appropriate to the study design. RESULTS: A total of 1020 citations were initially identified, with 27 meeting inclusion criteria. Eight studies were randomized controlled trials, five were cluster randomized trials, two were randomized before-after design studies, five were nonrandomized controlled before-after design studies, and seven were uncontrolled before-after design studies. Interventions focused on diabetes (n = 8), hypertension (n = 9), dyslipidemia (n = 7), and tobacco dependence (n = 3). Effect sizes ranged from 7.8 to 17.7 mm Hg and from 0.2% to 2.2% reductions in systolic blood pressure and hemoglobin A1c, respectively, while reductions in total cholesterol ranged from 18.2 to 27.1 mg/dl. Study quality was generally poor. CONCLUSIONS: Available evidence suggests a potential for substantial benefit in diabetes and hypertension but clinical benefits in lipid management remain unclear. The true effect of interventions is uncertain due to poor study quality, inconsistent results, and potential for publication bias. Further well-designed studies are needed to determine the true impact of community pharmacists' interventions in reducing major risk factors for cardiovascular disease.

Adverse drug reactions to antiretroviral therapy: Results from spontaneous reporting system in Nigeria.

AIM: This study evaluated the suspected adverse drug reactions (ADR) reported from a spontaneous reporting program in Human Immunodeficiency Virus (HIV) positive patients receiving antiretroviral therapy (ART) in Nigeria. MATERIALS AND METHODS: This descriptive study analyzed individual case safety reports (ICSRs) in HIV-positive patients receiving ART between January 2011 and December 2011 in 38 secondary hospitals. All ICSRs during this period were included. Chi-square was used to test the association between variables at 95% confidence interval. RESULTS: From 1237 ICSRs collated, only 1119 (90.5%) were valid for analysis. Mean age of patients was 35.3 (95%CI, 35.1-35.5) years; and 67.1% were females. A total of 1679 ADR cases were reported, a mean (± Standard Deviation, SD) of 1.5 (± 0.8) ADR cases per patient. Of reported ADRs, 63.2%, 8.2% and 19.3% occurred in patients on Zidovudine-based, Stavudine-based and Tenofovir-based regimens, respectively. The commonest ADRs included (12.0%) peripheral neuropathy, (11.4%) skin rash, (10.1%) pruritus and (6.5%) dizziness. ADR occurrence was associated with ART regimens, concomitant medicines and age (P < 0.05) unlike gender. Anaemia was associated with Zidovudine (AZT)/ Lamivudine (3TC) /Nevirapine (NEV) regimen [Odds ratio, OR = 6.4 (3.0-13.8); P < 0.0001], and peripheral neuropathy with Stavudine (d4T)/3TC/NEV regimen [OR = 8.7 (5.8-30.0), P < 0.0001] and Tenofovir (TDF)/Emtricitabine (FTC)/Efavirenz (EFV) regimen [OR = 2.1 (1.0-4.1), P = 0.0446]. Skin rash and peripheral neuropathy were associated with patients aged < 15years [OR = 3.0 (1.3-6.6), P = 0.0056] and 45-59years [OR = 1.9 (1.3-2.7), P = 0.0006] respectively. Palpitation and polyuria were associated with Salbutamol [OR = 55.7 (4.9-349.6), P = 0.0000] and Nonsteroidal anti-inflammatory drugs (NSAIDS) [OR = 50.2 (0.9-562.1), P = 0.0040] respectively. CONCLUSION: ADRs were less likely to occur in patients on stavudine-based and tenofovir-based regimens compared to zidovudine-based regimens. Peripheral neuropathy was also found to be associated with tenofovir-based regimen. This may require further studies and evaluation.

Patient-Reported Quality of Life During Antiretroviral Therapy in a Nigerian Hospital.

OBJECTIVES: We assessed the reported quality of life of patients with HIV/AIDS and explored the impact of patients' sociodemographic profile on the quality-of-life domains. METHODS: Consenting outpatients who met criteria were consecutively selected in a secondary health care facility in Benin City, Nigeria. Quality of life was determined in the nine domains of HIV/AIDS Targeted Quality of Life (HAT-QOL) instrument. Quality-of-life scores were computed on the scale of 0 to 100 and triangulated with a rated interval scale of 1 to 5 suited for quantitative analysis. Association between rated scores and each domain was explored by using Students' t test and analysis of variance at 95% confidence interval. RESULTS: Out of the 403 patients, 82.1% were females; 147 (36.1%) belonged to the modal age group of 20 to 30 years; the mean age for grouped data was 39.2 years. About 239 (58.7%) were not married. Also, 338 (83.0%) earned below $1500 per annum and 303 (74.40%) had basic education (grade 1 to grade 9). HAT-QOL scores indicated the following: overall function (89.96 ± 5.62); life satisfaction (91.94 ± 3.62); health worries (87.06 ± 4.28); financial worries (81.00 ± 3.95); medication worries (91.65 ± 4.47); HIV mastery (71.00 ± 3.11); disclosure worries (27.50 ± 7.57); provider trust (91.63 ± 1.96); and sexual function (70.25 ± 3.51). Likert-type rated scores were in agreement with HAT-QOL scores. Provider trust was associated with gender, employment status, and educational level. Sexual function was associated with gender and age (P < 0.05). CONCLUSIONS: Patients reported satisfactory quality of life in the domains of overall function, life satisfaction, health worries, financial worries, medication worries, HIV mastery, provider trust, and sexual function. Quality of life was low in the domain of disclosure worries, indicating concerns for discrimination and stigmatization. Age, level of education, and employment status had a strong impact on the quality of life of patients with HIV/AIDs.

Patient-reported outcomes of therapy with two brands of ibuprofen

Objective: To investigate patients’ reported outcome following medication with two brands of 400 mg ibuprofen used to alleviate musculoskeletal pains. Methods: Adult peasant manual laborers (85) who met criteria were randomly assigned to receive either of the brands (A or B). Data on pain alleviation were gathered using the Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analogue Scale (VAS), Present Pain Intensity (PPI), and Clinical Global Impression of Improvement (CGII) scales. Interval data obtained from the two brands were compared using the Students’ t-test at 95% confidence interval. Results: There were 42 participants, mean age=29.2 (SD=1.37) assigned to brand A and 43 (mean age=28.8 SD=1.14) in brand B of ibuprofen 400 mg. Brand B was consistently rated higher than brand A. Scores for medication efficacy were 10.4 (SD=1.65) (brand A) and 11.4 (SD=1.68) (brand B); t=2.768, P=0.007. Alleviation of pain symptoms: 10.8 (SD=1.64) and 11.6 (SD=1.72); t = 2.194, P=0.031. Similarly, rated scores on the impact of pain on quality of life were 10.5 (SD=2.00) and 12.1 (SD=1.85); t=3.830, P<0.001. There was a reduction in Present Pain Intensity scores by 32.7% and 34.3% for Brand A and brand B participants respectively. The decrease in Visual Analog pain scale score was 35.9% and 37.3% for brand A and brand B participants respectively. The decrease in SF-MPQ was by 85.1% and 69.9% for the brand A and brand B groups respectively. The clinical global impression of improvement for both groups of patients indicated an improvement rate of 71.4% and 61.9% for brand A and 81.4% and 74.4% for brand B participants. Conclusion: This clinical study infers that though the two brands of ibuprofen 400 mg are legally pharmaceutical equivalent, they are not clinically equivalent. In most of the parameters evaluated, brand B was rated more efficacious than brand A. This explains the patients’ preferences and demand for this brand of ibuprofen in the Nigerian community (AU)

Objetivo: Investigar los resultados comunicados por los pacientes después de la medicación con dos marcas de 400 mg de ibuprofeno usados para aliviar dolor musculo-esquelético. Métodos: Se asignó aleatoriamente a adultos trabajadores manuales del campo para recibir una de dos marcas (A o B). Se recogieron datos del alivio del dolor usando las escalas Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analogue Scale (VAS), Present Pain Intensity (PPI), and Clinical Global Impression of Improvement (CGII). Los datos obtenidos con las dos marcas se compararon usando es test t de Student en un intervalo de confianza del 95%. Resultados: Hubo 42 participantes de edad media=29,2 (DE=1,37) asignados a la marca A y 43 (edad media=28,8 DE=1,14) a la marca B de ibuprofeno 400 mg. La marca B fue evaluada consistentemente más alto que la A. Las puntuaciones de eficacia fueron 10,4 (DE=1,65) marca A y 11,4 (DE=1,68) marca B; t=2,768, P=0,007. El alivio del dolor: 10,8 (DE=1,64) and 11,6 (DE=1,72); t = 2,194, P=0,031. Del mismo modo, las puntuaciones del impacto del dolor en la calidad de vida fueron 10.5 (DE=2,00) y 12.1 (DE=1,85); t=3,830, P<0,001. Hubo una reducción en las puntuaciones en el Present Pain Intensity del 32,7% y 34,3% para los participantes de las marcas A y B respectivamente. La disminución en la Escala Visual Analógica del dolor fue del 39,5% y 37,7% para las marcas A y B respectivamente. La disminución en el SF-MPQ fue del 85,1% y 69,9% para las marcas A y B respectivamente. La impresión clínica global de mejoría para ambos grupos de pacientes indicó una tasa de mejoría de 71,4% y 61,9% para la marca A y de 81,4% y 74,4% para la marca B. Conclusión: Este estudio clínico infiere que las dos marcas de ibuprofeno 400 mg son legalmente equivalentes farmacéuticas, y que no son clínicamente equivalentes. En la mayoría de los parámetros evaluados, la marca B fue valorada más eficaz que la marca A. Esto explica las preferencias de los pacientes y la solicitud de esta marca de ibuprofeno en la comunidad nigeriana (AU)

Patient-reported outcomes of therapy with two brands of ibuprofen.

OBJECTIVE: To investigate patients' reported outcome following medication with two brands of 400 mg ibuprofen used to alleviate musculoskeletal pains. METHODS: Adult peasant manual laborers (85) who met criteria were randomly assigned to receive either of the brands (A or B). Data on pain alleviation were gathered using the Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analogue Scale (VAS), Present Pain Intensity (PPI), and Clinical Global Impression of Improvement (CGII) scales. Interval data obtained from the two brands were compared using the Students' t-test at 95% confidence interval. RESULTS: There were 42 participants, mean age=29.2 (SD=1.37) assigned to brand A and 43 (mean age=28.8 SD=1.14) in brand B of ibuprofen 400 mg. Brand B was consistently rated higher than brand A. Scores for medication efficacy were 10.4 (SD=1.65) (brand A) and 11.4 (SD=1.68) (brand B); t=2.768, P=0.007. Alleviation of pain symptoms: 10.8 (SD=1.64) and 11.6 (SD=1.72); t = 2.194, P=0.031. Similarly, rated scores on the impact of pain on quality of life were 10.5 (SD=2.00) and 12.1 (SD=1.85); t=3.830, P<0.001. There was a reduction in Present Pain Intensity scores by 32.7% and 34.3% for Brand A and brand B participants respectively. The decrease in Visual Analog pain scale score was 35.9% and 37.3% for brand A and brand B participants respectively. The decrease in SF-MPQ was by 85.1% and 69.9% for the brand A and brand B groups respectively. The clinical global impression of improvement for both groups of patients indicated an improvement rate of 71.4% and 61.9% for brand A and 81.4% and 74.4% for brand B participants. CONCLUSION: This clinical study infers that though the two brands of ibuprofen 400 mg are legally pharmaceutical equivalent, they are not clinically equivalent. In most of the parameters evaluated, brand B was rated more efficacious than brand A. This explains the patients' preferences and demand for this brand of ibuprofen in the Nigerian community.

Assessment of prescription profile of pregnant women visiting antenatal clinics

Managing medical complications in pregnancy is a challenge to clinicians. Objectives: This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. Methods: Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. Results: A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. Conclusion: The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent anti-malarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low (AU)

Manejar las complicaciones médicas en el embarazo es un reto para los clínicos. Objetivos: Este estudio delineó algunos patrones de enfermedades y prescripciones en embarazadas que visitan una clínica prenatal en Nigeria. Se determinó una clasificación de riesgo de los medicamentos. Métodos: Se investigaron los historiales médicos de 1200 mujeres embarazadas que visitaron las clínicas de preparto de tres centros en la ciudad de Benin , Nigeria. Los patrones de enfermedades se determinaron desde sus diagnósticos. Los patrones de prescripción se evaluaron utilizando los indicadores del a OMS y la clasificación de medicamentos de la Food and Drug Administration de Estados Unidos según el riesgo para el feto. Resultados: Durante el periodo de revisión, se evaluaron 1897 prescripciones de las 1200 mujeres embarazadas que visitaron. Los resultados indicaron que la malaria con 554 (38%) fue la enfermedad más prevalente, seguida de las infecciones respiratorias altas (IRA) con 13% y enfermedades gastrointestinales (GI) con 12%. La media de medicamentos prescritos por visita fue de 3,0 y 2434 (43%) fueron prescritas en genéricos. Minerales/vitaminas, con 2396 (42%) fueron los medicamentos mas prescritos, y los antibióticos aparecieron en 502 (8,8%). De todos los medicamentos prescritos, 984 (17%) se incluían en la categoría de riesgo fetal C y 286 (5%) en la categoría D. Conclusión: Este estudio concluyó que entre las mujeres embarazadas, la malaria era la enfermedad más frecuente, seguida de las IRA y las GI. Los minerales y vitaminas seguidos el os antibióticos encabezaron l alista de medicamentos prescritos. La media de medicamentos por visita fue mucho mayor que los estándares recomendados por la OMS. La aparición de medicamentos contraindicados era baja (AU)

Assessment of prescription profile of pregnant women visiting antenatal clinics.

UNLABELLED: Managing medical complications in pregnancy is a challenge to clinicians. OBJECTIVES: This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. METHODS: Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. RESULTS: A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. CONCLUSION: The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent antimalarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.

Consumer satisfaction with community pharmacies in Warri, Nigeria.

BACKGROUND: Consumer satisfaction is likely to affect the image of the pharmacist and pharmacy profession. Efforts should not only be made to track consumer satisfaction with pharmacy services but also to improve it where needed. OBJECTIVE: To investigate consumer satisfaction with community pharmacies in a Nigerian city. METHODS: A cross-sectional survey of a consecutive sample of 700 pharmacy consumers at 35 randomly selected community pharmacies was conducted. Data were gathered on consumer demographics and their satisfaction with the community pharmacies using a 32-item rated instrument that combined pharmaceutical care and traditional pharmacy items. Descriptive statistics was computed on sample characteristics and the questionnaire items. Inferential statistics used Student's t test and one-way ANOVA. RESULTS: The response rate for the survey was 71.9% (503/700). Cronbach's alpha test of reliability was computed to be 0.980. Of the respondents, 298 (59.2%), 284 (56.5%), and 101 (20.1%) rated their satisfaction as excellent regarding availability of genuine drugs, the pharmacist, and household consumer goods, respectively. The mean total score for pharmaceutical care items was found to be 3.50+/-1.32, while the mean total score for traditional pharmacy items was computed to be 3.56+/-1.34 (midpoint=3, range=1 to 5). Consumers' income status was associated with their satisfaction, with the lower income earners experiencing higher satisfaction (F=2.668, P=.050). CONCLUSION: Consumers in this survey experienced moderate service satisfaction with their community pharmacy encounters. The consumers were most satisfied with the pharmacists' professional attitude but dissatisfied with the provision of nondrug services in the community pharmacy. These services are mainly health promotion activities that are advocated under pharmaceutical care philosophy. There is an opportunity for the community pharmacies to introduce new services and enhance their consumer loyalty.

Attitudes of Nigerian pharmacists towards pharmaceutical care.

OBJECTIVE: To explore Nigerian pharmacists' attitudes towards pharmaceutical care, and determine significant attitudinal differences in different practice settings. METHOD: A 25-item self-completion pre-tested and validated questionnaire was administered to a convenience sample of 1500 pharmacists in Nigeria. Data were gathered on a Likert-type rating scale. Descriptive statistics including frequencies and mean scores, and significant attitudinal differences on sample characteristics were computed. MAIN OUTCOME MEASURE: Pharmacists' opinions on multi-item pharmaceutical care attitudinal scale. RESULT: The national survey achieved 67% response rate. About three-quarters (76%, n = 1005) of the respondents indicated willingness to embrace pharmaceutical care. Nearly all the pharmacists (96%) believed pharmaceutical care would enhance patients' appreciation of the pharmacist and 84% reported their intention to practice pharmaceutical care even if there is no additional income. An overwhelming 93% said that they would participate in any training program to enable them to practice pharmaceutical care, while less than a quarter (20%) claimed their pharmacy layout was suited for patient-centered practice. Three quarters (75%) of the respondents indicated positive attitude towards pharmaceutical care. Both male and female genders, all age groups, different levels of professional experience, and pharmacists in hospital, community, industrial and administrative practice settings had similar positive attitude scores. Only pharmacists' professional experience appeared to have a significant influence on attitude scores (F = 5.267; P = 0.001), with scores varying with the level of professional experience. CONCLUSION: The study has shown that the attitudes of Nigerian pharmacists towards pharmaceutical care are favorably high irrespective of the practice settings. The attitude ratings vary with the levels of professional experience, with pharmacists having less experience showing more positive attitude. Nigerian pharmacists indicated willingness to implement pharmaceutical care but expressed major concerns about their knowledge, professional skills, and pharmacy layout. Gradual introduction of pharmaceutical care would be logical.