Cardiovascular risk screening: a 10-year prediction cross-sectional study in a Nigerian agrarian community.

Introduction: cardiovascular disease (CVD) is a major public health issue with a high global death rate and a significant death contribution from low-and middle-income countries. Modifiable and non-modifiable risk factors assessment and screening are important in their effective prevention and control. This study was designed to screen and assess cardiovascular risk factors in an agrarian community in Nigeria and to predict their 10-year CVD risk. Methods: this was a cross-sectional study carried out in the Umueri community in Anambra State, Nigeria. Each participant responded to an epidemiologic survey using the World Health Organization (WHO) cardiovascular risk factors assessment tool with point-of-care screening procedures. The risk assessment for 10-year CV risk was conducted using region-specific WHO/ISH charts. Patients´ characteristics were analyzed and presented in frequencies and percentages. Results: the mean age, systolic blood pressure, fasting plasma glucose, and total cholesterol of the study population were 54 years ± 1.27, 132 mmHg ± 2.088, 130 mg/dl ± 4.608, and 215 mg/dl ± 10.355 respectively. However, 98 (48.8%) have never had their blood pressure checked. About a quarter of the population had a high predicted risk of developing CVD within 10 years. Conclusion: most of the assessed cardiovascular risk factors in the community are on average above the normal ranges and their probability risk of developing CVD within the next 10 years is high.

Telepharmacy Services in a Developing Country: Nigerian Community Pharmacists' and Patients' Perspectives on the Clinical Benefits, Cost, and Challenges.

Background: Telepharmacy as part of telehealth is an emerging concept in most developing countries with the need to understand the stakeholders' knowledge and acceptability of this concept, including patients' willingness to pay (WTP) for this service, which is critical for its successful implementation. Objective: This study aims to assess pharmacists' knowledge, attitude, perception, extent of practice, and perceived barriers to the practice of telepharmacy in Nigeria, as well as assess patients' acceptability and WTP for this service. Methods: A descriptive cross-sectional survey was carried out among 118 community pharmacists and 403 patients in Anambra State, Nigeria, using a well-structured and validated questionnaire. Collected data were descriptively and inferentially analyzed using SPSS version 23.0. Result: The surveyed community pharmacists had moderate knowledge of the telepharmacy concept (78.8%), with mean attitudinal, perception, and extent of practice scores of 74.2 ± 23.5%, 62.0 ± 22.8%, and 52.4 ± 21.4%, respectively. Lack of monetary motivation (73.7%), lack of software (56.8%), and operational difficulties (49.3%) were considered major barriers to its implementation. Over two-thirds of the participating patients (70.1%) considered the service very acceptable with 61.2% of the respondents willing to pay an average of US$ 2.76 ± 2.12 monthly for the services. Conclusion: Although community pharmacists in Anambra state, Nigeria showed a moderate knowledge of telepharmacy with a poor extent of the practice, they expressed a positive outlook on the concept. The study also revealed good acceptability of the concept by patients who were also willing to pay a moderately acceptable amount for the services.

Willingness-to-pay for a population-based-prostate-specific antigen screening for prostate cancer in Anambra State, Southeast, Nigeria: a contingent valuation study.

Background: Early diagnosis of cancer precursors improves treatment outcomes. Organized screening for prostate cancer is still uncommon in Nigeria, and if it is added to the national health budget, it may necessitate additional co-financing alternatives. Objectives: The study aims to evaluate the maximum willingness- to- pay amount and acceptability of a Population-based screening for prostate cancer among a group of Nigerian men. Methods: The study was a cross-sectional survey-based study conducted among men drawn from different districts of the state. The payment card elicitation format was used to estimate the average maximum WTP amount. Multivariate Logistic regression was used to evaluate the correlates of WTP. Result: A total of 439(81.9%) participants were willing to pay for the screening while only 97(18.1%) of the participants rejected the screening. The average WTP amount was US$6.01(mean ± median ± SD 6.01±4.12±5.75). Residence and knowledge of the disease were the major predictors. Conclusion: The findings showed that men in Anambra state Nigerian were willing to pay an average of US$6.01 for the Population-based screening. Even though the stated WTP amount seems low compared to the conventional cost of opportunistic screening (between USD 21), the majority of the participants 439(81.9%) willing to pay for the screening should be capitalized upon in finding alternative financing options for the program.

Evaluation of the hepatic effect of concomitant administration of ciprofloxacin and some antimalarial drugs in Plasmodium berghei infected mice: An in vivo study.

This study evaluated the hepatotoxic effects of artesunate (AS), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) co-administration with ciprofloxacin (CIP) using animal model. Chloroquine sensitive Plasmodium berghei NK65 strain infected albino mice (120) were utilized for this study, carried out in three phases. Phase 1 comprised eleven groups treated with different doses of either AS, AL, ASAQ or CIP alone. Phase 2 consisted of nine groups treated with 7mg/kg of CIP combined with different doses of AS, AL, ASAQ. Phase 3 comprised ten groups treated with 14mg/kg of CIP (CIP2) with different doses of AS, AL, ASAQ. Seventy-two hours after administration of drugs, toxicity was determined by evaluating the effect of drugs on liver enzymes using spectrophotometer. Statistical analysis revealed that CIP alone significantly (P<0.05) reduced the levels of Aspartate Transaminase (AST) and Serum Alanine Transaminase (ALT) compared to AS, AL and ASAQ alone. Combination of different doses of AS, AL and ASAQ with 7mg/kg CIP significantly increased the level of AST and ALT while combination of AS, AL and ASAQ with 14mg/kg CIP significantly decreased AST and ALT levels. Care should be taken during the co-administration of low dose ciprofloxacin with artesunate, artemether-lumefantrine or artesunate-amodiaquine.

Evaluation of Health Status of Type 2 Diabetes Outpatients Receiving Care in a Tertiary Hospital in Nigeria.

OBJECTIVES: The aim of this study was to determine the health status of type 2 diabetes patients in a Nigerian tertiary hospital, and examine the sociodemographic and clinical variables that predicted the health status of type 2 diabetes patients in terms of utility valuations and EuroQol Visual Analogue Scale (EQ-VAS) score. METHODS: This was a cross-sectional study of 147 diabetes patients attending the University of Nigeria Teaching Hospital, Enugu State, Nigeria. The EQ-5D-5L instrument, version 2.1, was used to evaluate patients' self-reported health status, and patients who gave informed consent completed the questionnaire while waiting to see a doctor. Descriptive and multiple linear regression analyses were performed using SPSS version 20. RESULTS: Overall, 147 patients participated in this study, with a mean age (± standard deviation) of 56.7 years (± 10.33). Over half of the respondents were females (55.1%) and more than half were older than 60 years of age. The mean EQ-VAS and utility valuations of respondents were 72.59 ± 10.51 and 0.72 ± 0.13, respectively. The age of respondents independently and significantly predicted EQ-VAS by -2.659 per year, while the age of respondents, level of education, duration of diabetes, and presence of other illnesses independently and significantly predicted utility valuations by -0.020 per year, +0.029 per level of education, -0.008 per year, and -0.044 per illness, respectively. Less than 39% of patients experienced no problems for each of the dimensions, except self-care (68%). CONCLUSION: The results of this study revealed a relatively low health status among type 2 diabetic patients in Nigeria. Old age, duration of diabetes and the presence of other illnesses were major contributors to the negative impact on health status, while a higher level of education contributed positively to health status. Adequate family support, as well as regular and effective patient counseling and education, may be worthwhile.

Upregulation of CD4+ T-Lymphocytes by Isomeric Mixture of Quercetin-3-O-Rutinoside and Quercetin-3-O-Robinobioside Isolated from Millettia aboensis.

BACKGROUND: Millettia aboensis (Hook. F.) Baker (Fabaceae) is popular in ethnomedicine for its acclaimed efficacy in a number of disease conditions. This study evaluated the immunomodulatory effect of the leaf extract as a possible mechanism of its ethnomedicinal uses. METHODS: Humoral and cellular immune responses of Balb/c mice to tetanus toxoid and cyclophosphamide, respectively, were used to monitor immunomodulatory activities of the ethanol leaf extract and fractions of M. aboensis at 200, 300 and 400 mg/kg. Active (butanol) fraction of the extract was subjected to chromatographic purifications to isolate the active compound and the structure elucidated by a combination of 1D and 2D NMR and mass spectrometry. Stimulation of specific T-lymphocytes using intracellular cytokine staining technique was used to evaluate immune-enhancing activity of the isolated compound. RESULTS: The extract and fractions evoked increase in both humoral and cellular immunity. At 400 mg/kg of butanol fraction, the normalized mean secondary production of IgG1 and IgG2a antibodies were 9.0 and 7.7, respectively. Serum cytokine production by butanol fraction following secondary challenge with tetanus toxoid showed that IL-12, IL-17A and IFN-γ were expressed by 48.14, 41.37 and 38.22%, respectively. Structural elucidation of the active compound revealed presence of isomeric mixtures of quercetin-3-O-rutinoside and quercetin-3-O-robinobioside (Compound 1a/b). Compound 1a/b exhibited in vitro upregulation of specific CD4+ T-lymphocytes that were largely IFNγ releasing with up to 43.7% stimulation at 6.25 µg/mL compared to the baseline effect in DMSO vehicle control group. CONCLUSION: M. aboensis expressed strong immune-enhancing properties, which may explain its ethnopharmacological use in disease management.

Expanding HIV/AIDS care service sites: a cross sectional survey of community pharmacists' views in South-East, Nigeria.

BACKGROUND: Community pharmacists are very accessible to most patients yet; they have been underutilized in the aspect of providing HIV care and services. The World Health Organisation recently recommended expanding community pharmacists' roles to address the increasing complexity of antiretroviral agents and co-infection drug regimen. This study therefore was designed to assess the readiness and willingness of community pharmacists in Nigeria to participate in the care of people living with HIV/AIDS and the possible inclusion of their pharmacy premises as sites for HIV care services. METHODS: A descriptive cross sectional survey was carried out among 205 community pharmacists in south east, Nigeria between October, 2016 and February, 2017. Two hundred and five self-administered questionnaires were distributed to conveniently selected community pharmacists in the region. Data collected were analysed using SPSS version 23. Descriptive statistics was conducted for the demographics and percentage mean scores for each domain were computed. The variables in each domain were categorised into groups and simple percentages were used to show the percentage distribution of the variables. Cross tabulation was also carried out to show the relationship between the variables and groups' differences were explored using analysis of variance and P-values <0.05 were considered significant. RESULTS: All distributed questionnaires were filled and retrieved. The overall knowledge of HIV among the surveyed pharmacists was seen to be high (70.41%). Although the percentage attitude score of the respondents towards HIV care services was on the average (57%), they were highly willing and ready to use their premise to offer HIV services with a percentage mean readiness score of 87.32%. However, their perceived skills in carrying out these services were observed to be low. CONCLUSION: Community pharmacists in the south eastern part of Nigeria have high knowledge of HIV and a somewhat attitude towards HIV care services with high willingness and readiness to be involved in HIV care and services. Despite efforts to engage community pharmacists in HIV services more is needed in the aspect of making adequate policies to further empower more community pharmacists in this aspect of care.

Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists.

BACKGROUND: In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists. METHODS: The study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers' willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider's perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective. RESULTS: A total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum-maximum] was US$1.23 [US$0.0-US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from 'never' to 'rarely') led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum-maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13-US$0.17] and US$0.41 [US$0.18-US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4-7.0). CONCLUSION: Test-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists' interest and uptake of test-based malaria treatment.

Knowledge and Implementation of Tertiary Institutions' Social Health Insurance Programme (TISHIP) in Nigeria: a case study of Nnamdi Azikiwe University, Awka.

INTRODUCTION: Tertiary Institutions' Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students' knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students' knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre. METHODS: Using a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software. RESULTS: Whereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3%) have never benefited from the scheme with 52.8% showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9%) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation. CONCLUSION: The study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme.

Mothers' willingness to pay for HPV vaccines in Anambra state, Nigeria: a cross sectional contingent valuation study.

BACKGROUND: Human papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers' willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG). METHODS: We conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9-12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting. RESULTS: A total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection. CONCLUSION: Demand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.

Herb drug interaction: effect of Manix® on pharmacokinetic parameters of pefloxacin in rat model.

OBJECTIVE: To evaluate the effect of Manix®, the commonly used polyherbal formulation on pefloxacin pharmacokinetic parameters. METHODS: Microbiological assay was employed using clinical isolate of Escherichia coli samples from hospitalized patients. RESULTS: Manix® altered the bioavailability parameters of pefloxacin as thus, maximal concentration (Cmax) of pefloxacin (0.91±0.31) µg/mL occurred at time to reach maximal concentration (tmax) 4.0 h while in the group that received Manix® alongside pefloxacin Cmax was (0.22±0.08) µg/mL at tmax 1.0 h respectively. The area under curve of pefloxacin alone was (7.83±5.14) µg/h/mL while with Manix® was (2.60±0.08) µg/h/mL. There was a significant difference between Cmax, tmax and area under curve between pefloxacin alone and pefloxacin after Manix® pre-treatment (P<0.05). CONCLUSIONS: The concurrent use of Manix® and pefloxacin has been found to compromise the therapeutic effectiveness of pefloxacin which could lead to poor clinical outcomes in patients.