Cost-effectiveness of dolutegravir vs. efavirenz-based combined antiretroviral therapies in HIV-infected treatment-naive patients in a Nigerian treatment centre.

Background: Dolutegravir (DTG) based antiretroviral therapy (ART) has largely replaced Efavirenz (EFV) based therapy as the preferred first-line regimen in the treatment of adults with HIV. This study was carried out to evaluate the comparative cost-effectiveness of DTG and EFV-based ART in HIV-infected treatment-naïve patients in a treatment centre in Nigeria. Methods: This was a retrospective case-control study of patients initiated on DTG vs. EFV-based regimens from January 2018 to December 2019 at the APIN/HAVARD clinic of Nigeria's Jos University Teaching Hospital. The current viral load result was used to determine treatment effectiveness using a benchmark of ≤200 copies/mL. Sensitivity analysis was carried out to ensure the robustness of the benchmark. The total cost of treatment was obtained by summing up the relevant cost components. Appropriate descriptive and inferential statistics were employed in data analysis using Statistical Product and Services Solutions (SPSS) V.25. The incremental cost-effectiveness ratio of DTG compared to EFV was presented as cost/effectiveness. Results: Treatment was effective in 42(51.9%) and 58(71.6%) patients initiated on DTG and EFV-based regimen, respectively. The incremental cost-effective ratio (ICER) of patients on DTG compared to those on EFV was $10.5076 per effectiveness, which was less than 1% of the Nigerian 2019 per capita Gross Domestic Product. Sensitivity analysis showed the robustness of the result. Conclusion: Efavirenz based regimen had higher treatment effectiveness than DTG-based regimen in treatment-naive patients after initiating treatment in a short term. Compared to EFV, DTG-based regimen is cost-effective in the management of treatment naïve HIV patients.

Risk and protective factors associated with depression in young people: what do Nigerian university students know?

Background: University students appear to experience a significantly higher rate of depression compared to the general population. However, there is limited data showing how much Nigerian university students know about the risk and protective factors related to depression. Objectives: To assess the knowledge of risk and protective factors associated with depression in young people among students of a Nigerian university. Methods: A cross-sectional descriptive survey was conducted among simple randomly selected students of the University of Nigeria, Nsukka. Two validated self-administered questionnaires were used for data collection. Descriptive statistics and multivariate binary logistic regression were used for the data analysis. Results: Out of 1591 participants, about 47% and 60% had good knowledge of risk and protective factors related to depression, respectively. The course of study, year of study, contact with a depressed person, and personal experience of depression significantly predicted students' knowledge of risk factors for depression. Similarly, course of study, year of study, and gender were the significant predictors of students' knowledge of protective factors against depression. Conclusions: The students had good knowledge of protective factors against depression, but were poor in knowledge of its associated risks. Therefore, provision of mental health services in the universities is recommended.

Development and validation of a questionnaire for evaluating knowledge of risk factors for teen depression among health care trainees of a Nigerian university.

INTRODUCTION: Increasing knowledge of factors predisposing individuals to depression appears to be an important preventive strategy. However, there is no validated instrument for evaluating knowledge of risk factors for depression among adolescents. Therefore, we aimed to develop and validate a questionnaire to assess knowledge of risk factors for teen depression. METHODS: Extensive literature search and expert consultations were carefully conducted. The content, face, and convergent validity of the prefinal Knowledge of Risk Factors for Teen Depression Questionnaire (KRFD-Q) were performed. The Cronbach's alpha and test-retest reliability of KRFD-Q were conducted. Exploratory factor analysis (EFA) was used to delineate the final items into distinct clusters. Participants' demographic characteristics were presented using descriptive statistics. All analyses were performed using SPSS version 20. RESULTS: A total of 17 items were generated after an extensive literature search and expert consultations. Two items were considered as repetitions and thus deleted. The overall Cronbach's alpha of KRFD-Q was 0.72. Test-retest reliability (r = 0.83, P < .0001) and convergent validity (r = 0.61, P = .034) were satisfactory. The corrected item-total correlation of KRFD-Q ranged from 0.13 to 0.45. The EFA identified three factors, (1) family abuse, stress, and self-criticism (7 items), (2) social/relationship factors (5 items), and (3) genetic and economic factors (3 items). DISCUSSION: The findings of this study demonstrate that 15-item KRFD-Q developed is satisfactorily valid and reliable to measure the knowledge of risk factors for teen depression among university undergraduate students.

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.

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.

Increasing use of artemisinin-based combination therapy for treatment of malaria infection in Nigerian hospitals / Aumento del uso de tratamientos combinados con artemisina para el tratamiento de la infección de malaria en hospitales nigerianos

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 artemether-lumefantrine. 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 (AU)

Objetivos: Este estudio trató de describir el patrón de prescripción ambulatoria de antimaláricos en un hospital secundario y terciario, y evaluar el cumplimiento de la Guía Nacional de Tratamiento Antimalárico (ATG). Métodos: Se realizó un audit de los archivos de prescripción de antamaláricos en dos establecimientos sanitarios de un periodo de seis meses en 2008. Se utilizaron cuestionarios semi-estructurados para recoger informaciones del conocimiento de médicos y farmacéuticos de la Guía Nacional de Tratamiento Antimalárico. Resultados: Los tratamientos de combinación con artemisina (TCA) fueron los antimaláricos más prescritos. Del total de prescripciones, el 81,4% TCA, de las cuales el 56,8% eran artemeter-lumefantrina. Sin embargo, el cumplimiento de los medicamentos indicados en las guías nacionales con el DU90% fue del 38,5% en el hospital terciario y del 66,7% en el secundario. La práctica de prescripción por nombre genérico todavía no era seguida en ninguno de los hospitales. El porcentaje de profesionales sanitarios que conocía las TCA era del 88,2% de los médicos y del 85,1% de los farmacéuticos. Sin embargo, el 13,3% y el 52,2% de médicos y farmacéuticos, respectivamente, no pudo enunciar adecuadamente la lista de medicamentos especificados en la guía. La amodiaquina fue la opción más frecuentemente preferida para tratar a niños de 0-3 meses con infección de malaria, en lugar de la indicada quinina oral. Conclusión: Este estudio mostró un aumento del uso de regímenes de combinación con artemisina para tratamiento de malaria no complicada en comparación con anteriores informes de Nigeria. Este estudio también remarca la necesidad de un periódico aseguramiento de la calidad interno entre los profesionales sanitarios, monitorizando el cumplimiento y el conocimiento de las guías clínicas para asegurar la práctica basada en la evidencia (AU)

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.