Knowledge, attitudes, and practices of adolescent girls regarding cervical cancer: a cross-sectional study in Enugu State, Nigeria.

Introduction: cervical cancer is the second leading cause of cancer death, among women, globally. The majority of the countries with the highest cervical cancer burden are in sub-Saharan Africa, including Nigeria. This study assessed the knowledge, attitudes, and practices regarding cervical cancer among secondary school students in an all-girls school. Methods: this cross-sectional study was conducted in Nsukka, Enugu State, Nigeria (April 2021). A 30-item self-administered structured questionnaire was filled by conveniently sampled students in Senior Secondary School (SS 2 and SS 3). Pearson's Chi-square was used to test the association between variables (Statistical significance: P < 0.05). Results: the mean age of the 103 respondents was 16.10 (± 1.00) years. The most common source of information about cervical cancer was mass media (n = 20, 19.4%). Less than half of the respondents had good knowledge of cervical cancer (n = 44; 42.7%) and had favorable attitudes towards the disease (n = 50; 48.5%). More than half of them had good cervical cancer practices (n = 87; 84.5%). They were highly open to screening (n = 92; 89.3%) and vaccination (n = 93; 90.3%). More respondents who had first-hand experience of cervical cancer from family members were aware of the disease compared to those who did not (71.4% Vs. 33.3%; χ2= 4.113; P = 0.043). Conclusion: the study highlights the need for adolescent girls to be educated about cervical cancer, to improve their knowledge and attitudes towards the disease, so they can make informed decisions about their practices.

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.

The effect of classroom lectures and a movie recommendation on pharmacy students' attitudes and social distancing toward people with schizophrenia.

INTRODUCTION: Stigma and negative attitudes toward people with mental health disorders can impair the provision of pharmaceutical care. The purpose of the study was to assess the effect of classroom lectures on mental health disorders and a movie recommendation on pharmacy students' attitudes and stigma toward persons with schizophrenia (PwS). METHODS: The study consisted of a presurvey and postsurvey carried out among final-year pharmacy students of the University of Nigeria Nsukka. A survey comprising 3 sections on sociodemographic details, attitudes toward PwS, and a social distance scale was given to conveniently sampled students before and after lectures on schizophrenia. Students were encouraged to watch a movie about the experiences of a PwS after the first lecture. RESULTS: One hundred seventy-nine students (of the 200 sampled, response rate 91.1%) agreed to participate and completed the survey instrument before the clinical lecture, whereas 108 students who took part in the presurvey participated in the postsurvey (response rate of 76.0%). The overall mean negative attitude score reduced from 2.79 ± 0.412 to 2.72 ± 0.357. The overall mean social distance score increased from 2.48 ± 0.415 to 2.49 ± 0.467, indicating increased stigma. In both presurveys and postsurveys, people with a friend or relative with schizophrenia had a lower mean negative attitude score compared with those who did not. People who had watched the movie recommendation (n = 85) had a higher mean negative attitude (2.74 vs 2.67, P = .433) and a lower social distance toward PwS (2.57 vs 2.48, P = .415). DISCUSSION: Classroom lectures on mental health among pharmacy students might not significantly improve the overall attitudes and social distance toward PwS. Schools of pharmacy should consider alternative formats of teaching mental health-related topics, such as contact with real patients and simulation.

Microbial contamination of packaged drinking water in Nigeria.

OBJECTIVES: About 18% of urban households in Nigeria depend on packaged sachet water as the primary source of drinking water. This review assessed microbial contamination of these products with an emphasis on total coliforms and the faecal indicator bacteria (FIB) - Escherichia coli (E. coli) and thermotolerant coliforms (TTC). METHODS: PubMed/Medline, African Index Medicus, AfroLib, Global Health Library, Embase and the ISI Web of Science databases were searched to identify original research published up to October 2020. The literature findings were synthesised narratively in line with the review objectives. To assess prevalence of microbial contamination, a random effects meta-analysis, was also conducted using the R metafor package in RStudio. The protocol for this review is registered on PROSPERO with reference number CRD 42019128474. RESULTS: Fifty-two of 429 studies were identified for inclusion. At 53.27%, contamination prevalence was higher for total coliforms (95% CI: 39.05-66.98, I2  = 81%, p < 0.01, 42 studies) than FIB (12.38%, 95% CI: 7.92-18.85, I2  = 61%, p < 0.01, 33 studies) suggesting that treatment failure is a major contributor to the poor microbial quality reported in the included studies. Within the FIB group, the prevalence of contamination with E. coli was 13.30% (95% CI: 8.23-20.80, I2  = 65%, p < 0.01, 27 studies) versus 6.24% (95% CI: 1.12-28.06, I2  = 72%, p < 0.01, six studies) for TTCs. Other microbial contaminants reported were Pseudomonas aeruginosa, Klebsiella and Enterococcus faecalis and these showed multidrug antibiotic resistance. CONCLUSIONS: The findings of this review highlight the need for improved regulatory oversight with more stringent monitoring of the microbial quality of sachet water products in Nigeria.

Patients' Satisfaction With Pharmaceutical Care Services in Asthma: An Intervention Study in 2 Nigerian Hospitals.

Quality in health care is commonly measured by patient satisfaction. This study assessed asthmatic patients' satisfaction with the pharmaceutical care services rendered in 2 Nigerian tertiary hospitals. This 3-arm intervention study was single-blinded, prospective, and randomized. The 3 arms were Usual Care, Individual Intervention, and Caregiver-assisted Intervention. Intervention arms received education for 6 months, whereas the Usual Care arm received no education. The Patient Satisfaction with Pharmaceutical Services questionnaire was utilized. Data were analyzed using the IBM SPSS Version 25.0 with statistical significance set as P < .05. Seventy-eight asthma patients participated in the 3-arm study. The majority of the patients (82.1%) were happy with the services provided by the pharmacists. More of the patients who received Individualized Intervention were highly satisfied, compared to those in the Caregiver-assisted Intervention arm and Usual Care arm (52.6% vs 44.7% vs 2.6%, χ2 = 32.124, P < .001). The Individualized Intervention satisfied patients better than the Caregiver-assisted Intervention. Pharmacists should strive to have direct communication with their patients despite the involvement of caregivers.

Knowledge and perception about asthma among students in a Nigerian single-sex secondary school.

INTRODUCTION: Asthma is prevalent among children and adolescents. Few studies have assessed the knowledge and perceptions of asthma among adolescents. OBJECTIVES: This study assessed the knowledge and perception about asthma among secondary school students in an all-girls school in Nigeria. METHODS: This cross-sectional study was conducted in a Nigerian secondary school in Enugu State (February 2020). In Senior Secondary School (SS1, SS2 and SS3), students could be in one of three specialized classes: Sciences, Humanities and Business. A self-administered structured questionnaire was filled by conveniently sampled students in SS1 and SS2. Inferential statistics utilized the Pearson's chi-square test and multiple linear regression with statistical significance set as P < 0.05. RESULTS: Three hundred and eighty-eight (388) students participated in the study (mean age = 14.64 ± 0.93 years). Majority of the students were in Science class (n = 299; 77.1%). There was high awareness about asthma (n = 384; 99.0%). More than half of them had good asthma knowledge (n = 279; 71.9%); close to three-fifths had favourable perception of asthma (n = 222; 57.2%). More students in SS2 had good knowledge of asthma compared to those in SS1 (76.7% vs. 67.2%; ꭓ2 = 4.338; P = 0.037). More students in Science class had favourable perceptions about asthma compared with those in Humanities and Business class (60.5% vs. 48.1% vs. 25.0%; ꭓ2 = 7.458; P = 0.024). CONCLUSION: Majority of the students were aware about asthma and had good knowledge of the disease while close to three-fifths had favourable perceptions about asthma.

Clinical pharmacy services provided in public sector hospitals in Nigeria: a national survey.

OBJECTIVES: Studies show that clinical pharmacy services are effective in optimizing medicines use and patients' outcomes. This study aimed to determine the clinical pharmacy services provided in public sector hospitals in Nigeria. METHODS: This was an online survey of 296 primary, secondary and tertiary care hospitals sampled purposively across the 36 States and Federal Capital Territory in Nigeria. Data analysis was conducted descriptively via χ 2 test and multivariate analysis of variance (MANOVA). KEY FINDINGS: Responses were obtained from 272 hospitals in the country with a survey completion rate of 88%. This included 55 tertiary, 72 secondary and 145 primary healthcare centres (PHCs). Pharmacists provided pharmaceutical care services in all the tertiary care hospitals, 94% of the secondary and in only 6% of the PHCs surveyed. Most of the secondary and tertiary care hospitals provided medicines information, patient education and counselling, and in-patient dispensing services [n = 97 (79%), 116 (94%), 88 (72%)], respectively. However, fewer than a third reported involvement in multidisciplinary ward rounds, medication chart review and antibiotic stewardship programmes [n = 18 (15%), 33 (27%), 22 (18%), respectively]. Furthermore, medication error reporting and pharmacovigilance services were each routinely provided in only about half of the secondary and tertiary care hospitals [n = 62 (50%)], and this was not associated with the level of care (P > 0.05). CONCLUSIONS: The findings of this study demonstrate disparity in clinical pharmacy service availability across the various levels of care in Nigeria and emphasize the need to prioritize their integration within the primary care sector.

Impact of pharmacist-led educational interventions on asthma control and adherence: single-blind, randomised clinical trial.

Background Asthma is an important cause of morbidity and mortality worldwide. Education is a critical component in the management of asthma. Objective This study sought to assess the impact of pharmacist-led educational interventions on asthma control and adherence. Setting Tertiary Hospitals in Nigeria Method This was a single-blind, three-arm, prospective, randomised, controlled, parallel-group study conducted in the Respiratory Units of the University of Nigeria Teaching Hospital, Enugu State and the Lagos University Teaching Hospital, Lagos State between March 2016 and September 2017. The three arms were: Usual Care, Individual Intervention, Caregiver-assisted Intervention (1:1:1 ratio). The Intervention arms received education for 6 months while the Usual Care arm received no education. The Asthma Control Test and the 8-item Morisky Medication Adherence Scale were filled at baseline, 3 months, and 6 months after baseline. Data were analyzed using the IBM SPSS Version 25.0 with statistical significance set as P < 0.05. Main outcome measure Asthma control and adherence. Results Seventy-eight (78) asthma patients participated; thirty-nine (39) per hospital; thirteen (13) in each arm. The Individual Intervention arm possessed significantly better asthma control compared to Usual Care at 3 months (21.42 Vs. 18.85; P = 0.004, t = 3.124, df = 25, 95% confidence interval = 0.88 - 4.28) and 6 months (21.81 Vs. 19.58; P = 0.003, t = 3.259, df = 25, 95% confidence interval = 0.82 - 3.64). The Individual Intervention arm also possessed significantly better adherence compared to Usual Care at 3 months (6.81 Vs. 4.94; P = 0.001, t = 3.706, df = 25, 95% confidence interval = 0.83 - 2.90) and 6 months (7.28 Vs. 5.13; P < 0.001, t = 4.094, df = 25, 95% confidence interval = 1.07 -3.24). The Caregiver-assisted Interventions had no significant improvement in asthma control and adherence. Conclusion The individualized educational interventions produced better improvements in asthma control and adherence.

Knowledge and practice of the Global Initiative for Asthma report among community pharmacists in a Nigerian State.

INTRODUCTION: few studies have been conducted to evaluate pharmacists´ knowledge and practice of the asthma guidelines. The Global Initiative for Asthma (GINA) report was developed to reduce practice variability and to improve the quality of asthma care. This study aimed to assess the knowledge and practice of the GINA report among community pharmacists in a Nigerian State. METHODS: this cross-sectional survey was conducted among community pharmacists in Enugu State, Nigeria (May to July, 2018). Data were collected with a 39-item structured self-administered questionnaire and analyzed using the IBM SPSS Version 21.0. Descriptive statistics were used to summarize data. Inferential statistics utilized the Pearson Chi-Square test where applicable, with statistical significance set at P < 0.05. RESULTS: a total of 89 community pharmacists in Enugu State participated in the study (76.7% participation rate). More than half of them were less than 40 years old (60.7%), male (59.6%) and only had the Bachelor of Pharmacy (B.Pharm) degree (83.1%). About a tenth of the community pharmacists (10.1%) reported that they stock the peak flow meter. Few of them (2.2%) utilized the Asthma Control Test™ in their practice. After categorization, less than half of the community pharmacists had good knowledge of asthma (34.8%) and demonstrated good practice of the GINA report (11.2%). CONCLUSION: the community pharmacists had poor knowledge of asthma and demonstrated poor practice of the GINA report. With adequate knowledge of the guidelines, community pharmacists can assist patients with making informed decisions and proffer appropriate recommendations to physicians.

Assessment of the steps taken towards avoidance of medication errors among hypertensive outpatients attending a tertiary health care facility in Nigeria: a cross-sectional study.

INTRODUCTION: Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits. METHODS: A cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The IBM SPSS Version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant. RESULTS: A total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001). CONCLUSION: Patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.

Evaluation of the hepatic effect of concomitant administration of ciprofloxacin and some antimalarial drugs in Plasmodium berghei infected mice: An in vivo study.

This study evaluated the hepatotoxic effects of artesunate (AS), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) co-administration with ciprofloxacin (CIP) using animal model. Chloroquine sensitive Plasmodium berghei NK65 strain infected albino mice (120) were utilized for this study, carried out in three phases. Phase 1 comprised eleven groups treated with different doses of either AS, AL, ASAQ or CIP alone. Phase 2 consisted of nine groups treated with 7mg/kg of CIP combined with different doses of AS, AL, ASAQ. Phase 3 comprised ten groups treated with 14mg/kg of CIP (CIP2) with different doses of AS, AL, ASAQ. Seventy-two hours after administration of drugs, toxicity was determined by evaluating the effect of drugs on liver enzymes using spectrophotometer. Statistical analysis revealed that CIP alone significantly (P<0.05) reduced the levels of Aspartate Transaminase (AST) and Serum Alanine Transaminase (ALT) compared to AS, AL and ASAQ alone. Combination of different doses of AS, AL and ASAQ with 7mg/kg CIP significantly increased the level of AST and ALT while combination of AS, AL and ASAQ with 14mg/kg CIP significantly decreased AST and ALT levels. Care should be taken during the co-administration of low dose ciprofloxacin with artesunate, artemether-lumefantrine or artesunate-amodiaquine.

Health Professionals' Stigma towards the Psychiatric Ill in Nigeria.

BACKGROUND: Stigma affects the quality of life of the mentally ill, and health professionals are considered to be involved in possessing negative attitudes towards them. We evaluated the prevalence of stigmatization among different health professionals in Nigerian hospitals. METHODS: This study was a descriptive, cross-sectional and comparative survey assessing attitudinal views of health professionals (doctors, pharmacists, and nurses) regarding mental illness in two hospitals in Eastern Nigeria. The survey utilized the 40-item Community Attitude to Mental Illness, CAMI-2 questionnaire. The prevalence and the factors that contribute to negative attitudes among this cohort were assessed. Statistical analysis using T-tests, ANOVA and Pearson Correlation were conducted. RESULTS: Attitudes to all the four constructs of the CAMI-2 were non-stigmatizing. Stigmatizing attitudes were significantly higher among pharmacists, doctors and then nurses (p<0.006). Health professionals who did not have contact with the mentally ill (p<0.0001), who were males (p=0.008) and had lower years of working experience (p=0.031) expressed significantly higher stigmatizing attitudes towards the mentally ill. Conclusions: Nigerian health professionals were largely non-stigmatizing towards the mentally ill. However, being a pharmacist, of male gender, and working in a non-psychiatric hospital were associated with stigmatizing attitudes when they exist.

Inhibition of cytochrome P450 3A enzyme by Millettia aboensis: its effect on the pharmacokinetic properties of efavirenz and nevirapine

ABSTRACT The chronic and comorbid nature of HIV infection necessitate the use of multiple drugs including herbs to relieve symptoms with a possible increase in herb–drug interaction cases. This study was designed to evaluate the effect of Millettia aboensis (Hook. f.) Baker, Fabaceae, on cytochrome P450 3A isoenzyme and the influence of this effect on the bioavailability of two antiretroviral agents. In vitro effect of ethanol extract of M. aboensis on intestinal and liver microsomes extracted from female rats was assessed using erythromycin-N-demethylation assay method while in vivo effects were determined by estimating simvastatin plasma concentrations in rats. The effect of the extract on pharmacokinetic parameters of orally administered efavirenz (25 mg/kg) and nevirapine (20 mg/kg) was determined in rats divided into groups (n = 5). Plasma drug concentrations were assayed using HPLC and pharmacokinetic parameters determined through a non-compartmental analysis as implemented in WinNonlin pharmacokinetic program. The extract inhibited both intestinal and liver microsomal cytochrome P450 3A isoenzyme activities in vitro and enhanced simvastatin absorption in vivo with possible inhibition of metabolizing enzymes as indicated by significant (p < 0.05) increase in maximal concentration, area under curve and mean resident time of the drug. However, further in vivo interaction studies in animal model did not produce significant (p > 0.05) changes in the pharmacokinetic parameters of efavirenz and nevirapine. HPLC fingerprinting indicated the presence of quercetin and kaempferol in the extract. These findings revealed M. aboensis as an inhibitor of cytochrome P450 3A enzyme but, with no significant effect on the bioavailability of orally administered nevirapine and efavirenz.

Evaluation of drug-drug interactions among patients with chronic kidney disease in a South-Eastern Nigeria tertiary hospital: a retrospective study.

INTRODUCTION: The risk of drug-drug interactions (DDIs) is high in patients with chronic kidney disease (CKD) necessitating dose adjustments or the avoidance of drug combinations. This study aimed to evaluate DDIs among patients with CKD in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. METHODS: This study was a retrospective review of patients with CKD who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. The drug-drug interactions (DDIs) of the prescribed drugs were classified using the RxList interaction checker. The IBM SPSS Version 21.0 was utilized for statistical analysis with P-value ≤ 0.05, considered statistically significant. RESULTS: A total of 749 DDIs were identified from the folders of the 169 patients with CKD that were eligible. Majority were above 50 years old and in stage 4 or 5 CKD. Furosemide, lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were significant and independent predictors of DDIs among the patients. About 70% of the drug combinations required monitoring as they fell within the "significant category" of the RxList interaction checker. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate. CONCLUSION: The prevalence of DDIs was high among the CKD patients. Prescribers and pharmacists in Nigerian hospitals may need to pay close attention to prescriptions of patients with CKD to identify, prevent and resolve undesirable DDIs.

Evaluation of drug-drug interactions among patients with chronic kidney disease in a South-Eastern Nigeria tertiary hospital: a retrospective study

Introduction: The risk of drug-drug interactions (DDIs) is high in patients with chronic kidney disease (CKD) necessitating dose adjustments or the avoidance of drug combinations. This study aimed to evaluate DDIs among patients with CKD in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria.Methods: this study was a retrospective review of patients with CKD who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. The drug-drug interactions (DDIs) of the prescribed drugs were classified using the RxList interaction checker. The IBM SPSS Version 21.0 was utilized for statistical analysis with P-value ≤ 0.05, considered statistically significant.Results: a total of 749 DDIs were identified from the folders of the 169 patients with CKD that were eligible. Majority were above 50 years old and in stage 4 or 5 CKD. Furosemide,lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were significant and independent predictors of DDIs among the patients. About 70% of the drug combinations required monitoring as they fell within the "significant category" of the RxList interaction checker. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate.Conclusion: the prevalence of DDIs was high among the CKD patients. Prescribers and pharmacists in Nigerian hospitals may need to pay close attention to prescriptions of patients with CKD to identify, prevent and resolve undesirable DDIs

Use of simulated patient approach to assess the community pharmacists' knowledge of appropriate use of metered dose inhaler.

RATIONALE: The pharmacist charged with the responsibility of drug administration and counseling should have the basic knowledge and skills necessary to demonstrate the use of metered dose inhalers (MDIs) to asthma patients for the maximization of treatment outcomes. OBJECTIVE: This study was designed to evaluate the community pharmacists' knowledge of the appropriate use of MDIs in Anambra State, Nigeria. METHODS: The study was carried out in two major cities in Anambra State, Nigeria, using 41 registered community pharmacists. A simulated patient approach utilizing two adequately trained pharmacy students were used. Obtained data were analyzed using independent t-test and one-way ANOVA through SPSS version 18. RESULTS: The pharmacists had a mean demonstration score of 45.45%. Step number seven of the correct use of MDI, which involves breathing in and depressing the canister was the most demonstrated step (90.2%) while step 4 which involves tilting the head back slightly was the least demonstrated (14.6%) by the pharmacists. Among five identified critical steps in asthma guideline used, two were well demonstrated (75.6% and 90.2%): one averagely demonstrated (51.2%) and two poorly demonstrated (39% and 31.7%). Sociodemographic characteristics did not influence the demonstration ability of the pharmacists in this study. CONCLUSION: The study indicated that community pharmacists lacked the adequate knowledge of appropriate use of MDI. Training programs for pharmacists focusing on the use of such devices will enable them to educate patients on the effective use of MDIs in patients with asthma.