A two-tool assessment of the quality of life of patients with breast cancer using generic and disease-specific tools in a Nigerian teaching hospital.

Assessing the quality of life (QoL) of breast cancer (BC) patients using a triangulation of tools is crucial for understanding their well-being and tailoring specific interventions to improve their overall experience. The study assessed the QoL of BC patients using a combination of generic and disease-specific validated questionnaires. The study utilized a self-administered questionnaire-based cross-sectional design among BC patients attending the Oncology clinic in a Nigerian teaching hospital. The 23-item EORTC-BR23 questionnaire and the 15-item HRQoL 15D questionnaire were provided to consenting eligible respondents for data collection. Descriptive (e.g., frequency, percentages, mean, median, etc.) and inferential (T-test and one-way ANOVA) statistical analyses were conducted on the cleaned data, with significant p values set at less than 0.05. A total of 60 female BC patients participated in the study. Respondents that were aged 41-50 years and 50-60 years were 20 (33.3%) and 19 (31.7%) respectively. Patients who were diagnosed with BC one year ago before the study were 22 (39.3%) with 51 (85%) reporting no positive family history of BC. Patients who had undergone surgery, radiotherapy, hormonal therapy, and chemotherapy were 52 (86.7%), 27 (45.0%), 14 (24.1%), and 54 (90%) respectively. The patients scored 30.00 ± 4.67% and 72.36 ± 2.93% for future perspective and body image, respectively, in the functional scales of the EORTC-BR23 with a maximum possible score of 100%. On the symptom scale, they scored 47.46 ± 2.52% and 63.40 ± 5.03% for side effects of therapy and being upset about hair loss, respectively. The patients' quality of life utility score in the 15-D tool was 0.79 ± 0.02. With p values less than 0.005, age, time since diagnosis, and cancer stage were influential determinants of patients' QoL. The QoL of the participants based on the HRQoL-15D was determined to be high. For the EORTC-BR23, respondents reported high quality of life for body image and sexual function but low quality of life for both sexual enjoyment and future perspective in terms of the functional scale. The symptom scale of EORTC-BR23 showed high symptoms for only the domain of upset by hair loss resulting in low QoL. Socio-demographic factor that affects the QoL of BC patients were age, number of years since diagnosis and stage of BC.

Effectiveness of a pharmacist-led educational intervention on health outcomes in hypertension management at community pharmacies in Nigeria: A two-arm parallel single-blind randomized controlled trial.

AIMS: This study determined the impact of a pharmacist-led educational intervention on the health outcomes of hypertensive patients in community pharmacies. METHODS: A 2-arm parallel single-blind randomized trial design was adopted among hypertensive patients in 4 pharmacies in Abuja and Lokoja, Nigeria. A pharmacist-led educational intervention was provided to the patients in the intervention group. The study outcomes, namely changes in adherence to medication, quality of life and cost of medication were measured using MARS-10, SF-12 and official price list, respectively. Independent and paired-sample t-tests were conducted on the data. RESULTS: A total of 128 patients participated in the study. All of them completed the study and were included in the analysis: 70 in the control arm and 58 in the intervention arm. There was a significant improvement in components of Behaviour (2.57 vs. 2.98), Attitude (2.59 vs. 3.14) and Negative attitude (1.62 vs. 1.92). There was a better improvement in adherence in the intervention arm: 8.05 ± 1.32 vs. 6.55 ± 2.24; t = -4.65, P = .0001. There were no changes in the respondents' health status after intervention in both groups (P < .05). There was a weak inverse association between the physical health component and mental health component: R = -0.2, P = .04 and a positive association with overall adherence (R = 0.26, P = .004) in the intervention group, in whom the monthly cost of treatment decreased from N2233.1 to N2068.4. CONCLUSION: Community pharmacy educational intervention improves health outcomes, particularly with adherence among patients with hypertension. Health-related quality of life of the patients improved, but the physical health component was better than that of the mental health component.

HIV infections averted at PEPFAR-APIN clinics in Nigeria: a ten-year retrospective evaluation of the clinical outcomes of post-exposure prophylaxis services.

Introduction: Nigeria contributes a high fraction to the global burden of HIV infections. Post-exposure prophylaxis (PEP) is a proven strategy to prevent transmission of the virus. The aim of this study was to determine the clinical outcomes of PEP in Nigeria at four clinics funded by United States President's Emergency Plan for AIDS Relief and AIDS Prevention Initiative in Nigeria (PEPFAR-APIN): Ahmadu Bello University Teaching Hospital (ABUTH), Jos University Teaching Hospital (JUTH), University of Maiduguri Teaching Hospital (UMTH) and University College Hospital (UCH).Methods: This study adopted a multisite retrospective design using the site's databases (2006-2016). Retrieved data was exported into SPSS version 25 for statistical analysis. Outcomes were measured as a proportion of HIV infections averted after PEP. Frequencies and percentages were used to describe the findings, while binary logistic regression was used to determine the sociodemographic predictors of clinical outcomes.Results: The average age of the 575 PEP patients whose data were retrieved was 30.45 (SD ±9.50 years), with 344 (59.8%) being females. Out of 545 patients,157 (28.8%) indicated their job status as students. Out of 273 patients, 198 (72.5%) reported their exposure type was non-occupational. The HIV status of 129 (22.4%) patients was negative after completing PEP. Prescribed regimen (ß = -0.048, 95% CI -0.095 to -0.001, p = 0.045) and type of exposure (ß = 0.351, 95% CI 0.042-0.660, p = 0.027) were predictors of post-PEP HIV status in JUTH and ABUTH respectively.Conclusion: There was a high rate of lost-to-follow-up among the PEP patients, but the incidence of seroconversion was low in those who were tested after PEP. The right choice of regimen and presenting with non-occupational exposure affected the outcome of the service.

Effectiveness of Telepharmacy in Rural Communities in Africa: A Scoping Review.

Objectives: This review examined the effectiveness of telepharmacy in rural communities in Africa to identify the barriers that hinder its implementation and integration as well as highlight the gaps in the existing research on telepharmacy. Data Source: PubMed and Google Scholar search (2008-2023) was conducted using keywords related to telepharmacy, telemedicine, telehealth, and rural communities. Study Selection and Data Extraction: The inclusion criteria for the review include peer-reviewed articles published in English language and studies that focus on the implementation and evaluation of telepharmacy in rural communities. Data Synthesis: In all articles used, access to quality health care in rural communities has been a persistent challenge in Africa. Digital technologies such as telemedicine, telepharmacy, and artificial intelligence were reported to have emerged as promising solutions to improve health care access and outcomes in rural communities. Telepharmacy, in particular, has the potential to provide medication-related services to patients irrespective of one's location. However, the implementation of telepharmacy in Africa has been slow, and there are several barriers affecting its integration and adoption in rural communities that include access to technology, limited infrastructure, and regulatory challenges. Gaps and limitations in the existing research on telepharmacy in rural communities were highlighted from the articles. Conclusion: Telepharmacy can improve health care access and outcomes in rural communities by bridging the gap between pharmacists and patients. However, the lack of infrastructure, inadequate funding, and regulatory challenges pose significant barriers to its implementation. Future research should focus on addressing these challenges and exploring the potential of telepharmacy to improve health care in rural communities in Africa.

Development and reliability testing of a cervical cancer patients knowledge and practice of self-care management of treatment-related adverse events questionnaire.

INTRODUCTION: Cervical cancer (CC) treatment-related adverse events (AEs) were found to be among the major reasons for treatments delays and medication non-adherence. Knowledge and practice of self-care management of these AEs are therefore needed to complement the pharmacotherapeutic interventions. Instruments for assessing CC patients' knowledge and practice of self-care management of treatment-related Adverse Events (AEs) are lacking. Hence, the rational for this study. METHODS: A prospective, cross-sectional study was conducted on CC patients receiving chemotherapy, radiotherapy or both, with or without surgery in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, a tertiary hospital in North-Western Nigeria. A panel of 14 experts judged the content validity of the items initially selected. Purposive sampling technique was used, 31 CC patients were recruited and interviewed for the questionnaire pre-testing. Descriptive statistics and psychometric analysis were conducted using SPSS Version 20.0 for Windows. A Cronbach's alpha coefficient ≥0.70 was considered acceptable. RESULTS: A 12-domain questionnaire instrument was developed. Eight (57.1%) of the expert panelists rated the questions' items as "Very good for the study" and none of them rated any of the content "not relevant for the study". The reliability studies showed that the overall knowledge and practice questions response rates were 71.0% and 77.4% and Cronbach's alpha (α) values were 0.956 and 0.913, respectively. CONCLUSION: A reliable, 12-domain cervical cancer patients' knowledge and practice of self-care management of treatment-related adverse events questionnaire was developed. Further research on the psychometric qualities of the instrument is needed.

How do patients prefer specialized clinical pharmacy service to other prevention of mother-to-child transmission of human immunodeficiency virus services? An evaluation of their willingness to pay and willingness to accept choices and ratios.

WHAT IS KNOWN AND OBJECTIVE: Donor agencies provide most of the funds for HIV services in developing countries. Due to the global economic downturn, there has been a reduction in funding for HIV-related services in Nigeria. This study compared the willingness to pay (WTP)-willingness to accept (WTA) ratios for prevention of mother-to-child transmission (PMTCT) services to specialized clinical pharmacy services among patients of two Nigerian hospitals. METHODS: This was a cross-sectional survey using contingent valuation method at Ahmadu Bello University Teaching Hospital (ABUTH) and University of Nigeria Teaching Hospital (UNTH). WTP and WTA were elicited using an interviewer-administered questionnaire and a payment card. The responses to the WTP and WTA questions were reported as frequencies and percentages, while the amounts were determined as mean. All costs were obtained in Nigerian Naira (N360 = $1). RESULTS AND DISCUSSION: Of the 219 mothers who participated in the study, 172 (78.5%) had no health insurance. Primary prevention of HIV (PPV) had the highest "yes" WTP response of 152 (69.4%) and the highest mean WTP amount of N6067.20. It also had the least "no" WTA response of 162 (74.0%) and the least WTA amount of N232.09. Specialized clinical pharmacy service (SCPS) had the highest WTA/WTP ratio of 4.0826 in ABUTH and 9.3750 at UNTH. Its income effect was -3.0826. A 1% increase in income led to 0.0550 (95% CI: -0.3068 to 0.1968) decreased odds to pay for PPV. WHAT IS NEW AND CONCLUSION: Most patients assessed in this study were willing to pay for PPV than other services. Majority of them were also willing to forgo PMTCT Drugs Only. SCPS had the highest value for the patients, but they did not want to pay a high amount for it. Employment status, health insurance status, educational level and age were predictors of patients' WTP and WTA.

Assessing the impact of COVID-19 on prescription patterns and antibiotic use: Insights from three military health facilities.

BACKGROUND: The COVID-19 pandemic disrupted health systems globally and there are suggestions it impacted antibiotics prescribing patterns in clinical practice. OBJECTIVES: This study aimed to assess the effects of the COVID-19 pandemic on the prescribing patterns in three Nigerian military health facilities and investigate the factors associated with antibiotic prescriptions. METHODS: This was a two-year cross-sectional retrospective study. Three hospitals and a total of 11,590 prescriptions were purposively and conveniently sampled respectively. The World Health Organisation (WHO) and International Network of Rational Use of Drugs (INRUD) prescribing indicators were used to assess for polypharmacy, injection use, use of antibiotics, use of generic drugs and prescriptions from essential drug lists for the periods of the pandemic and before the pandemic. Indicators from both periods were compared for statistical significance using the independent t-test. Generalized linear modelling was applied to assess the factors associated with antibiotic prescriptions. The relationship between the receipt of antibiotics and independent variables was presented using incident risk ratios (IRR). RESULTS: Our findings showed that all five WHO/INRUD prescribing indicators were above the reference limit for the two-year study period. The study found there was a significant statistical difference between the COVID- and non-COVID-19 periods, with polypharmacy and antibiotic use indicators elevated during the pandemic compared to the latter. COVID-19 (IRR = 1.09), comorbidity (IRR = 1.74), pregnancy (IRR = 0.93), out-of-pocket payments (IRR = 1.10) and the inpatient department (IRR = 1.51) were associated with antibiotic prescriptions. CONCLUSIONS: This provides insight on impact of the pandemic on prescription patterns and advocates for stewardship programs in clinical settings to ensure the rational use of drugs.

Assessment of the State of Pharmacovigilance in Secondary Hospitals in the Federal Capital Territory of Nigeria, Using WHO Pharmacovigilance Indicators.

BACKGROUND: The importance of pharmacovigilance (PV) in ensuring drug safety, especially in the detection and prevention of adverse drug reactions (ADRs) is critical. However, PV activities in Nigeria still face many challenges, such as very low spontaneous reporting rates, and inadequate training and funding. This study assessed the state of pharmacovigilance in the federal capital territory of Nigeria (FCT), using WHO pharmacovigilance indicators. METHODS: A cross-sectional questionnaire-based survey was carried out among secondary healthcare facilities in the FCT. The WHO Pharmacovigilance Indicators Questionnaire, which consists of the structural, process and outcome measures, was used to collect data from the focal person for pharmacovigilance at all the consenting facilities. Descriptive statistics were used to summarize all variables. Ethical approval was obtained from the Ethics Review Committee of the FCT development authority. RESULTS: Of the 14 secondary healthcare facilities in the FCT, 11 agreed to the study (response rate = 84.6%). Among the respondents, 4 (36.4%) were females, and 2 (18.2%) had 9 years of experience in pharmacovigilance. For the core structural indicators, 7 (63.6%) of the facilities had a pharmacovigilance center while only 4 (36.4%) had a copy of the Nigerian pharmacovigilance policy. Regarding financial provisions, 10 (90.9%) hospitals reported that there was no regular financial provision for the center while 10 (90.9%) centers had a standard adverse drug reaction reporting form. For the core process indicators, the mean ± SD of the nine core process indicators ranged from 0.9 ± 3.0 to 75.6 ± 38.6 and the total number of reports in the local database, therapeutic ineffectiveness, and medication error were limited. CONCLUSION: The assessment of pharmacovigilance activities in the Federal Capital Territory of Nigeria revealed significant gaps in infrastructure, financial support, and process implementation. Despite the presence of pharmacovigilance centers in the majority of facilities, the lack of consistent financial support and limited adherence to core process indicators highlight the need for enhanced training, resources, and policy enforcement to improve ADR reporting and overall drug safety monitoring. Strengthening these areas is crucial for advancing pharmacovigilance practices and ensuring patient safety in Nigeria.

Assessment of the knowledge of healthcare workers on monkeypox in Nigeria.

Background: Monkeypox, a re-emerging zoonotic disease caused by the monkeypox virus (MPXV), poses a public health challenge in Nigeria. To effectively combat this disease, it is essential to assess the knowledge of healthcare workers (HCWs) in Nigeria concerning monkeypox outbreak. Methods: A cross-sectional web-based survey with 609 healthcare workers in Nigeria was conducted using a structured questionnaire to assess their knowledge of monkeypox. Data were coded and analyzed with Microsoft Excel and Python in Anaconda Jupyter Notebook. Results: The majority of respondents (n=318, 52.2%) had good knowledge of MPXV but also had knowledge gaps regarding certain symptoms and disease similarities. Interestingly, respondents were completely unaware of the possibility of sexual transmission of the disease. However, they recognized the possible significant impact of monkeypox on the social and economic lifestyle of Nigerians (n=582, 95.6%, adjOR=21.181, 95% CI: 14.450-31.051). Respondents had mixed knowledge regarding the use of smallpox vaccines and antiviral agents for monkeypox prevention and treatment. Furthermore, a significant proportion (n=526, 86.4%, adjOR=0.159, 95% CI: 0.126-0.201) attributed the outbreak to bioterrorism. The logistic regression highlighted a strong influence of academic qualification, type of healthcare provider, years of experience, and geopolitical zone of practice, on monkeypox knowledge in Nigeria. Conclusion: The study highlights the importance of continuous education for healthcare professionals in Nigeria to improve monkeypox outbreak management. Despite their moderate performance, there are knowledge gaps in critical areas among HCWs, necessitating further research to explore reasons and influencing factors for knowledge levels.

A Cross-sectional Study on Effects of University Closure Due to Industrial Disputes on Pharmacy Students.

OBJECTIVE: To assess the effects of the closure of universities due to industrial disputes on pharmacy students. METHODS: A descriptive cross-sectional study was conducted among third-year to final-year pharmacy students at the University of Nigeria Nsukka (UNN) from July to August 2023 using a 23-item structured self-administered questionnaire. Responses were analyzed using SPSS v27.0. Frequencies and percentages were used to describe the variables, while chi-square tested the association between the variables. RESULTS: Of 306 students who participated in the study (response rate: 99.0%), 218 (71.2%) were within the age range of 21 to 25 years, while more than half of the participants 187 (61.0%) had less than 4 distinctions in the last professional examinations. Overall, slightly above half of the respondents 172 (56.2%) were negatively impacted by the strike; more than half of them agreed to the item "I felt anxious and unprepared for school activities after the strike" 204 (66.7%). Slightly above half of them also had a good perception of the strike 154 (50.3%); more than half of them agreed with the item "During the strike, I felt that education has lost its worth" 212 (69.3%). Students with less than 4 distinctions in the last professional examination had a better perception of the strike, while students aged 21 to 25 years were more negatively impacted by the strike than other students. CONCLUSION: Academic strikes in Nigerian universities caused anxiety, increased reported depressive episodes, and poor performance among pharmacy students, necessitating online classes and prompt dispute resolution.

Assessment of Academic Resilience and Its Associated Factors Among Pharmacy Students in Twelve Countries.

OBJECTIVE: Academic resilience, a critical determinant of academic achievement, is affected by various factors. There is a paucity of large-scale international assessments of academic resilience among pharmacy students. Therefore, this study aimed to assess academic resilience among pharmacy students in 12 countries and to evaluate factors associated with their academic resilience levels. METHODS: A cross-sectional online survey-based study was conducted among randomly selected pharmacy students in 12 countries: Egypt, Türkiye, Indonesia, Pakistan, Bangladesh, Iraq, Jordan, Nigeria, Malaysia, Saudi Arabia, Sudan, and the United Arab Emirates. After pilot testing, the validated 30-item academic resilience scale (ARS) was used for the assessment. The data were collected between November 1, 2022 and April 15, 2023. Descriptive and inferential statistics were performed, as appropriate. RESULTS: A total of 3950 were received from the 12 participating countries. The mean age was 21.68 ± 2.62 years. About two-thirds of the responses were from female participants and those studying for Bachelor of Pharmacy degrees. Overall, the findings show moderate academic resilience, which varied across countries. The median (IQR) of the total ARS-30 was 114 (103-124). Females exhibited lower negative affective and emotional response subscale levels than males. There were significant cross-country variations in the ARS-30 and all subscales. The highest overall levels were reported for Sudan, Pakistan, and Nigeria and the lowest were reported for Indonesia and Türkiye. Students in private universities tended to have higher overall ARS levels than public university students. Higher academic performance was significantly associated with ARS levels, whereas those with excellent performance exhibited the highest ARS levels. Students with exercise routines had higher ARS levels than those without exercise routines. Finally, students who were engaged in extracurricular activities had higher ARS levels than those who did not participate in these activities. CONCLUSION: The study offers insights into the factors affecting academic resilience in pharmacy students across several countries. The findings could guide interventions and support activities to improve resilience and academic outcomes.

Willingness to Pay for Clinical Pharmacy Services Among People With Diabetes in Nigerian Community Pharmacies.

OBJECTIVES: This study aimed to assess willingness to pay (WTP) for clinical pharmacy services among people with diabetes and to determine the factors affecting WTP for these services. METHODS: This was a cross-sectional exit survey of 450 people with diabetes visiting 15 community pharmacies in Uyo metropolis, Akwa Ibom State, Nigeria, between August and September 2021. Self-reported questionnaires were administered to eligible patients just before leaving the community pharmacy. Data were analyzed using SPSS (version 25.0). Statistical significance was set at P < .05. RESULTS: Response rate was 87.3%. Two hundred respondents (50.9%) were willing to pay an average amount of US$2.83 (minimum-maximum, US$0.12-US$24.27) for clinical pharmacy services. The two most often cited reasons for those who were unwilling to pay were their inability to pay and their opposition to paying for any healthcare services. Employment status (P < .001), personal monthly income (P < .001), satisfaction with income (P < .001), household monthly income (P < .001), health insurance coverage (P < .001), insulin use (P < .001), perception of the pharmacist's relevance in healthcare (P = .013) and in diabetes care (P < .001), and satisfaction with the pharmacist's services (P < .001) significantly affected WTP choices. None of the patient characteristics predicted the maximum amounts patients were willing to pay. CONCLUSIONS: Many of the people with diabetes assessed were willing to pay for clinical services at a reasonable price. Although most patient variables affected their WTP choices, none of the variables predicted the maximum amount they were willing to pay. For possible remuneration for clinical services, community pharmacists should continue to grow their practices and stay current with patient care.

Assessing health-related quality of life of people with diabetes in Nigeria using the EQ-5D-5L: a cross-sectional study.

Assessing the health-related quality of life (HRQoL) of people with diabetes is important to evaluate treatment effectiveness and identify interventions that would be beneficial to the patients. This descriptive cross-sectional study aimed to assess the HRQoL of people with diabetes visiting 15 community pharmacies in Akwa Ibom State, Nigeria, and to identify its determinants. The English (Nigeria) version of the EQ-5D-5L was administered to 420 eligible patients between August and September 2021. Data were analyzed with SPSS (IBM version 25.0) and presented descriptively; differences in HRQoL scores were examined using inferential statistics. Statistical significance was set at p < 0.05. Most participants (56.8%) were female; 193 (49.6%) were between the ages of 30 and 49. The median (interquartile range, IQR) for the EQ VAS and EQ-5D-5L index scores, respectively, were 80.0 (65.0-85.0) and 0.77 (0.62-0.90). Most participants reported problems with usual activities (52.7%), pain/discomfort (60.2%), and anxiety/depression (57.6%). The EQ VAS score and EQ-5D-5L utility index were significantly (p < 0.05) associated with respondents' age, marital status, work status, and personal monthly income. The HRQoL of participants was relatively high. Nevertheless, implementing strategies aimed at pain management and providing psychological support for people with diabetes in Nigeria may improve their HRQoL.

Assessment of public knowledge and attitude toward antibiotics use and resistance: a community pharmacy-based survey.

BACKGROUND: Antimicrobial resistance is a public health challenge affecting all aspects of healthcare systems. Policies to reduce antimicrobial resistance should be implemented and monitored in community pharmacies, because they are patients' first point of care. Public awareness of relevant knowledge and attitudes on antimicrobials is a feasible strategy to mitigate the spread of antimicrobial resistance by exploiting the relationship between pharmacists and patients in the community pharmacy setting. The study evaluated and determined predictors of antibiotic knowledge and attitudes toward antibiotic use and resistance in community pharmacy patients. METHODS: A cross-sectional design was used to retrieve data in five randomly selected community pharmacies in Lagos and Abuja using a self-administered questionnaire. Descriptive and inferential statistics were utilized for characterizing and determining the associations between predictors and outcomes at p < 0.05. Logistic regression was used to identify predictors of patients' knowledge and attitude to antibiotic use. RESULTS: A total of 964 clients participated in the study: 526(54.7%) were females, and 358(37.3%) were aged 25-34. chlorpheniramine-maleate and levonorgestrel were wrongly identified as antibiotics by 621 (64%) and 490 (50%) respondents, respectively. Many respondents, 448(46.5%), strongly agree that antibiotic creams should be mixed with body creams. The result of the multivariable logistic regression showed secondary education [Odds Ratio (OR): 0.31, 95% CI 0.10-0.97, p value: 0.044], urban residence (OR: 1.45, 95% CI 1.01-2.08, p value: 0.043) and age 34 (OR: 1.55, 95% CI 1.01-2.37, p value: 0.045) were strong predictors of knowledge on antibiotics, while community pharmacy location (OR: 5.48, 95% CI 3.45-8.70, p value: ≤ 0.001), urban residence (OR: 2.57, 95% CI 1.67-3.96, p value: ≤ 0.001), and antibiotic recommender (OR: 0.55, 95% CI 0.35-0.85, p value: 0.008) were predictors of respondents' attitude to antibiotic use. CONCLUSIONS: The study established that sociodemographic factors could impact community pharmacy clients' knowledge and attitude toward antibiotic use and resistance and should be considered when developing policies to curb the spread of resistant microbes. Community pharmacies should educate community pharmacy clients on the dangers associated with the misuse of antibiotics with stringent antibiotic stewardship programs and restrict access to antibiotics over-the-counter.

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.

Effectiveness of educational interventions on hypertensive patients' self-management behaviours: an umbrella review protocol.

BACKGROUND: Although different educational interventions have been widely used to manage and treat hypertension, alone or in combination with other interventions, there is a significant variation in their claimed effectiveness. REVIEW QUESTION/OBJECTIVE: The objective of this umbrella review is to determine the effectiveness of educational interventions, alone or in combination with other interventions, for improving blood pressure control and self-management practices among hypertensive patients. The review question is: Do educational interventions, alone or in combination with other interventions, improve self-management practices among patients with hypertension? METHODS: We will conduct a review of systematic reviews involving studies that implemented educational interventions, alone or in combination with other interventions, designed to change self-care practices among hypertensive patients who are 18 years and above, regardless of their sex and ethnicity. Following the guidelines set forth in the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, a comprehensive literature search will be conducted from September to December 2023 on six electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar. Search terms will be developed using database-specific indexed terms and text words derived from the review aim. We will present the effects of the educational interventions, alone or in combination with other interventions, on hypertension self-management practices. We will report the outcome data with 95% CIs for each study. Relative risk, mean differences or ORs will be used, depending on the measuring indices in each study. ETHICS AND DISSEMINATION: Ethical approval is not required as this study will use aggregated data from previously published systematic reviews. However, we have registered the protocol in PROSPERO. We confirm that all methods will be performed following the guidelines of the Declaration of Helsinki. The findings from this study will be disseminated through presentations at academic conferences and publication in peer-reviewed international journals. PROSPERO REGISTRATION NUMBER: CRD42022375581.

Predictors of fertility awareness among selected married women of childbearing age in Nigeria: a cross-sectional survey.

Background: Increased fertility awareness can help infertile couples to achieve pregnancy. Objectives: This study aimed to determine both the predictors and levels of fertility awareness among married Nigerian women of childbearing age. Methods: A nationwide cross-sectional survey. Data were collected via online and face to face questionnaires. Descriptive and inferential analysis were done with SPSS 25. Results: Most respondents married between ages 24-29 years old (40%) and just over half had good fertility awareness (53%). The associated factors were age at menarche (X2 = 9.962, p = 0.007), geopolitical zone of residence (X2 = 17.301, p = 0.008), level of education (X2 = 64.843, p < 0.001), employment status (X2 = 9.319 p = 0.025) menstrual cycle charting (X2 = 66.392, p < 0.001), use of internet to increase awareness (X2 = 39.849, p < 0.001) and books (X2 = 58.855, p < 0.001). Fertility awareness was lower for those with secondary education than postgraduates (AOR=0.213, 95% CI 0.116-0.390, p < 0.001). Moreover, the odds of having good fertility awareness were less in those who did not chart their menstrual cycle (AOR=0.363, 95% CI 0.245-0.538, p < 0.001). Conclusion: Menstrual cycle charting and level of education were predictors of fertility awareness.

Healthcare professionals' perceived stigmatization about direct care of COVID-19 Patients: development and validation of the discrimination about COVID-19 (DisCOV-19) instrument.

Background: The novel coronavirus disease 2019 (COVID-19) is a public health concern worldwide. Healthcare professionals are among the most vulnerable groups in the fight against COVID-19 because they are directly involved in the care of at-risk persons and patients with Covid-19. Objectives: This study aimed to measure the level to which healthcare workers feel that they can be discriminated due to their involvement in the direct care of COVID-19 patients. Methods: A cross-sectional online survey was conducted among healthcare professionals in Nigeria. A nineteen-item discrimination against COVID-19 (DisCOV-19) questionnaire was developed and validated for the study. Descriptive statistics and One-Way Analysis of Variance were used for data analysis. P<0.05 was considered statistically significant. Results: Out of the 286 healthcare practitioners that participated in the study, 58.4% and 30.1% were pharmacists and physicians, respectively. The majority of the participants were at least "moderately concerned" about disability (60.9%), death (71.7%), unknown complications (65.1%), and risk of infecting family members and friends (83.2%) if asked to provide care for COVID-19 patients. The physicians had a significantly higher mean discrimination score compared to the pharmacists (p=0.041). Pharmacists had a significantly lower mean discrimination score than the nurses (p=0.011). Conclusions: Many of the healthcare professionals reported a certain level of concern and perceived that they could face some forms of discrimination for providing care to COVID-19 patients.

Factors associated with the timely completion of doctoral research studies in clinical pharmacy: A mixed-methods study.

INTRODUCTION: There is growing scientific evidence of mental and well-being issues that doctoral research students face as a result of not finishing their program on time. This study aims to explore the factors associated with the timely completion of doctoral research studies in the clinical pharmacy speciality. METHODS: This was a mixed-method study that combined surveys with in-depth interviews. Current doctoral research students and pharmacists who have recently completed their doctoral research program participated in the study. A validated questionnaire and an interview topic guide developed from the literature and pretesting were used to collect data. Data for this study were collected between February 2021 and September 2021. Quantitative data were analysed with the Statistical Package for Social Sciences (SPSS) V.25 while interview data were subjected to reflexive thematic analysis. RESULTS: 47 students who are currently pursuing their doctoral research program in clinical pharmacy participated in the survey, while 8 pharmacists who had recently completed their doctoral research program in clinical pharmacy participated in the in-depth interviews. Five themes were identified: factors contributing to delay in the program, factors contributing to the timely completion of the program, ways to improve the program, advice to current students and advice to prospective students. Having more than one supervisor, supervisors' commitment to the research work and support from the department were identified as facilitators of timely completion of doctoral research programs in clinical pharmacy. CONCLUSION: Our study provides an understanding of the barriers and facilitators of timely completion of doctoral research programs in the clinical pharmacy specialist, and how these can be used to improve the postgraduate study programs in Nigeria.

Pharmacists' Readiness to Receive, Recommend and Administer COVID-19 Vaccines in an African Country: An Online Multiple-Practice Settings Survey in Nigeria.

Background: Without a cure, vaccination is the most reliable means of combating COVID-19 pandemic, since non-pharmacological measures could not prevent its spread, as evidenced in the emergence of a second wave. This study assessed the readiness of pharmacists to receive, recommend and administer COVID-19 vaccines to clients in Nigeria. Methods: This was a cross-sectional study in which responses were collected from pharmacists in Nigeria through Google Form link. A 21-item questionnaire was developed and validated for the study. The link was shared on the WhatsApp groups of eligible respondents. The response was downloaded into Microsoft Excel (2019) and cleared of errors. This was uploaded into KwikTables (Beta Version 2021) for data analysis. Descriptive statistics such as frequencies and percentages were used to describe the data. Chi-squared test was used to determine the relationship between all the responses and the practice areas of the pharmacists. Results: A total of 509 pharmacists responded to the study, but 507 indicated their areas of practice. The highest response of 247(48.7%) was obtained from hospital pharmacists, then community pharmacists; 157(31.0%). Hospital and community pharmacists accounted for 96 and 66 of the 191(37.7%) pharmacists that would probably accept the vaccine (p=0.126). The Pfizer-bioNTech vaccine was the preferred brand for 275(54.2%) respondents. Healthcare Professionals>Elderly>General Populace>Children was the order of roll-out recommended by 317(62.5%). Adverse-effect-following-immunization was the concern of 330(65.1%) pharmacists. Age was a factor in their likelihood of recommending the COVID-19 vaccine to clients (p=0.001). Conclusion: This study established that most pharmacists are willing to accept to be vaccinated against COVID-19, recommend and administer it to other citizens. They were impressed by the effectiveness and cost of some of the vaccines, but were concerned about their possible adverse effects. The pharmacists would want the authorities to consider strategies that will make the vaccines accessible to all citizens.