Cost implications of treatment of diabetes mellitus in a secondary healthcare facility in Ibadan.

BACKGROUND: Diabetes and its complications remain a major health challenge in Nigeria. AIM: To evaluate the economic cost of type 2 diabetes mellitus in a secondary healthcare facility in Ibadan, Nigeria. METHODS: The study was carried out in Oyo state general hospital Ibadan, Nigeria using two methods of data collection. A retrospective study design in which data were extracted from case files of diabetic patients using a pre-designed data form and secondly with an Open-ended, Affirmation, Reflective listening and Summaries (OARS) method. Data was analysed using frequencies mean and correlation statistical tools. RESULTS: Majority of the patients (73%) earned less than $125 per month. Hypertension was the most common (98.08%) co-morbid disorder with diabetes mellitus and the most common complication noted was neuropathy (48.10%). Metformin was the most widely prescribed oral hypoglycemic agent (90.40%). The annual cost of diabetes mellitus was $20,827.37. for the 52 patients while the average annual cost of diabetes per patient was $400.52 but higher in age group 60-69 years. There was a significant correlation (p < 0.05) between age (at onset of diabetes and at registration at the healthcare facility) and total cost of drugs used. CONCLUSION: The study demonstrated that type 2 diabetes mellitus and its complications imposed significant economic burden on the patients. There is need for the policy maker of health sector in the country to plan towards reducing the financial burden of diabetes on the society.

An assessment of the rate, types and severity of prescribing errors in a tertiary hospital in southwestern Nigeria.

BACKGROUND: Accurate medication prescribing is an important process in ensuring the best possible outcomes in patient care. Worldwide literature is replete with studies reporting high prevalence of prescribing error which are the most common type of avoidable medication errors and hence are an important target for improvement. OBJECTIVES: This study assessed types and prevalence of prescribing errors, their clinical significance, when in the prescribing process they occurred and the medications commonly associated with prescribing errors. METHODS: A retrospective review of 2010 in-patients' records from medical and paediatric specialties of a tertiary hospital in South West Nigeria was undertaken. Prescriptions that met the standard as enumerated in the Nigeria Standard Treatment Guideline (STG) were assessed. Prescription error rates for potentially clinically serious and total errors were determined. RESULTS: The total prescribing error rate was 40.9% (95% CI 37.8 to 41.4) with 1.3% (95% CI -1.1 to 3.7) being clinically serious. Omitting to write an ending date or duration for therapy and unsafe abbreviations were the most common errors. Prescriptions involving antimicrobials produced the bulk of errant prescriptions. CONCLUSION: Prescribing errors were found to be common. There was poor compliance with the Nigeria Standard Treatment Guidelines which outline the essential elements of a prescription. Continuing prescriber education on proper prescription writing and rational drug use is recommended as a way to reduce prescribing errors.

Pharmacists and Nurses Perception of Medication Errors in a Nigerian University Teaching Hospital

Purpose: To investigate the type and frequency of all medication dispensing and administration errors as perceived by pharmacists and nurses respectively; and the factors associated with such errors in a Nigerian university teaching hospital. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals; Ile-Ife and Ilesa; Nigeria. Data was collected by the use of pre-tested questionnaire administered to 35 pharmacists and a stratified sample of 130 nurses over a period of 2 weeks. The questionnaires were sorted and analysed. Results: The pharmacists that responded (80) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamental factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff

Pharmacists and Nurses Perception of Medication Errors in a Nigerian University Teaching Hospital

Purpose: To investigate the type and frequency of all medication dispensing and administration errors as perceived by pharmacists and nurses respectively; and the factors associated with such errors in a Nigerian university teaching hospital. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals; Ile-Ife and Ilesa; Nigeria. Data was collected by the use of pre-tested questionnaire administered to 35 pharmacists and a stratified sample of 130 nurses over a period of 2 weeks. The questionnaires were sorted and analysed. Results: The pharmacists that responded (80) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamental factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff.) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamen- tal factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff

Positive benefits of a pharmacist-managed hypertension clinic in Nigeria.

OBJECTIVE: The aim of this study was to determine whether the provision of further practice-based support by pharmacists will bring about improved outcomes for blood pressure (BP) control in middle-aged and elderly Nigerian hypertensive patients managed with combination diuretics (amiloride hydrochloride 5 mg+hydrochlorothiazide 50 mg) and/or methyl dopa at the primary care level. DESIGN AND SETTING: This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients. PATIENTS AND METHOD: The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2-3.0-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the pharmacist-managed hypertension clinic and followed for the study period. Participating pharmacists counselled for current medication, personalized goals of lifestyle modification stressing weight loss and/or increased activity, increased patient awareness by providing relevant education about hypertension and associated/related diseases, adjusted drug therapy to optimize effectiveness and minimize adverse events, utilized treatment schedules that enhanced patients' adherence to therapy, and monitored treatment outcomes between enrollment and return visits. Patient satisfaction and the number of treatment failures within 6 months post enrollment were compared with retrospective data from our earlier study involving physician-managed patients under a similar setting. RESULTS: Uncontrolled BP reduced from 92 to 36.2% by 10.15+/-5.02 days after enrollment. Treatment failures were observed at 5.9% of the total return visits (n=184) within 6 months. CONCLUSION: Pharmacist-managed hypertension clinics can improve BP control, reduce treatment failure and increase patient satisfaction.

Prevalence of Hypertension in a University Community in South West Nigeria

A worksite study of hypertension prevalence was carried out in a university community in Southwestern Nigeria. Overall crude prevalence was 21% in the respondent population. About 16% of these were already on treatment with medicines. The study established no significant (p>0.05) relationship between coffee consumption and hypertension.Prevalence was 32% in subjects with over 3 children, while among subjects witheye problem, diabetics and those who took local kola nutsand it was 18.6%, 1.9% and 7.4%, respectively. There is need for increased awareness of the disease and other cardiovascular risk factors within the populace and to encourage the possession or provision of self-measurement blood pressure devices

Malaria Prevention: Knowledge, Attitude And Practice In A Southwestern Nigerian Community

Assessing and analyzing local malaria problems are a prerequisite for successful control interventions. We sought to assess the knowledge of the symptoms of malaria, attitude towards preventive measures as well as treatment seeking behaviors among members of the Ile-Ife community in southwestern Nigeria.A cross sectional study was carried out using a questionnaire, which was self or researcher administered to community members of semi-urban Ile-Ife.Analysis of "what respondents will do first" during malaria attack showed that 35.5%, 0.9% and 13.4% of respondents will use synthetic anti-malarials, consult a herbalist and use local herb, respectively, while 27.3%, 1.7% and 18.2% will go to the hospital, take spiritual/ritual waters for cure and just pray, respectively, with 3.0% of the respondents indicating that they will ignore the signs. Factors influencing respondents' choice of malaria treatment and preventive methods included cost, religious beliefs, perceived safety, convenience and respondents' state of health for 22.7%, 5.4%, 20.8%, 26.5% and 24.6% of the respondents, respectively. The use of insecticide impregnated net are uncommon amongst the respondents (0%). Treatment seeking practice in malaria was related to level of education and religion. We found that convenience and the severity of the disease affected respondents' choice of treatment in more than 50% of the cases. We suggest that malaria public enlightenment efforts should be intensified, effective malaria preventive methods be made affordable and that support be provided to make malaria treatments at public hospitals free

Managing hypertension with combination diuretics and methyldopa in nigerian blacks at the primary care level.

OBJECTIVE: To gain insight into the control of hypertension and to suggest possible interventions within a selected black population treated with combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) and/or methyldopa for uncomplicated essential hypertension. DESIGN AND SETTING: A 2-year retrospective cohort review of the outpatient medical records of a State Comprehensive Health Center in southwestern Nigeria. Free primary health service, including free drugs, is provided in the health facility for all patients. PATIENTS AND METHODS: The study population included outpatients continuously registered at the health centre between June 1999 and June 2002, aged >/=36 years, with 2-6 months' history of hypertension or newly diagnosed hypertension and followed for 6 months after diagnosis. They were managed with methyldopa 250mg and/or combination diuretics (amiloride 5mg + hydrochlorothiazide 50mg) or a combination in two different regimens for at least 6 months. Participating physicians measured patients' blood pressure with a validated device and recorded demographics and medical history. Patients were considered to have hypertension if systolic blood pressure was >140mm Hg and diastolic blood pressure was >90mm Hg. RESULTS: Bivariate regression analysis revealed that systolic blood pressure contributed moderately to the variances of drug and regimen decisions. Among the 128 hypertensive patients with average and modal ages of 57.2 +/- 11.1 and 60 years, respectively, only 37.5% had controlled blood pressure after the first treatment; with 10.2% and 4% of the study population needing, respectively, three and five re-treatments within 6 months to achieve target blood pressure levels. CONCLUSION: A high percentage of uncontrolled blood pressure and re-treatment rates were observed within the study population. A more aggressive management strategy that individualises diuretic therapy by titrating dose to systolic blood pressure and prioritises lifestyle modification in middle-aged and elderly black hypertensive patients is suggested.

Antimicrobial effectiveness of six paradols. 1: A structure-activity relationship study.

The pattern of antimicrobial effectiveness of (0)-, (2)-, (3)-, (4)-, (8)- and (9)-paradols was studied. (3)- Paradol was more active than the other homologues with a minimum inhibitory concentration (MIC) of 1 mg/ml when tested against Proteus vulgaris, Pseudomonas aeruginosa, Staphylococcus aureus and Botryodiplodia theobromae. At 0.2 mg/ml, (3)-paradol completely inhibited the spore germination of Trichophyton mentagrophytes and after 3 h of exposure at 0.5 mg/ml, it inhibited the growth of a heavy inoculum of Staphylococcus aureus (1 X 10(9) cells/ml).