Quality of Drug Prescribing and Dispensing Practices in Primary Healthcare Centres in an Urban Local Government Area in Nigeria.

BACKGROUND: Irrational drug use remains a major issue in developing countries; hence this study used the World Health Organization and the International Network for the Rational Use of Drugs (WHO/INRUD) core drug indicators to assess the quality of prescribing and dispensing practices in Primary Health Centres (PHCs) in Obio-Akpor Local Government Area (LGA) in Nigeria. METHODS: This descriptive cross-sectional study which covered 10 PHCs in Obio-Akpor LGA comprised a review of prescription records and a survey of patients and prescribers. A systematic random sample approach was used to retrieve 1300 prescriptions from August to October 2021 to evaluate prescribing indicators while direct observation of 325 consecutive patient encounters in the PHCs was used to evaluate the patient-care indicators. Twenty-three prescribers in the 10 PHCs who were available and willing to participate in the study, completed the self-administered questionnaire for assessment of the factors affecting prescribing practices. Descriptive and inferential analyses were done using the Statistical Package for the Social Sciences and p-values d" 0.05 were considered statistically significant. RESULTS: From the 1300 retrieved prescriptions, a total of 3805 medications were prescribed for the 1300 encounters giving 2.9 (± 0.5) as the mean medications prescribed per encounter. Prescriptions in generic forms were 69.9% and 75.6% of drugs prescribed were from the Nigeria essential medicine list for PHCs. Encounters with antibiotics and injectables included in the prescriptions were 62.6% and 22.3% respectively. Antimalarial, antihypertensive, and antidiabetic medications were prescribed in 43.8 %, 9.6 %, and 1.7 % of the cases, respectively. Most (91.6 %) of the recommended drugs were dispensed, 98.2% of the drugs dispensed were appropriately labelled, and 95.5 % of the patients had an adequate understanding of their drug doses. The pharmacy stocked 88.7% of the key medications, and all PHCs had a copy of the EDL. CONCLUSION: There was evidence of irrational drug use practices in PHCs in Obio-Akpor LGA. This calls for the implementation of periodic training for PHC workers, the promotion of effective monitoring and adherence to the policy of rational drug use in PHCs.

CONTEXTE: L'utilisation irrationnelle des médicaments reste un problème majeur dans les pays en développement ; c'est pourquoi cette étude a utilisé les indicateurs de base de l'Organisation mondiale de la santé et du Réseau international pour l'utilisation rationnelle des médicaments (OMS/INRUD) pour évaluer la qualité des pratiques de prescription et de délivrance dans les centres de soins de santé primaires (SSP) de la zone de gouvernement local (LGA) d'Obio-Akpor au Nigéria. MÉTHODES: Cette étude transversale descriptive, qui couvre 10 centres de santé primaires dans la zone de gouvernement local d'Obio-Akpor, comprend un examen des dossiers de prescription et une enquête auprès des patients et des prescripteurs. Une approche d'échantillonnage aléatoire systématique a été utilisée pour récupérer 1300 ordonnances d'août à octobre 2021 afin d'évaluer les indicateurs de prescription, tandis que l'observation directe de 325 rencontres consécutives avec des patients dans les SSP a été utilisée pour évaluer les indicateurs de soins aux patients. Vingt-trois prescripteurs des 10 SSP, disponibles et désireux de participer à l'étude, ont rempli le questionnaire auto-administré pour évaluer les facteurs affectant les pratiques de prescription. Les analyses descriptives et inférentielles ont été réalisées à l'aide du logiciel Statistical Package for the Social Sciences et les valeurs p d" 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: Sur les 1300 ordonnances récupérées, 3805 médicaments ont été prescrits au total, ce qui donne une moyenne de 2,9 (± 0,5) médicaments prescrits par consultation. Les prescriptions sous forme générique représentaient 69,9 % et 75,6 % des médicaments prescrits figuraient sur la liste des médicaments essentiels du Nigeria pour les SSP. Les rencontres avec des antibiotiques et des injectables inclus dans les prescriptions étaient respectivement de 62,6 % et 22,3 %. Des antipaludéens, des antihypertenseurs et des antidiabétiques ont été prescrits dans 43,8 %, 9,6 % et 1,7 % des cas, respectivement. La plupart (91,6 %) des médicaments recommandés ont été délivrés, 98,2% des médicaments délivrés étaient correctement étiquetés et 95,5 % des patients comprenaient bien les doses de médicaments. La pharmacie stockait 88,7 % des principaux médicaments et tous les SSP disposaient d'une copie de la liste de médicaments d'urgence. CONCLUSION: Il existe des preuves de pratiques irrationnelles d'utilisation des médicaments dans les SSP de l'AGL d'Obio-Akpor. Ceci appelle à la mise en œuvre d'une formation périodique pour les travailleurs des SSP, à la promotion d'un suivi efficace et à l'adhésion à la politique d'utilisation rationnelle des médicaments dans les SSP. Mots-clés: Prescription de médicaments, Indicateurs de qualité, Utilisation rationnelle des médicaments, Centre de soins de santé primaires, Nigeria.

Care-recipient perspectives on the responsiveness of Orthopedic surgical services in a tertiary center in Nigeria

Responsiveness optimisesthe system-based approach to meeting legitimate demands by healthcare recipients. This study assessed the responsiveness of orthopaedic services at the University of Port Harcourt Teaching Hospital (UPTH) from the perspectives of the care recipients. Methods:Descriptive cross-sectional study among 442 consecutively recruited recipients of orthopaedic services at UPTH from March to June 2020. Close-ended questionnaire with responsiveness conceptualised by five constructs: dignity, autonomy, confidentiality, quality of basic amenities and choice of care provider, each measured along 4-point response scale. The internal consistency reliability of the responsiveness scale was determined by the Cronbach's alpha coefficient. Descriptive (frequency, percentages, bar charts) and inferential (ordinal logistic regression) statistics were conducted and p-values ≤ 0.05 were considered statistically significant. Results: Response rate was 97.3% and the Cronbach's alpha coefficient for the responsiveness scale was 0.83. Participants' mean age was 38.5±14.8years with more being males (55.8%), privately employed (34.9%) and completed secondary education (82.5%). Proportion of respondents who gave excellent ratings across responsiveness domains were dignity (32.8%), autonomy (34.2%), confidentiality (26.3%), amenities (25.8%) and no excellent rating for choice of provider. Marital, employment and visit status were the most consistent factors associated with feedback on autonomy, choice of providers, confidentiality domains.Conclusion: More orthopaedic patients were pleased with the level of autonomy and dignity than choice of providers and quality of basic amenities. There is the need for enhanced responsiveness of orthopedic services to meeting the unique needs of patients and achieving improved quality of care and patient outcomes

Healthcare providers' satisfaction with participation in private health insurance scheme in a city in the southern Nigeria

Health insurance coverage in Nigeria is still very low as over 70% of health care expenditure is financed by out-of-pocket payment. Health care providers are critical participants in the private health insurance scheme, therefore, their perception and satisfaction with the scheme is fundamental in ensuring sustainability. This study assessed health providers' satisfaction with private health insurance scheme in Port Harcourt Rivers State.Method: A descriptive cross-sectional study which engaged a two-stage sampling method to recruit 60 participating health facilities and 180 responding health personnel by simple random sampling at each stage. A structured, pretested interviewer-administered questionnaire was used to collect data on the levels of satisfaction with the four major domains of satisfaction viz; billing rate, payment models, HMO administrative processes and claims management. Data was analysedusing of SPSS, version 26. Characteristics of the responding facilities were tabulated and compared. Level of satisfaction was deduced by Likert Scale according to the domains of satisfaction. Regression analysis with p-value was set at less than or equal to 0.05 was used to determine the predictors of satisfaction with participation in health insurance. The level of satisfaction with negotiated billing rates, payment models, HMO administrative processes and claims management were analyseddescriptively, and results were presented as means, standard deviation, frequencies and percentages, in tables, pie and bar charts

Pattern and Predictors of Patients' Willingness to Comply with Recommendations after Surgical Consultations in a Teaching Hospital in Nigeria.

BACKGROUND: Willingness of patients to comply with decisions taken during surgical consultations may influence the quality of care and health outcome. OBJECTIVE: This study determined the pattern and predictors of patients' willingness to adhere to surgical recommendations. METHODS: A descriptive cross-sectional study involving about 490 adults recruited by systematic sampling. The content validity and internal consistency reliability of the tool which assessed patients' willingness to comply with recommendations for follow-up visit, drug prescription, investigation and surgical procedure were determined. Frequencies distribution and multivariate ordinal logistic regressions were conducted and p-value <0.05 was considered significant. RESULTS: A total of 466 respondents' data was analysed giving a response rate of 95.1%. The Cronbach's alpha of the questionnaire was 0.7 and the mean age of the respondents was 43.7 +15.7 years. About a fifth (18.2%) earned more than N==150,000 ($385) and out-of-pocket payment was the prevalent mode of making payments (83.3%). Follow-up visit was the most frequent recommendation (31.8%) and patients' willingness to accept recommendations ranged from 62.7% (admission) to 93.2% (prescription). The visit status was the most consistent predictors of patients' willingness to accept the various recommendations. CONCLUSION: Fewer patients were willing to accept the recommendation for an admission than other recommendations. Findings are useful in developing strategies to improve patients' adherence with recommendations following consultations with surgeons.

CONTEXTE: La volonté des patients de se conformer aux décisions prises lors des consultations chirurgicales peut influencer la qualité des soins et les résultats de santé. OBJECTIF: Cette étude a déterminé le modèle et les prédicteurs de la volonté des patients d'adhérer aux recommandations chirurgicales. METHODES: Une étude transversale descriptive impliquant environ 490 adultes recrutés par échantillonnage systématique. La validité du contenu et la fiabilité de la cohérence interne de l'outil qui a évalué la volonté des patients de se conformer aux recommandations pour la visite de suivi, la prescription de médicaments, l'investigation et la procédure chirurgicale ont été déterminées. La distribution des fréquences et des régressions logistiques multivariées ont été menées et une valeur p < 0,05 a été considérée comme significative. RESULTATS: Au total, les données de 466 répondants ont été analysées, ce qui donne un taux de réponse de 95,1 %. L'alpha de Cronbach du questionnaire était de 0,7 et l'âge moyen des répondants était de 43,7 +15,7 ans. Environ un cinquième (18,2%) gagnait plus de 150 000 ( 385 $) et le paiement direct était le mode de paiement le plus répandu (83,3 %). La visite de suivi était la recommandation la plus fréquente (31,8%) et la volonté des patients d'accepter les recommandations variait de 62,7% (admission) à 93,2% (prescription). Le statut de la visite était le prédicteur le plus constant de la volonté des patients d'accepter les diverses recommandations. CONCLUSION: Moins de patients étaient prêts à accepter la recommandation d'admission que les autres recommandations. Les résultats sont utiles pour développer des stratégies visant à améliorer l'adhésion des patients aux recommandations suite aux consultations avec les chirurgiens. MOTS CLÉS: Patient hospitalise; Patient externe; Acceptation des soins de sante per le patient; Consultation, Hôpital, Enseignement, Nigeria.

Relationship Between Patient Satisfaction and Willingness to Comply With Physicians' Recommendation in Referral Surgical Outpatient Clinic in Nigeria.

The relationship between patient satisfaction with surgical care and their willingness to comply with doctors' recommendations has not been studied in the country. This study determined the relationship between ambulatory patients' satisfaction with care and their willingness to adhere to the surgeons' recommendations in the surgical outpatient clinic (SOPC) of the University Teaching Hospital. This analytical cross-sectional study was conducted among 490 adult respondents at the SOPC selected through a systematic sampling method with a sample interval of 1:2. The short form of the Patient Satisfaction Questionnaire with 7 domains and tool developed for patient willingness to comply with surgeons' recommendations were used. Descriptive and inferential analyses were performed, and P values of <.05 were considered significant. A total of 466 respondents' data were analyzed, giving a response rate of 95.1%. About 52.8% were males and 47.2% were females. The associations between domains of patient satisfaction and willingness to surgical instructions were mostly weak and nonsignificant. Their satisfaction with communication with the surgeons was the most consistent predictor of patient willingness and showed significant relationships with their willingness to accept follow-up visits (P = .002), drug prescription (P < .001), and further investigation (P < .001). Access/convenience and general satisfaction were significantly associated with their willingness to recommend the surgery clinic to close friends and relatives. Patient satisfaction with care has a significant relationship with their willingness to adhere to surgical recommendations.

Awareness and acceptability of strategies for preventing mother to child transmission of HIV among antenatal clients in Calabar, Nigeria.

BACKGROUND: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. METHOD: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal, State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. RESULT: Majority of the respondents (94.7%) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2%) than they were of avoiding breastfeeding (58.5%) and Cesarean delivery (22.8%) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2%) than they would avoid breastfeeding (69.0%) and accept Cesarean delivery (38.0%) for preventing mother to child transmission of HIV High educational status was significantly associated with a positive attitude to these strategies. CONCLUSION: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace.

Awareness and Acceptability of Strategies for Preventing Mother to Child Transmission of HIV among Antenatal Clients in Calabar; Nigeria

Background: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. Method: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal; State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. Result: Majority of the respondents (94.7) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2) than they were of avoiding breastfeeding (58.5) and Cesarean delivery (22.8) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2) than they would avoid breastfeeding (69.0) and accept Cesarean delivery (38.0) for preventing mother to child transmission of HIV. High educational status was significantly associated with a positive attitude to these strategies. Conclusion: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace

Risk factors associated with sexual assault in Calabar south eastern Nigeria.

BACKGROUND: Sexual assault inflicts significant physical and psychological trauma in the victims. Interventions to prevent this violent crime against women are a major public health concern. The aim of this study is to identify the risk factors for sexual assault as seen in victims presenting in our hospital. METHOD: Twenty-two case records of sexual assault victims treated at the University of Calabar Teaching hospital were reviewed for this study. RESULTS: The incidence of reported sexual assault in this study was 2.1% with a rising trend observed. Age range was from 4 to 23 years. Six (27.3%) victims were primary school pupils. Twelve (54.5%) victims had not attained menarche, and 20 (90.9%) cases were single. Recorded place of assault was commonly along a bush track (36.4%) and a nearby cemetery (22.7%). Time of assault was mainly in the evening (50.0%). Identity of the assailant was known in 7 (31.8%) cases. Commonest weapon used by the assailant was a knife (36.4%). CONCLUSION: Concerted effort is required to curb the rising trend of reported sexual assault. Interventions aimed at creating public awareness of the possible risk factors may reduce the incidence of this detestable event in the community.

KAP of HIV prevention and screening among pregnant women attending specialist antenatal clinics in Calabar, Nigeria.

BACKGROUND: There is a growing concern globally to reverse the growing incidence of HIV especially in Sub-Saharan Africa. This study was conducted to determine the level of awareness, attitude and practice of antenatal HIV screening in Calabar. METHOD: Descriptive multi-centric study of 400 antenatal attendees in Calabar, carried out in October 2005 using pre-tested, semi-structured and interviewer-administered questionnaire for data collection. RESULT: Of the 96.7% women with knowledge of HIV infection, 41.2% were assessed to have excellent knowledge of the mode of transmission. Awareness of antenatal HIV screening was observed in 96.2% women; while 93.7% approved of antenatal HIV screening. Awareness and approval of antenatal HIV screening was significantly related to age and educational status. The proportion of women who had HIV test in current pregnancy was 70.2%. Pre-test counseling was done in 65.8% of women. Most women (78.2%) who had not been screened were willing to undergo HIV testing. Spousal disapproval (23.1%) was the main reason for unwillingness to undergo HIV testing. CONCLUSION: The study revealed high levels of awareness, approval and practice of antenatal HIV screening. However, pre test counseling was not consistently given in cases tested.

Trauma related to sexual assault in Calabar, south eastern Nigeria.

BACKGROUND: A woman who is sexually assaulted experiences intense anxiety and fear. The associated stigmatization often results in under reporting and management difficulties. The aims of this study are to document the types of injuries seen in victims of sexual assault and to highlight problems in management of cases. METHOD: Twenty-two case files of sexual assault victims between January 1998 and December 2001 were reviewed for age, types of injuries sustained and treatment received. RESULT: Age range of all victims was 4 to 23 years. The knife was used by the perpetrator in 8 (36.4%) cases. Time interval between assault and presentation to hospital was up to 12 hours in 13 (59.1%) cases. Superficial abrasions, bruises, and lacerations were observed in 12 (54.6%) cases. Six (27.3%) victims paid for human immunodeficiency virus screen and the results were non-reactive. Ten (45.5%) victims had primary repair of perineal tear. CONCLUSION: Sexual assault is associated with multiple bruises, lacerations, and perineal tears. Commercialization of medical services was a hindrance to proper management of cases.

Sexuality; Contraception and Unintended Pregnancy among Female Student Nurses in Calabar; Nigeria

Background - There has been increased concern on human sexuality; especially with respect to contraception and the control of sexually transmissible infections. There is need to identify the sociodemographic characteristics that influence sexual behaviour and contraceptive use among young women. Methods - A descriptive cross sectional study that focused on the socio-demographic characteristics; sexuality; knowledge and use of modern contraceptive technology as well as interventions taken in the event of inadvertent pregnancy was conducted. A structured; close- ended questionnaire was randomly administered to 195 female nursing students with 60; 65 and 70 of them in their first; second and third year respectively. Results - Majority (76.7) of the students were in the age bracket of 20 - 24years. While 65.6of them were sexually active; only 54.9had knowledge of family planning. Condom was the commonest contraceptive used (37.4) and the main reasons were that of effectiveness (31.8) and safety (30.3). There was a significant relationship between respondents with multiple sexual partners and incidence of unwanted pregnancies (p=0.003). The majority (51.2) of those with unwanted pregnancies resorted to induced abortion