Artemisinin-based antimalarial combination therapy amongst healthcare professionals in a tertiary facility in south-south Nigeria: preferences, tolerability, and cost considerations

Background: Nigeria adopted the Artemisinin-Based Combination Therapy (ACT) as the mainstay of treating uncomplicated malaria in February 2005. However, the individual preferences for the use of these medicines by health care professionals (HCP) as distinct from their observed prescribing practices is largely unknown. This study determined the preferences, tolerability and cost of the ACTs among HCP in Benin-City. Methods: This descriptive cross-sectional study was conducted in the University of Benin Teaching Hospital, Benin-City, Nigeria. Consenting HCPs were recruited consecutively for the study. Semi structured questionnaires were administered to doctors, nurses and pharmacists in the hospital. Information obtained included demographics, treatment of malaria in the previous year, antimalarial medication preferences and tolerability as well as cost of ACT. Results: A total of 556 HCPs, 295 doctors (54.1%), nurses 200 (36.0%), pharmacists 61(11.0%) completed the questionnaire. In the previous year, 224 (75.9%) doctors, 153 (79.1%) nurses, and 48 (70.5%) pharmacists had treatment for malaria and self-medication was highest among doctors (228,77.3%). Artemether-Lumenfantrine was the most preferred antimalarial used, 294 (52.8%); however, 1.6% used chloroquine sulphate and ACTs were perceived to be ineffective by 25.4%. Adverse effects were experienced by 167 (29.1%) resulting in 50 (9.0%) discontinuing their medication. Between 500 and 1500 Naira (~US$1-4) was expended on ACT by 66.3% of the staff, while 21.4% were concerned about the high cost of medications. Conclusion: This study highlights the use and preferences, self-medication practices, perceived lack of effectiveness and high cost of ACTs from a HCP perspective. There is an urgent need to address these concerns in view of adverse consequences as well as the likely possibility of its the impact on prescribing practices.

The current use of the artemisinin-based combination therapies in adult patients at a tertiary hospital, South-South Nigeria

Objective:The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommendedtreatment for Plasmodium falciparum.We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria. Methods:This was a cross-sectional study conducted among adult patients and their caregivers atthe University of Benin Teaching Hospital, Nigeria,using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought.Result:Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0%), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors' prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312(52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira.Conclusion: This study showed adult patients' preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians.

Adherence To Essential Hypertension Treatment Guidelines In A Tertiary Hospital In Nigeria

Objective: This study determined the level of prescribers’ adherence to the World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the management of hypertension at the Lagos University Teaching Hospital (LUTH), Nigeria. Methods: This study employed a retrospective cross-sectional design. Two groups were used: Group A (300 patients) were treated before the guidelines review in 2003, while Group B (200 patients) were treated after. The two study groups were compared, and systolic blood pressure of 130 mm Hg or above was taken as the index of hypertension. Results: There were 198 (66%) male patients in Group A, while Group B had 136 (68%) males. The highest age for Group A was 50–59 y for 89 (30%) patients, unlike group B that had 58 (29%) patients in aged 40–49 y as the highest. The highest blood pressure range for patients in Group A was 150–159 mm Hg for 64 (21%) patients, unlike Group B that had 43 (22%) patients as the highest in the same range. Furosemide was present in 282 (24%) prescriptions for group A patients. However, atenolol was present in 61 (20%) prescriptions for the same group. In group B, Furosemide was prescribed in 197 (97%) encounters, while Nifedipine was found in 81(40%) prescriptions. Conclusion: Prescribers at LUTH complied substantially with WHO/ISH guidelines in the management of hypertension. Diuretics and beta-blockers were used before the guideline review. After the review, diuretics and calcium channel blockers were the most frequently prescribed antihypertensives.

Association between maternal lipid profile and gestational diabetes mellitus

Background: Dyslipidemia is the third component of metabolic syndrome and is a wellknown cardiovascular risk factor. However, the association of dyslipidemia with gestational diabetes mellitus is still a subject of ongoing research in Nigerian obstetric populations.Objective: To determine the relationship between second trimester maternal fasting plasma lipid constituents and gestational diabetes mellitus.Methods: This was a prospective nested case control study that enrolled 288 pregnant women out of which 36 women with GDM (cases) where matched with 72 without GDM (controls) following results of oral glucosetolerance testing and plasma fasting lipid profiles done between 24 28 weeks. The patients were followed up until delivery to document maternal and fetal outcomes. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in percentages while continuous variables were expressed as means (±Standard Deviation). Student ttest and Chisquare test or Fishers exact test were used for comparing variables between the two groups. A value of <0.05 at 95%confidence interval was considered statistically significant.Results: The overall mean plasma lipid levels for the four lipid constituents in the study population were 187.9mg/dL, 163.5mg/dl, 49.1mg/dL and 108.1mg/dL for TC, TG, HDLc and LDc respectively. The mean plasma triglyceride was significantly higher in cases compared to the controls: 187.0±67.7mg/dL vs. 151.7±66.4mg/dL, (p = 0.01). Abnormaltriglyceride was significantly associated with GDM (AOR:4.8, 95% CI (1.6-14.4), (p= 0.005).Conclusion:Maternal dyslipidemia (abnormal triglyceride) was shown to be significantly associated with GDM in this study and it appeared to be causally related

Genotype And Abo Blood Group Association With Prevalence Of Malaria Among Patients In University Of Nigeria Medical Center: A Cross-Sectional Evaluation

Objective: The aim of this study was to evaluate the prevalence of malaria and its relationship with the ABO blood group and genotype at the University of Nigeria Medical Centre. Methods: The study had a prospective cross-sectional design in which malaria status and blood groups and genotype were determined. All collected data were analysed using Statistical product and services Solution (V.21). Frequencies and percentages were used to describe the data while Chi-square and Pearson correlation were used to determine associations between malaria prevalence and patients’ demographic and clinical characteristics. Statistical significance was considered for p<0.05. Results: Three hundred and twenty-three (323) patients were tested for malaria, 245(75.9%) of whom tested positive. The prevalence was highest for patient’s aged 19-25 y (28.5%). The difference was statistically significant for age: χ2 (5) = 33.60, p = 0.0005. There were more blood group O (57.6%) among the patients, while AA genotype was the majority (72.4%). Those with blood group O had the highest prevalence of malaria (33.7%) and it was statistically significant (χ2 (3) = 72.10, p = 0.0005)). Correlation showed that the association between blood group and malaria prevalence was moderate (R = 0.457). The AA genotype had more incidence of malaria (54.5%), but the difference was not statistically significant. Conclusion: The prevalence of malaria was high among the patients surveyed. Its association with the patients’ ABO blood group was established to be statistically significant, with blood group O having the highest incidence. Although AA genotype was observed to have the highest cases of malaria, the relationship was found not to be significant.

Use of Intermittent Preventive Treatment for Malaria among Pregnant Women in Kubwa, Abuja, Nigeria.

Background and Aims of Study: Malaria in pregnancy remains one of the infectious diseases threatening the health of pregnant women and the unborn child in Africa. The use of Sulphadoxine-Pyrimethamine (SP) as intermittent preventive treatment of malaria in pregnancy (IPTp) has been shown to greatly reduce the impact of malaria in pregnancy and its complications when administered appropriately according to set protocol. The aim of this study is to ascertain the appropriate use of SP among pregnant women who received ante-natal care (ANC) and determine its relationship with feto-maternal outcome. Place and Duration of Study: Daughters of charity Primary Health Center, Kubwa, Abuja, between January 2010 and June 2011. Methodology: A retrospective study of 200 pregnant women, who attended ANC, delivered and followed-up to post-natal clinic at Daughters of Charity primary health centre and was administered SP between January 2010 and June 2011. Ante-natal records were retrieved and socio-demographic variable, number of doses of SP received as well as feto-maternal outcome were collected and analyzed. Results: The use of IPTp among pregnant women in this facility is low, accounting for only 6% of the study population, while 79% were not administered IPTp throughout their pregnancy. Majority of the primigravida (61 out of 70) who were more vulnerable to malaria in pregnancy did not receive any dose of IPTp. Conclusion: More effort is required to increase IPTp coverage in the community. This may be achieved by improving the awareness of IPTp among health care workers, pregnant women and the entire community at large.

Antimicrobial and Preliminary Phytochemical studies of Methanol Extract of Root Bark of Crossopteryx febrifuga (Rubiaceae).

Crossopteryx febrifuga is one of the useful plants used in Hausa traditional medicine in North Western Nigeria. It belongs to the family Rubiaceae. The phytochemical studies of the root bark of the plant was carried out using standard procedure. The was found tocontain: steroids, flavonoids, terpenoids, anthraquinones, cardiac glycosides, tannins, alkaloids and saponnins. The antimicrobial activity screening was carried out using both bacterial and fungal strains. The bacterial strains include: Pseudomonas aeruginosa, Staphylococcus aureus, Eschericia coli. The fungal strains Include: Aspergillus fumigatus, Candida albicans, Aspergillus flavus and Aspergillus niger. In general, the extract showed considerable activity on the bacterial species. It inhibited the growth of both gram positive and gram negative microorganism with zones of inhibition ranging from 7- 23 mm at concentrations of 50 μg/ml, 100 μg/ml and 200 μg/ml. The plant extract did not show significant activity on fungal strains. It inhibited the growth of Aspergillus fumigatus at 400 μg/ml and 500 μg/ml which produced zones of inhibition of 8 mm and 12 mm respectively at the stated concentration. It can be concluded that the activity showed by the methanolic extract of the plant is as a result of the phytochemicals present in the plant.

Use of anhydrous calcium phosphate and selected binders in the tablet formulation of a deliquescent crude plant extract: Vernonia galamensis (Asteraceae).

In this study, the effect of anhydrous calcium phosphate, an efflorescent pharmaceutical powder of reduced moisture content, ideal for moisture-sensitive materials; and the comparative binding effects of maize starch, polyvinylpyrrolidone and gelatin were investigated in the tablet formulation of the deliquescent crude extract of the leaves of Vernonia galamensis (Asteraceae). Materials used include; anhydrous calcium phosphate (BDH chemicals Ltd. Poole, England), maize starch and gelatin (May and Baker, Germany). Granule and tablet analyses were carried out according to standard procedures in the BP 2007. Preparations of the binders at varying concentrations of 2.5, 5.0 and 7.5% w/v were used to produce the granules by wet granulation method and compressed into tablets at 26.25KN. The mechanical strengths and drug release properties of the designed tablets were assessed using the crushing strengthfriability, disintegration time ratio (CSFR:DT) and dissolution rate. An increase in binder concentration led to an increase in crushing strength, decrease in friability and increase in disintegration time of the tablets. Anhydrous calcium phosphate used as diluent along with polyvinylpyrrolidone as binder produced the best quality tablets in terms of the CSFR: DT ratio and dissolution rate as compared to the diluent used with maize starch and gelatin as binders.

Primary bone tumours and tumour-like lesions in children in Zaria, Nigeria

Background: Studies on bone neoplasms are generally scanty globally and more so in children. Primary bone tumours and tumour-like lesions in children have not been reported from Zaria. Objective: To determine the relative frequencies; sex and age distributions; and anatomical sites of occurrence of primary bone tumours and tumour-like lesions in children in Zaria. Materials and Methods: A retrospective review of histopathology reports of 40 children with bone tumours and tumour-like lesions in 11 years of age. Results: Benign tumours accounted for 12 (30) of the 40 tumours reviewed (osteoma 2.5; osterochondroma 22.5; fibroma 5); while malignant tumours occurred in 19 (47.5) (osteosarcoma 5; Burkitt's lymphoma 37.5; diffuse lympholastic lymphoma 5). Tumour-like lesions accounted for 9 (22.5); all fibrous dysplasia. Out of 40 tumours; 23 (57.5) occurred in males and 17 (422.5) in females. The majority of tumours; 45occurred in the age group of 10-15 years; followed by 15 (37.5) occurring in the 5-9 years age range. The most common malignany was Burkitt's lymphoma 15 (37.5). Maxilla was the most common site for malignant (30) and benign tumours (12.5). Conclusion: This study has shown that; primary bone tumours are relatively uncommon in children in our setting