Prescribing practices in the management of childhood diarrhoea in primary health care centres in a sub-urban community in Nigeria

Background: Childhood diarrhoea remains the second leading cause of morbidity and mortality among children under the age of five. Oral rehydration therapy and zinc tablets are the cornerstone for its management both at home and in the health facilities. Primary health care is the first level of contact of individuals and communities with the health care system and appropriate prescription is crucial for sustainable health benefits. This study assessed the prescribing pattern for childhood diarrhoea management and determined the appropriateness of treatment for acute watery diarrhoea without comorbidities in Primary Health Care (PHC) facilities in a sub-urban community in Nigeria.Methods: This descriptive study was done in 19 PHC facilities in Ikorodu Local Government Area of Lagos State, Nigeria. A retrospective review of 1271 prescriptions for diarrhoeal cases of children between 6 to 59 months was done using the records from the Outpatient Department register for a period of one year. Descriptive analysis was done. Results: From the cases reviewed, 1239 (97.5%) had acute watery diarrhoea (AWD), either alone 819 (64.4%), or with malaria/fever 347 (27.3%), cough/URTI 59 (4.6%), and other conditions 14 (1.1%). For cases of AWD alone, there were 499 (60.9%) prescriptions for ORS/Zinc, 249 (30.4%) for antibiotics and 203 (28.4%) for antimalarials. Antibiotic and antimalarial injections were also included in the prescriptions.Conclusion: This study found the prescription pattern for childhood diarrhoea to be inadequate with suboptimal prescriptions of ORS/Zinc. The prescriptions of antibiotics and antimalarials for acute watery diarrhoea was high and unnecessary

Knowledge and use of insecticide treated nets as a malaria preventive tool among pregnant women in a local government area of Lagos state, Nigeria.

Malaria has been described as the foremost public health concern in tropical and subtropical regions of the world, Nigeria inclusive. This survey set out to assess the knowledge, attitude and practice on the use of ITNs as a malaria preventive tool among pregnant women and to determine its level of recommendation and proper instructions given by pharmacists. Structured questionnaires were administered to pregnant women attending antenatal clinics at two selected hospitals in Alimosho Local Government Area (ALGA) of Lagos State and also to community pharmacists practicing in the same ALGA. Data was analyzed using Epi Info 2002 and Microsoft Excel. Forty eight community pharmacists and 163 pregnant women participated in the study. About 77 and 91% of pregnant women were aware of ITNs at Igando GH and the private hospital respectively. Only 11.2% and 37.5% actually used it. Majority of the pharmacists (95.8%) recommended the use of ITNs and 95% of them also gave counsel on ITN use while 5% did not. There is a wide difference between the level of awareness and the rate of use of ITNs by pregnant women. More emphasis should be placed on ownership and use of ITNs so that the benefit of its protection can be derived.

Antimalarial Prescribing Patterns in State Hospitals and Selected Parastatal Hospitals in Lagos; Nigeria

Background: Malaria is a curable and preventable disease and it is a major public health problem in Nigeria. Chloroquine was the first line drug in its treatment in Nigeria until recently where the Artemisinin based Combination Therapies (ACTs) are being promoted. Inappropriate prescribing i.e. the failure to prescribe drugs in accordance with guidelines based on scientific evidence to ensure safe; effective; and economic use; is an irrational drug use behavior. Increased benefits from chloroquine or a slowdown of progression to resistance could be achieved by improving prescribing practice; drug quality; and patient compliance. Objective: To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State. Methods: The study was carried out in all the ten government General Hospitals under Lagos State Hospitals Management Board (now Lagos State Health Service Commission); one parastatal hospital and one oil company clinic; using patient prescriptions. One hundred prescriptions each for adults and children for each month for a period of one year ( January to December 2000) were systematically sampled. Where there were fewer than 100 prescriptions in a month; all the prescriptions available were sampled for analysis. Results: Average number of drugs per encounter in all the hospitals was 4.259 + 0.009. Average number of injections per encounter was 1.215 + 0.009. About 48.5of all the presriptions had at least one injection while 40.9of the prescriptions had dipyrone injection. Average drug cost per encounter was N 147.40 + 0.765. Percentage of encounters with chloroquine was 82.5followed by sulphadoxinepyrimethamine 14.2. Percentage of prescriptions with correct dose of chloroquine was 47.5Conclusions: Polypharmacy exists in all the hospitals.The average number of drugs per encounter for the majority of the hospitals was above 4 . Less than half of the prescriptions had the correct dose of chloroquine. This study can serve as a baseline for intervention on irrational prescribing

Cigarette Smoking among Healthcare Professional Students of University of Lagos and Lagos University Teaching Hospital (Luth); Idi-Araba; Lagos; Nigeria

Background:It is aknown fact that health professionals can play a critical role in reducing tobacco use. In fact; it has been shown that even brief and simple advice from health care professionals can substantially increase smoking cessation rates. Students in healthcare professions are future healthcare professionals; identifying and documenting their knowledge; attitudes and practices with regards to tobacco smoking would shed light as to their future effectiveness in providing this much needed public health initiative in their practices. Objective: This research was carried out to determine cigarette smoking habit among healthcare professional students of University of Lagos and Nursing students of Lagos University Teaching Hospital. Methods: The study was a cross-sectional descriptive survey. Data was collected by the use of a structured; self administered questionnaire which was aimed at determining their smoking status and their attitudes. The target population was first and final professional year students representing the two class extremes and attempt was made to survey all the students that fell within this identified target population without randomization. Data was collected between March and June 2007 Results: Out of 814 qualified participants; 433 responded to the questionnaire (53). Smoking prevalence was highest among dental students (8.48) while both Physiotherapy and Nursing students had nil prevalence rates. Overall; the current smoking prevalence was 3.93. There was no statistically significant difference between the smoking habits of first year and final year students (p= 0.99). Based on Fagerstrom nicotine addiction test; only a small proportion of the current smokers can be classified as being maximally addicted (6.0). Conclusions: From this study it can be concluded that smoking prevalence is low among healthcare professional students at the University of Lagos and this is a good indication that they would play critical role in reducing tobacco use. It is recommended that a tobacco counselling unit should be set up by the school authority

Care-seeking Behaviour for Malaria Treatment among Community Primary School Teachers (a Cross Sectional Study)

Background: Malaria is one of the leading causes of morbidity and mortality in Nigeria; especially among the vulnerable groups; the pregnant women and children under five years. Malaria control through appropriate attitudinal approach remains very vital because even with a large arsenal of treatment and preventive measures; wrong attitude to these control measures will obviate or reduce the overall impact of malaria control. Aim: To determine how malaria is identified and diagnosed among community primary school teachers; their care seeking behavior and possible factors that influence their choice of care source and also how prompt they seek care when malaria is perceived. Methods: Structured questionnaires were used to collect information from the study group. A community - based cross sectional study was carried out among 920 community primary school teachers in 60 public primary schools. Data was analysed using SPSS and differences in proportions were compared using chi-square test. P -value 0.05 was considered statistically significant. Results: The findings indicate that malaria is correctly identified but self-diagnosis [427 (46.4)] is more common among the respondents. However; diagnosing malaria for their children was more by laboratory test. Over one half of the respondents sought care in either government or private health facilities with effectiveness of treatment outcome being the major factor that influences their choice of care source. While 521 (57.3) of the respondents sought care for their children within 24 hours of onset of malaria symptoms; 606 (66) of them sought care for themselves as soon as they noticed the malaria signs and symptoms. Conclusion: The respondents in this study exhibited positive care-seeking behaviour; although their malaria diagnosis is highly presumptive. The reliability of treatment obtained is a crucial factor in the choice of the respondents' care source