Cost-effectiveness of drug-management of hypertension among patients in selected secondary facilities in Nigeria: Empirical evidence for rational prescription choices / Costo-efectividad del manejo farmacológico de la hipertensión en pacientes de entidades de segundo nivel seleccionados en Nigeria: evidencia empírica para elecciones racionales de formulación

Abstract Background: The financial burden of managing hypertension in developing countries, where most of healthcare is funded out-of-pocket, is huge and poor patients cannot sustainably afford it. This is a challenge for most people, especially in sub-Saharan Africa with poor health indices, and this informed the investigation of the cost-effectiveness of anti-hypertensive drugs. Methodology: This was essentially a before-and-after study without control, in which blood pressure was assessed after commencing treatment with anti-hypertensive drugs among hypertensive patients. A systematic sampling technique was employed to recruit 320 participants from new patients attending cardiology clinic and admitted into the wards in four secondary health facilities offering specialized medical services in Nigeria. Results: The median cost of drug treatment of hypertension per week was N977.50; this cost was much lower for monotherapy than combined therapy. Similarly, the median costs of treatment per decrease in systolic and diastolic blood pressures were higher with combined therapy than monotherapy. The median cost of treatment per decrease in systolic blood pressure was higher than diastolic pressure. Diuretics had the most cost per decrease in diastolic blood pressure, while ACEI had the highest costs per decrease in systolic blood pressure and the highest cost per week. The lowest cost per week was recorded for beta-blockers, which also had the lowest cost per decrease in diastolic blood pressure and similar to the average cost per unit decrease in systolic blood pressure for centrally acting drugs. Conclusion: There was a significant improvement in blood pressure three months following the start of anti-hypertensive drugs. Beta-blockers appeared most cost-effective while diuretics as well as ACE inhibitors were the least. Monotherapy costs less per week, but it could not be proved from this study that it was more cost-effective than combined therapy.

Resumen Antecedentes: la carga financiera del manejo de la hipertensión en países en vías de desarrollo, donde la mayoría de la atención en salud es financiada por cuenta propia, es enorme, y los pacientes de escasos recursos no lo pueden costear de manera sostenible. Este es el reto para la mayoría de las personas, especialmente en África subsahariana que tiene indicadores de salud pobres, y esto fundamentó la investigación de la costo-efectividad de las drogas antihipertensivas. Metodología: esencialmente un estudio antes-después, sin control, en el cual se evaluó la tensión arterial luego de iniciar tratamiento con antihipertensivos en pacientes hipertensos. Se empleó una técnica de muestreo sistemático para reclutar 320 participantes de entre los pacientes nuevos atendidos en consulta de cardiología y hospitalizados en cuatro entidades de salud de segundo nivel en Nigeria. Resultados: el costo medio semanal del tratamiento farmacológico de la hipertensión fue de N977.50; este costo fue mucho menor para la monoterapia que para la terapia combinada. Asimismo, el costo medio de tratamiento por reducción en las cifras de tensión arterial sistólica y diastólica fue mayor con la terapia combinada que con la monoterapia. El costo medio de tratamiento por reducción en la tensión arterial sistólica fue mayor que para la tensión diastólica. Los diuréticos tuvieron el mayor costo por reducción en tensión arterial diastólica, mientras que los IECA tuvieron el mayor costo por reducción en tensión arterial sistólica y el costo más alto por semana. El costo más bajo por semana se registró para los beta-bloqueadores, los cuales también tuvieron el menor costo por reducción en la tensión arterial diastólica y un costo similar al promedio por unidad de reducción en la tensión arterial sistólica para los medicamentos de acción central. Conclusión: hubo una mejoría significativa en la tensión arterial luego de tres meses del inicio de drogas antihipertensivas. Los beta-bloqueadores parecieron ser los más costo-efectivos, mientras que los diuréticos e inhibidores de ECA fueron los menos costo-efectivos. La monoterapia costó menos por semana pero no se pudo comprobar con este estudio que fuera más costo-efectivo que la terapia combinada.

How mindful of their own health are healthcare professionals? perception and practice of personnel in a tertiary hospital in Nigeria.

OBJECTIVES: To assess health professionals' perception and determinants of their health and practice of preventive self-care. METHODS: An analytic cross-sectional design was employed, and 232 professionals were selected by stratified sampling from all health professional departments of Delta State University Teaching Hospital. Healthcare professionals who had worked in the hospital for at least six months were included in the sampling frame. Pregnant women and supernumerary professionals were excluded. A self-administered questionnaire was used, and data analysed using SPSS. The main outcome measures were the level of perception of self-health and level of practice of preventive selfcare. RESULTS: More than four-fifths of doctors and 64.8% of nurses had good perception of their health, with significant association between perception and service area (X2 = 11.828, p =0.008). Screening practice was lowest amongst doctors except for HIV/HBV screening. Whereas 63.4% of all participants adjudged their BMI to be normal, only 36.2% actually had normal BMI, the difference being significant (p <0.001). Almost 20% of doctors had not had a BP check in a year or more, and the same proportion of doctors and nurses had never checked their FBS. The proportion of personnel who had never checked their serum lipid profile was high among nurses (76.1%) and doctors (58.3%). CONCLUSION: Respondents had good perception but poor preventive behaviour, beginning management after disease onset. This may be ominous for the sector. Urgent health promotion action to safeguard productivity is needed. Comprehensive data from a multi-centre study will provide a deeper understanding of the issue. FUNDING: None declared.

2017 American College of Cardiology/American Heart Association Clinical Guideline-based Prevalence of Hypertension in a semi-urban community in Nigeria: Public Health Perspective / Guía clínica de 2017 sobre prevalencia de hipertensión del American College of Cardiology/American Heart Association en una comunidad semi-urbana de Nigeria: Perspectiva de Salud Pública

Abstract Background: Evidence from previous studies has consistently revealed that patients develop target organ damage even with seemingly normal blood pressure thus informing the development of a new treatment guideline in 2017. The prevalence of hypertension in Nigeria ranges from 8-45%, however this is expected to change due to the new guideline. Thus, this study sought to estimate the prevalence of hypertension based on 2017 ACC/AHA clinical guidelines, and determine its associated factors. Methods: In this cross-sectional study a total of 296 participants were recruited with a simple random technique using a table of random numbers. Blood pressure, weight and height were measured and data was analysed with SPSS version 22. The primary outcome measures included proportion of respondents with hypertension based on AHA guideline and JNC 7 classifications, as well as the association between hypertension and BMI, age, sex and marital status. Results: The mean age of study participants was 38.71years, and male to female ratio was 2:3. Overall prevalence of hypertension was 63.5% and 22.6% based on the new guideline and JNC 7 classification respectively; higher risk of hypertension was significantly associated with the AHA guideline (p< 0.001). Association between body mass index, marital status (currently married/not married), sex, age group (≥40 vs. < 40years) and systolic as well as diastolic hypertension was significant (p< 0.001). Females were more than twice as likely to be hypertensive as males [OR: 2.51 (1.54 - 4.10)]. Age and weight were the only significant predictors of abnormal blood pressure, diastolic and systolic hypertension. Conclusion: Prevalence of hypertension based on the new guideline is staggeringly high and portends a huge public health problem. This conundrum requires immediate intervention in order to forestall the damaging effects of hypertension on vital body organs and for participants to lead a healthy life.

Resumen Antecedentes: La evidencia de los estudios previos ha revelado, consistentemente, que los pacientes desarrollan daños en los órganos diana aun cuando su presión arterial es aparentemente normal, lo cual ha impulsado el desarrollo de una nueva guía de tratamiento en 2017. La prevalencia de la hipertensión en Nigeria oscila del 8 al 45%, aunque está previsto que cambie, debido a esta nueva guía. En nuestro estudio calculamos la prevalencia de la hipertensión, basada en la guía clínica de ACC/AHA de 2017, y determinamos sus factores asociados. Métodos: En este estudio transversal reunimos a un total de 296 participantes mediante una técnica aleatoria simple, utilizando una tabla de números aleatorios. Medimos la presión arterial, el peso y la altura, y analizamos los datos con SPSS versión 22. Las medidas del resultado primario incluyeron la proporción de respondedores hipertensos, basándonos en la guía AHA y en la clasificación JNC 7, así como en la asociación entre hipertensión e IMC, edad, sexo y estado civil. Resultados: La edad media de los participantes del estudio fue de 38,71 años, siendo el ratio varón:mujer de 2:3. La prevalencia global de la hipertensión fue del 63,5% y del 22,6%, sobre la base de la nueva guía y la clasificación JNC 7, respectivamente. El mayor riesgo de hipertensión se asoció significativamente a la guía AHA (p< 0,001). La asociación entre índice de masa corporal, estado civil (actualmente casados/solteros), sexo, grupo de edad (≥40 vs. < 40 años), e hipertensión sistólica y diastólica fue significativa (p< 0,001). Las mujeres superaron en más del doble a los varones, en cuanto a la probabilidad de padecer hipertensión [OR: 2,51 (1,54 - 4,1)]. La edad y el peso constituyeron los únicos factores predictivos significativos de presión arterial anormal e hipertensión diastólica y sistólica. Conclusión: La prevalencia de la hipertensión basada en una nueva guía es asombrosamente elevada, presagiando un gran problema de salud pública. Este interrogante requiere una intervención inmediata, a fin de prevenir los efectos dañinos de la hipertensión en los órganos vitales, y animar a los participantes a llevar una vida sana.

Perspectives and practices of cancer screening among workers at a tertiary health facility in Nigeria: indications for adaptation and integration of best practices.

OBJECTIVES: This study identified correlates of good screening performance for three common cancers, while weighing them against the backdrop of existing knowledge, to enable policy makers and healthcare providers focus appropriately to close the gaps that exist in cancer screening in our locale. STUDY DESIGN: Cross-sectional design. SETTING: Tertiary health facility. PARTICIPANTS: Workers at Delta State University Teaching Hospital, Nigeria. RESULTS: Females had significantly better knowledge of cervical cancer, p<0.001; their knowledge of the other two cancers studied did not differ significantly from that of males. Staff members with less than 2 years of service, consistently had significantly better knowledge of all 3 cancers than others, p<0.05. Staff with good knowledge of all 3 cancers also decreased significantly with increasing number of years since graduation, p<0.001. Workers in clinical departments generally had better attitude towards screening for all 3 cancers compared to their counterparts in the non-clinical departments, p<0.001. Tertiary education, being in a clinical department, and Christianity were associated with a better attitude and practice of screening. The practice of screening was generally poor, as 54.9% and 89% of females had never screened for breast cancer and cervical cancer respectively; while almost all (93.5%) males 40 years and over had never screened for prostate cancer. CONCLUSION: Overall, knowledge of cancer screening was fair for all cancers; attitude to screening was good towards all cancers. However, significant gaps in compliance with screening were identified for all cancers. Setting up screening facilities and programmes in the work place could help to close these gaps. FUNDING: None declared.

Adherence to antimalarial drug policy among doctors in Delta State, Nigeria: implications for malaria control.

BACKGROUND: Malaria is a public health problem compounded with a widespread emergence of drug-resistant Plasmodium falciparum which necessitated the formulation of a new antimalarial drug policy (AMP). OBJECTIVE: This study was designed to assess adherence to the policy among physicians in health facilities in Delta state, Nigeria. DESIGN: Cross-sectional, analytic study. Data were collected with a semi-structured questionnaire. SETTING: Two secondary and one tertiary health facilities in Delta State, Nigeria. PARTICIPANTS: Physicians selected with a simple random technique from the facilities. MAIN OUTCOME MEASURES: Prescribing pattern of antimalarial drugs and adherence to WHO treatment guideline among doctors. RESULTS: Majority (90.8%) of respondents believed the antimalarial policy (AMP) should be strictly adhered to, although three-fifth (61.0%) of them rated its performance as poor. The level of adherence to the national antimalarial drug policy was high (78.5%) as most doctors prescribed Arthemeter-Lumefantrine, AL for uncomplicated malaria however barely two-fifth (35.4%) adhered to prescribing injectable Artesunate for complicated malaria. AL, (71.9%) was the most prescribed antimalarial drug for uncomplicated malaria The most prescribed antimalarial drugs for complicated malaria was artesunate (40.0%) followed by quinine (27.6%) and artemether (26.7%); although, chloroquine was also prescribed. CONCLUSION: The level of adherence to AMP among doctors was sub-optimal. Continuous education of doctors on the new AMP is needed to achieve malarial control. FUNDING: No funding was received for this study.

Adherence to antimalarial drug policy among doctors in Delta State, Nigeria: implications for malaria control

Background: Malaria is a public health problem compounded with a widespread emergence of drug-resistant Plasmodium falciparum which necessitated the formulation of a new antimalarial drug policy (AMP).Objective: This study was designed to assess adherence to the policy among physicians in health facilities in Delta state, Nigeria. Design: Cross-sectional, analytic study. Data were collected with a semi-structured questionnaire.Setting: Two secondary and one tertiary health facilities in Delta State, Nigeria Participants: Physicians selected with a simple random technique from the facilities Main outcome measures: Prescribing pattern of antimalarial drugs and adherence to WHO treatment guideline among doctors. Results: Majority (90.8%) of respondents believed the antimalarial policy (AMP) should be strictly adhered to, although three-fifth (61.0%) of them rated its performance as poor. The level of adherence to the national antimalarial drug policy was high (78.5%) as most doctors prescribed Arthemeter-Lumefantrine, AL for uncomplicated malaria however barely two-fifth (35.4%) adhered to prescribing injectable Artesunate for complicated malaria. AL, (71.9%) was the most prescribed antimalarial drug for uncomplicated malaria The most prescribed antimalarial drugs for complicated malaria was artesunate (40.0%) followed by quinine (27.6%) and artemether (26.7%); although, chloroquine was also prescribed.Conclusion: The level of adherence to AMP among doctors was sub-optimal. Continuous education of doctors on the new AMP is needed to achieve malarial control