Knowledge and dispensing practice of community pharmacists towards antipsychotic medicines in a Nigerian metropolitan city - a cross-sectional study.

BACKGROUND: Antipsychotic drugs are prescription-only-medications which require valid prescriptions before it can be obtained from a pharmacy. On the other hand, community pharmacists in developing countries have sometimes been implicated in over-the-counter dispensing of prescription-only-medications. OBJECTIVE: This study investigated the accessibility of antipsychotic drugs without prescriptions from community pharmacies, and the factors responsible for the over-the-counter dispensing of antipsychotics by community pharmacists. METHODS: An exploratory cross-sectional mixed method survey design using pretested structured questionnaires among 119 community pharmacists, simulated patients in 119 community pharmacies, and one-on-one in-depth interview among eleven (11) community pharmacist-owners/superintendent pharmacists were utilized for data collection. The knowledge of the pharmacists on antipsychotics including classification, side effects, and dispensing practices were explored. Qualitative data was analyzed with thematic analysis, while quantitative data was analyzed using descriptive statistics. RESULTS: Majority of the community pharmacists (87.4%) showed good knowledge of antipsychotics as it relates to the different classes and the side effects peculiar to each class. Antipsychotic medications were dispensed by 85 (71.4%) of community pharmacists without a prescription. One-on-one in-depth interview sessions with community pharmacist owners/superintendent pharmacists demonstrated that community pharmacists are knowledgeable about antipsychotics and their side effects. Reasons given for dispensing this class of drugs without prescription included emergencies, and knowledge of the person as being on the drugs long-term. About 4% pharmacists were adamant on dispensing only with prescription. CONCLUSION: Community pharmacists in Ibadan metropolis readily dispense antipsychotics without valid prescriptions despite having an optimal knowledge about the negative implications of doing so. This could be due to weak legislation and regulation of drug laws. There is a need for more stringent regulations as well as adequate sensitization about the negative effects of inappropriate dispensing of prescription-only-medications.

Effect of educational intervention on medication reconciliation practice of hospital pharmacists in a developing country - A non-randomised controlled trial.

BACKGROUND: Medication reconciliation is an evidence-based practice that reduces medication-related harm to patients. This study evaluated the effect of educational intervention on medication reconciliation practice of pharmacists among ambulatory diabetes and hypertensive patients. METHODS: A non-randomized clinical trial on medication reconciliation practice was carried out among 85 and 61 pharmacists at the intervention site and control site, respectively. Medication reconciliation was carried out among 334 (intervention-183; control-151) diabetes and/or hypertensive patients by the principal investigator to indirectly evaluate pharmacists' baseline medication reconciliation practice at both sites. A general educational intervention was carried out among intervention pharmacists. Medication reconciliation was carried out by the principal investigator among another cohort of 96 (intervention-46; control-50) and 90 (intervention-44; control-46) patients at three and six months postintervention, respectively, to indirectly assess pharmacists' postintervention medication reconciliation practice. Thereafter, a focused educational intervention was carried out among 15 of the intervention pharmacists. Three experts in clinical pharmacy analysed the medication reconciliation form filled by the 15 pharmacists after carrying out medication reconciliation on another cohort of 140 patients, after the focused intervention. Data was summarized with descriptive (frequency, percentage, mean ± standard deviation) and inferential (Pearson product-moment correlations analysis, independent-samples t-test and one-way ANOVA) statistics with level of significance set at p<0.05. KEY FINDINGS: Baseline medication reconciliation practice was poor at both sites. Post-general educational intervention, medication discrepancy was significantly reduced by 42.8% at the intervention site (p<0.001). At the intervention site, a significant increase of 54.3% was observed in patients bringing their medication packs for clinic appointments making medication reconciliation easier (p=0.003), at 6-months postintervention. Thirty-five, 66 and 48 drug therapy problems were detected by 31 (43.1%), 33 (66.0%) and 32 (71.1%) intervention pharmacists at 1-, 3- and 6-month post-general educational intervention, respectively. Post-focused educational intervention, out of a total of 695 medications prescribed, 75 (10.8%) medication discrepancies were detected and resolved among 42 (30%) patients by the 15 pharmacists. CONCLUSIONS: The educational interventions improved pharmacists' medication reconciliation practice at the intervention site. It is expected that this research would help create awareness on medication reconciliation among pharmacists in developing countries, with a view to reducing medication-related patient harm.

Attitude towards medication deprescribing among older patients attending the geriatric centre: a cross-sectional survey in Southwest Nigeria.

OBJECTIVES: This study set out to assess older people's perception of their medications, attitude towards medication use and their willingness to have medications deprescribed in a geriatric centre in Southwestern Nigeria. DESIGN AND SETTING: A cross-sectional study was conducted at the Chief Tony Anenih Geriatric Centre, University of Ibadan, using an interviewer-administered questionnaire. The questionnaire used was a revised version of the Patient's Attitude Towards Deprescribing Questionnaire. Descriptive statistics, and multivariate and bivariate analyses were performed using SPSS V.23. Statistical significance was set at p<0.05. PARTICIPANTS: 415 older patients aged ≥60 years who attended the geriatric centre in University College Hospital Ibadan between April and July 2022. MAIN OUTCOME MEASURE: The primary outcome was the willingness of the older person to deprescribe if recommended by the physician. RESULTS: The mean age of the participants was 69.6±6.4 years, and 252 (60.7%) were female. Overall, the willingness and positive attitude to medication deprescribing among respondents were 60.5% and 89.7%, respectively. Factors significantly associated with willingness to deprescribe were financial self-support (p=0.021), having no previous hospital admission (p=0.009), better-perceived quality of health relative to peers (p<0.0001), polypharmacy (p=0.003), and the domains burden of medication (p=0.007), medication appropriateness (p<0.0001), concerns about stopping medications (p<0.0001) and involvement with medications (p<0.0001). The predictive factors for improved willingness to deprescribe were direct involvement with medications (OR=2.463; 95% CI 1.501 to 4.043, p<0.0001), medication appropriateness (OR=0.462; 95% CI 0.254 to 0.838, p=0.011) and concerns about stopping medications (OR=2.031; 95% CI 1.191 to 3.463, p=0.009). CONCLUSION: Participants demonstrated greater willingness to deprescribe if the physicians recommended it. Predictive factors that may influence willingness to deprescribe were direct involvement with medications, appropriateness of medication and concerns about stopping medications.

Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria.

BACKGROUND: Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. OBJECTIVES: To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use. METHOD: Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. RESULTS: Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. CONCLUSION: Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.

Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria.

OBJECTIVES: To evaluate available and desired sources and types of social-support among hypertensive and type-2-diabetes (T2D) patients. Associations of medication adherence and clinical outcome with access to most available social-support and medicine affordability were subsequently investigated. DESIGN: Cross-sectional questionnaire-guided interview among 250-hypertensive and 200-T2D patients, and review of medical records to retrieve disease-specific clinical parameters. SETTINGS: University College Hospital and Ring-Road State Hospital, Ibadan, southwestern Nigeria. PARTICIPANTS: Adults out-patients with hypertension, T2D, and T2D comorbid with hypertension were enrolled, while in-patients were excluded. RESULTS: Family source of support was the most available [hypertensive (225; 90.0%); T2D (174; 87.0%)], but government and non-governmental organisation support were largely desired, with financial support preferred, 233(93.2%) hypertensive and 190(95.0%) T2D, respectively. Adherent hypertensive patients with or without access to family support were (127; 56.4%) versus (18; 72.0%), p=0.135; while for T2D were (103; 59.2%) versus (21; 80.8%), p=0.035. Mean systolic blood pressure of hypertensive and fasting plasma glucose of T2D with access to family and financial support were better than their counterparts without access (p>0.05). Hypertensive (110; 76.4%) and T2D (87; 87.0%) participants who consistently afford medicine expenses had significantly better adherence and outcome (p<0.05). CONCLUSIONS: Family source of support is the most accessible, but government and non-governmental organisation support were largely desired. Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, unwavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for expanded social-support system in order to consistently ensure improved outcome. FUNDING: None declared.

Evaluation of CYP2D6 phenotype in the Yoruba Nigerian population.

BACKGROUND: There is a lack of information on CYP2D6, a major metabolizing enzyme, in Africa ethnic nationalities. The objective was to determine CYP2D6 phenotype in Yoruba Nigerians using dextromethorphan (DEX). METHOD: A total of 89 healthy volunteers received 30 mg of DEX orally followed by blood and urine sample collection at 3-hour and over 8 h post-dose, respectively. DEX and dextrorphan (DOR) concentrations were determined using High Performance Liquid Chromatography (HPLC). The metabolic ratio (MR, DEX/DOR) were plotted for the phenotype determination. RESULTS: The log MR that separated poor (PMs) from normal metabolizers (NMs) was 0.28 and 0.75 for urine and plasma, respectively. Two subjects (2.3%) identified as PMs had a mean MR of 17 and 3.2 in plasma and urine, significantly higher than that of NMs (p < .0001). A positive correlation between urine and plasma MR was noted. CONCLUSION: The prevalence of PMs in the Yoruba Nigerians was similar to that reported among blacks.

Hospital and community pharmacists' perception of the scope, barriers and challenges of pharmacy practice-based research in Nigeria.

OBJECTIVES: To evaluate perception, extent of involvement and barriers to pharmacy practice-based research among community and hospital pharmacists in Ibadan, Oyo state, southwestern Nigeria. METHODS: A prospective cross-sectional study was carried out among 65 hospital and 86 community pharmacists with at least five-year post-qualification experience, using pre-tested questionnaire. Socio-demographic information, extent of involvement, relevance and scope, as well as barriers to pharmacy practice-based research were explored. Data were summarised using descriptive statistics. Kruskal-Wallis and Mann-Whitney-U tests were used for evaluating ranked variables at p<0.05. RESULTS: Nearly all participants (>95.0%) in each practice category agreed that pharmacy practice-based research is essential to pharmacy profession. Greater than 90.0% agreed that pharmacy practice-based research may help in identifying gaps to improve practice. Thirty-five (40.7%) community and 36(55.4%) hospital pharmacist participants had previously involved in practice-based research. Seventy-seven (89.5%) community and 55(84.3%) hospital pharmacists agreed that acquisition of additional research-oriented training is essential for effective conduct of pharmacy practice-based research. More than one-half in each category agreed that inadequate financial commitment and lack of access to patient's data are major barriers to pharmacy practice-based research. CONCLUSIONS: Community and hospital pharmacists agreed that pharmacy practice based research is essential to pharmacy profession, especially in identifying areas of focus to improve practice. Necessity for acquiring additional training in research, financial constraints and lack of access to patient's data were identified as barriers to pharmacy practice-based research. Thus, there is a need to continually stimulate pharmacists' interest in research so as to enhance professional competence and promote healthcare development.

Hospital and community pharmacists' perception of the scope, barriers and challenges of pharmacy practice-based research in Nigeria

Objectives: To evaluate perception, extent of involvement and barriers to pharmacy practice-based research among community and hospital pharmacists in Ibadan, Oyo state, southwestern Nigeria. Methods: A prospective cross-sectional study was carried out among 65 hospital and 86 community pharmacists with at least five-year post-qualification experience, using pre-tested questionnaire. Socio-demographic information, extent of involvement, relevance and scope, as well as barriers to pharmacy practice-based research were explored. Data were summarised using descriptive statistics. Kruskal-Wallis and Mann-Whitney-U tests were used for evaluating ranked variables at p<0.05. Results: Nearly all participants (>95.0%) in each practice category agreed that pharmacy practice-based research is essential to pharmacy profession. Greater than 90.0% agreed that pharmacy practice-based research may help in identifying gaps to improve practice. Thirty-five (40.7%) community and 36(55.4%) hospital pharmacist participants had previously involved in practice-based research. Seventy-seven (89.5%) community and 55(84.3%) hospital pharmacists agreed that acquisition of additional research-oriented training is essential for effective conduct of pharmacy practice-based research. More than one-half in each category agreed that inadequate financial commitment and lack of access to patient’s data are major barriers to pharmacy practice-based research. Conclusions: Community and hospital pharmacists agreed that pharmacy practice based research is essential to pharmacy profession, especially in identifying areas of focus to improve practice. Necessity for acquiring additional training in research, financial constraints and lack of access to patient’s data were identified as barriers to pharmacy practice-based research. Thus, there is a need to continually stimulate pharmacists’ interest in research so as to enhance professional competence and promote healthcare development (AU)

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Do diabetes-specialty clinics differ in management approach and outcome? A cross-sectional assessment of ambulatory type 2 diabetes patients in two teaching hospitals in Nigeria.

OBJECTIVES: To evaluate management approach and outcome in two endocrinologist-managed clinics using data on treatment adherence, diabetes-specific parameters, prescribed medications and self-management practices among ambulatory type 2 diabetes patients. Opinion on cause(s) and perceived fear about diabetes were also explored. DESIGN: A cross-sectional prospective study using semi-structured interview among consented patients for eightweek, and a review of participants' case notes at 3-month post-interactive contact for details of diabetes-specific parameters and antidiabetes medications. SETTINGS: The University College Hospital (UCH) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in southwestern Nigeria. PARTICIPANTS: Adult patients with type 2 diabetes, on therapies for >3-month and who had average fasting blood glucose (FBG)>6.0mmol/L were enrolled. All patients with type 1 diabetes, and type 2 diabetes who decline participation were excluded. Out of 185 participants who were approached, 176(95.1%) consented and completed the study including 113(64.2%) from UCH and 63(35.8%) in OAUTHC. RESULTS: Mean FBG for patients were 9.6mmol/L in UCH and 11.0mmol/L in OAUTHC (p=0.03). Medication adherence among patients was 47(46.5%) in UCH and 31(52.5%) in OAUTHC (p=0.46). Prescribed antidiabetes medications between the clinics significantly differ. Practice of self-monitoring of blood glucose among participants was 26(23.0%) in UCH and 13(20.6%) in OAUTHC (p=0.72). Thirty-two participants (29.4%) in UCH and 33(43.4%) from OAUTHC (p=0.02) mentioned complications as perceived fear about type 2 diabetes. CONCLUSION: There are differences and similarities between the diabetes-specialty clinics with respect to diabetes management and outcome. This underscores the necessity for a protocol-driven treatment approach in ensuring improved diabetes care and outcome. FUNDING: None declared.

Evaluation of prescription pattern and patients' opinion on healthcare practices in selected primary healthcare facilities in Ibadan, South-Western Nigeria.

BACKGROUND: Inappropriate prescribing negatively impacts on health and economy of individual and the society. OBJECTIVES: To evaluate the prescribing patterns and patients' opinions on healthcare practices in selected primary healthcare centres (PHC) in Ibadan, South-Western Nigeria. METHODS: A prospective cross-sectional study was carried out among patients and healthcare workers in selected PHCs using semi-structured questionnaires. Also, patients' prescription records were reviewed using the WHO-prescribing indicators. RESULTS: About one-half (210; 52.5%) were very satisfied with convenience of obtaining prescribed medicines in the PHCs, accessibility of PHC to abode (158;39.5%) and affordable medications (136;34.0%). Patients were dissatisfied with follow-up of care (191; 47.8%), courtesy of workers (184; 46.3%) and non-availability of medicines (138;34.5%). Number of drugs per encounter was 5.8±2.3 and % encounter with an antibiotic was >26.8% in each facility. Hematinics accounted for (814; 35.0%), analgesics (544; 23.4%), antimicrobials (303;13.0%) and antihypertensives (5; 0.2%). CONCLUSION: Primary healthcare attendees were satisfied with medication costs affordability and accessibility of PHC to abode but expressed dissatisfaction with follow-up of care and courtesy of workers. Also, inappropriate prescriptions characterized by polypharmacy and overuse of antibiotics were common underscoring the need for regular training of PHC workers on rational drug use and instituting appropriate measures for improvement.

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria.

BACKGROUND: Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care. OBJECTIVES: To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome. METHODS: A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011. RESULTS: Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%). CONCLUSIONS: The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice.

Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria.

OBJECTIVE: To determine the influence of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria. METHODS: A cross-sectional study using pre-tested structured questionnaire among 176 consented patients recruited from the endocrinology clinics of two teaching hospitals between November, 2010 and January, 2011; and a retrospective review of case notes of the cohort for details of prescribed medications and blood glucose values. Descriptive statistics were used to summarize the data. Tests of proportions were evaluated using Chi-square or Fisher's exact test as appropriate. The differences in mean fasting blood glucose (FBG) between and among categorical variables were compared using student t-test and ANOVA respectively, with p<0.05 considered significant. RESULTS: Mean number of prescribed medications was 4.6 ±1.4. Almost two thirds 103 (60.6%) were placed on >4 medications. Adherence was better among patients on >4 medications compared to those on ≤4 medications (p=0.05). However, patients on >4 medications were mostly older adults (>60 years of age), and they were in the majority (66.7%) who had tertiary education compared to 33.3% of those on ≤4 medications who had tertiary education (p=0.02). Adherence rates to antidiabetes medications were in the ranking of oral antidiabetes medications (OAM) alone (50.0%) > insulin plus OAM (44.0%) > insulin alone (41.7%) with no significant difference (p=0.77). There was a significant difference in mean FBG among patients on >4 medications (172.1 ±61.1mg/dL) versus (198.8 ±83.8mg/dL) among those on ≤4 medications (p=0.02). CONCLUSIONS: Prescribing more than four medications is linked to improved adherence and glycemic outcome. However, age and educational background of patients are important factors that need to be considered when prescribing multiple medications for type 2 diabetes.

Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria / Efecto del número y tipo de antidiabéticos en la adherencia y la glucemia de pacientes ambulatorios con diabetes tipo 2 en el suroeste de Nigeria

Objective: To determine the influence of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria. Methods: A cross-sectional study using pre-tested structured questionnaire among 176 consented patients recruited from the endocrinology clinics of two teaching hospitals between November, 2010 and January, 2011; and a retrospective review of case notes of the cohort for details of prescribed medications and blood glucose values. Descriptive statistics were used to summarize the data. Tests of proportions were evaluated using Chi-square or Fisher’s exact test as appropriate. The differences in mean fasting blood glucose (FBG) between and among categorical variables were compared using student t-test and ANOVA respectively, with p<0.05 considered significant. Results: Mean number of prescribed medications was 4.6±1.4. Almost two thirds 103 (60.6%) were placed on >4 medications. Adherence was better among patients on >4 medications compared to those on ≤4 medications (p=0.05). However, patients on >4 medications were mostly older adults (>60 years of age), and they were in the majority (66.7%) who had tertiary education compared to 33.3% of those on <=4 medications who had tertiary education (p=0.02). Adherence rates to antidiabetes medications were in the ranking of oral antidiabetes medications (OAM) alone (50.0%) > insulin plus OAM (44.0%) > insulin alone (41.7%) with no significant difference (p=0.77). There was a significant difference in mean FBG among patients on >4 medications (172.1 ±61.1mg/dL) versus (198.8 ±83.8mg/dL) among those on <=4 medications (p=0.02). Conclusion: Prescribing more than four medications is linked to improved adherence and glycemic outcome. However, age and educational background of patients are important factors that need to be considered when prescribing multiple medications for type 2 diabetes (AU)

Objetivo: Determinarla influencia del número y tipo de medicamentos antidiabéticos en la adherencia y la glucemia de pacientes con diabetes tipo 2 en el suroeste de Nigeria. Métodos: Estudio transversal utilizando un cuestionario pre-estructurado en 176 pacientes que aceptaron, reclutados en la clínica de endocrinología de dos hospitales Universitarios entre noviembre 2010 y enero 2011; y revisión retrospectiva de las notas clínicas de la cohorte para recopilar los detalles de medicamentos prescritos y valores de glucemia. Se utilizó estadística descriptiva para presentar los datos. Las proporciones se analizaron usando test chicuadrado o pruebas exactas de Fischer cuando fue apropiado. La diferencia entre las medias de glucemia en ayuno (FBG) se compararon usando ttest y ANOVA, considerando significativos p<0,05. Resultados: La media de medicamentos prescritos fue de 4,6±1,4. Casi dos tercios, 103 (60,6%), tenían >4 medicamentos. La adherencia era mejor entre los pacientes con >4 medicamentos comparados con los de ≤4 medicamentos (p=0,05). Sin embargo, los pacientes con >4 medicamentos eran mayoritariamente adultos mayores (>60 años) y en su mayoría (66,7%) tenían educación terciaria, comparado con el 33,3% de los de <=4 medicamentos con educación terciaria (p=0,02). Las tasas de adherencia a medicamentos antidiabéticos estaban en el margen de los antidiabéticos orales solos (AOS) (50,0%) > insulina más AOS (44,0%) > insulina sola (41,7%) sin diferencias significativas p=0,77). Hubo diferencia significativa en la FBG entre los pacientes con >4 medicamentos contra los de <= (172.1±61.1mg/dL vs. 198.8±83.8mg/dL, respectivamente. p=0,02). Conclusión: Prescribir más de cuatro medicamentos está asociado con una mejoría de la adherencia y de resultados de la glucemia. Sin embargo, la edad y la escolaridad son factores importantes que deben considerarse cuando se prescriben medicamentos para la diabetes tipo 2 (AU)

Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria / Adherencia a la medicación entre pacientes con diabetes tipo 2 en establecimientos sanitarios terciarios en el suroeste de Nigeria

Objective: To assess adherence to medication among ambulatory patients with type 2 diabetes, ascertain the level of glycemic control, and evaluate patients’ opinions on probable reasons for nonadherence with a view to identify areas of intervention to improve adherence. Methods: A prospective cross-sectional study was carried out at a 900-bed tertiary teaching hospital in Ibadan, Southwestern Nigeria between June and August, 2009. Out of 140 consented patients, 114 (81.4%) properly responded to the validated and pre-tested data collection tool and these were subsequently considered for analysis. Descriptive statistics were used to summarize the data. Means and proportions were compared using student t-test and chi-square or Kruskal-Wallis test as appropriate, with p<0.05 considered statistical significant. Results: Approximately sixty percent of the patients were adjudged adherent with prescribed medication. Out of 58.8% of the cohort who gave their recent fasting plasma glucose (FPG) values, 59.7% had FPG above 110mg/dL. The mean FPG for patients was 139.05 (SD=70.5)mg/dL, males and females significantly differed in their mean FPG, 146.55 (SD=85.0)mg/dL versus 133.33 (SD=57.6)mg/dL respectively (p=0.032). Also, the mean FPG values for adherent patients, 137.09 (SD=59.3)mg/dL was lower than their non-adherent counterparts, 143.92 (SD=87.6) mg/dL, but the difference was not statistically significant (p=0.095). Financial constraint (34.4%) was the major barrier to optimal adherence with medication. A significant association exist between genders and opinions on physician’s mode of approach during patientphysician interaction as a contributory factor for non-adherence (p=0.038). Conclusion: Medication adherence of ambulatory type 2 diabetes patients is considerable. However, the relatively high level of adherence did not appear to have significantly impacted on patients’ glycemic status due to a substantial number who had plasma glucose above the recommended targets. Multiple methods may be required to detect patient who report adherence but who may in fact be nonadherent. Also, adherence to other aspects of diabetes management plan needs to be encouraged in order to accomplish optimal glycemic control. Initiatives targeting patient-specific intervention to improve medication adherence should be considered (AU)

Objetivo: Evaluar la adherencia a la medicación entre pacientes ambulatorios con diabetes tipo 2, determinar el nivel de control glucémico, y evaluar las opiniones de los pacientes sobre las probables razones de la no adherencia con vista a identificar áreas de intervención en la mejora del cumplimiento. Métodos: Se realizó un estudio prospectivo transversal en un hospital universitario terciario de 900 camas en Ibadan, Suroeste de Nigeria, entre junio y agosto de 2009. De los 140 pacientes que consintieron, 114 (81,4%) respondieron correctamente al instrumento validado y pre-testado de recogida de datos y fueron consiguientemente analizados. Se usó estadística descriptiva para resumir los datos. Las medias y proporciones se compararon usando t de Student y chi cuadrado o test de Kruskal-Wallis, con p<0,05 como significación estadística. Resultados: Aproximadamente el 60% de los pacientes fueron considerados adherentes con la medicación prescrita. Del 58,8% de la cohorte que dio sus valores recientes de glucemia en ajuno (GA), el 59,7% tenía la GA por encima de 110 mg/dL. La media de GA fue de 139,05 (DE=85,0) mg/dL; hombres y mujeres difirieron significativamente en las medias: 146.55 (DE=85,0) mg/dL versus 133,33 (DE=57,6) mg/dL respectivamente (p = 0,032). También, las medias de GA en pacientes adherentes, 137,09 (DE=59.3) mg/dL fue menor que en su contraparte no adherente, 143,92 (DE=87,6) mg/dL, pero la diferencia no fue significativa (p=0,095). Las restricciones financieras (34,4%) fueron la principal barrera para una buena adherencia a la medicación. Existe una asociación significativa entre géneros y opiniones de la forma del médico de abordar la interacción paciente-médico como un factor contributivo de no adherencia (p=0,038). Conclusión: La adherencia a la medicación en los pacientes ambulatorios con diabetes tipo 2 es considerable. Sin embargo, el relativamente alto nivel de adherencia no pareció tener impacto significativo en el estado glucémico debido al número importante que tenia glucemias por encima de las recomendadas. Pueden necesitarse múltiples métodos para detectar pacientes que reportan ser adherentes pero que de hecho no lo son. Asimismo, la adherencia a otros aspectos del manejo de la diabetes deben ser promovidos para conseguir un óptimo control glucémico. Deberían ser consideradas iniciativas dirigidas a cada paciente para mejorar la adherencia a la medicación (AU)

Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in southwestern Nigeria.

OBJECTIVE: To assess adherence to medication among ambulatory patients with type 2 diabetes, ascertain the level of glycemic control, and evaluate patients' opinions on probable reasons for non-adherence with a view to identify areas of intervention to improve adherence. METHODS: A prospective cross-sectional study was carried out at a 900-bed tertiary teaching hospital in Ibadan, Southwestern Nigeria between June and August, 2009. Out of 140 consented patients, 114 (81.4%) properly responded to the validated and pre-tested data collection tool and these were subsequently considered for analysis. Descriptive statistics were used to summarize the data. Means and proportions were compared using student t-test and chi-square or Kruskal-Wallis test as appropriate, with p<0.05 considered statistical significant. RESULTS: Approximately sixty percent of the patients were adjudged adherent with prescribed medication. Out of 58.8% of the cohort who gave their recent fasting plasma glucose (FPG) values, 59.7% had FPG above 110mg/dL. The mean FPG for patients was 139.05 (SD=70.5)mg/dL, males and females significantly differed in their mean FPG, 146.55 (SD=85.0)mg/dL versus 133.33 (SD=57.6)mg/dL respectively (p=0.032). Also, the mean FPG values for adherent patients, 137.09 (SD=59.3)mg/dL was lower than their non-adherent counterparts, 143.92 (SD=87.6) mg/dL, but the difference was not statistically significant (p=0.095). Financial constraint (34.4%) was the major barrier to optimal adherence with medication. A significant association exist between genders and opinions on physician's mode of approach during patient-physician interaction as a contributory factor for non-adherence (p=0.038). CONCLUSIONS: Medication adherence of ambulatory type 2 diabetes patients is considerable. However, the relatively high level of adherence did not appear to have significantly impacted on patients' glycemic status due to a substantial number who had plasma glucose above the recommended targets. Multiple methods may be required to detect patient who report adherence but who may in fact be non-adherent. Also, adherence to other aspects of diabetes management plan needs to be encouraged in order to accomplish optimal glycemic control. Initiatives targeting patient-specific intervention to improve medication adherence should be considered.

Self medication among hospitalized patients in selected secondary health facilities in South Western Nigeria / Auto-medicación entre pacientes hospitalizados en establecimientos secundarios selectos en el sur oeste de Nigeria

Practice of self-medication has not been evaluated in hospitalized patients especially in Nigerian hospitals. Objectives: To evaluate the practice of self-medication among hospitalized patients with an aim to unearth some of the reasons for, and perceptions of benefits of this type of behaviour in secondary health care facilities. Methods: This study was carried out among 197 in-patients admitted in three secondary health facilities in southwestern Nigeria using structured questionnaire. Effects of variables such as age, gender and marital status on the practice of self medication were also evaluated using the Fisher's Exact test at p<0.05 as level of significance. Results: Response rate of the study was 93.8% with 174 respondents (88.3%) perceived that the medications prescribed for them were efficacious. Almost 38% of the respondents were self-medicating, with herbal medicines (29.2%) and western medicines (37%) partly due to side effects of the prescribed medicines. Thirty one (15.7%) respondents obtained medicines for self medication through relatives and friends. Prescription medicines used for self medication constituted 7.5%. Major reasons given for self medication included habit, availability and necessity. Ninety respondents (35.7%) had been informed by health care personnel about possible side effects of the medications. Ninety six respondents (48.7%) experienced side effects with the prescribed medications and was a major reason for self medication. Seventy six respondents (79.2%) who had side effects or other secondary symptoms informed healthcare personnel in the hospital while 16 (16.7%) informed relatives and friends. There was statistically significant association between age and the action taken on whom was informed (p=0.001). Conclusions: There is need for extra vigilance from health personnel directly responsible for care of hospitalized patients to look for incidences of self-medication and patient education on the negative aspects of administering undisclosed medicines to their health care givers especially while they are hospitalized (AU)

La práctica de la auto-medicación no ha sido evaluada en los pacientes hospitalizados, especialmente en Nigeria. Objetivos: Evaluar la práctica de auto-medicación entre pacientes hospitalizados con el objetivo de desenterrar algunos motivos y percepciones del beneficio de este comportamiento en establecimientos de cuidados secundarios. Métodos: Este estudio fue realizado entre 197 pacientes hospitalizados en tres establecimientos de cuidados secundarios en el suroeste de Nigeria utilizando un cuestionario estructurado. También se evaluó, utilizando la prueba exacta de Fischer con p<0,05 como nivel de significación, el efecto sobre la práctica de auto-medicación de variables como edad, género, estado civil. Resultados: La tasa de respuesta del estudio fue del 93,8% con 174 respondentes (88,3%) que percibían que los medicamentos prescritos eran eficaces para ellos. Casi el 38% de los respondentes se auto-medicaban, el 29,2% con plantas medicinales y el 37% con medicinas occidentales, en parte debido a los efectos secundarios de los medicamentos prescritos. 31 (15,7%) de los respondentes obtenía los medicamentos para auto-medicación de sus parientes y amigos. De los medicamentos de auto-medicación, el 7,5% eran medicamentos de prescripción. Las principales razones aportadas para la auto-medicación incluían la costumbre, la disponibilidad y la necesidad. 90 respondentes (35,7%) habían sido alertados por el personal sanitario de los posibles efectos secundarios de los medicamentos. 96 (48,7%) experimentó efectos secundarios de la medicación prescrita y esta fue la principal razón para la auto-medicación. 76 (79,2%) de los que habían tenido efectos secundarios informaron al personal sanitario del hospital, mientras que 16 (16,7%) que tuvo efectos secundarios u otros síntomas secundarios informó a sus parientes y amigos. Hubo una asociación estadística entre la edad y la acción tomada sobre quien era informado (p=0,001). Concusiones: Existe una necesidad de una vigilancia extra del personal sanitario directamente responsable de los cuidados de los pacientes hospitalizados para localizar la aparición de auto-medicación y de la educación de los aspectos negativos de la administración de medicamentos no declarada a sus profesionales de la salud, especialmente mientras están hospitalizados (AU)

Self medication among hospitalized patients in selected secondary health facilities in South Western Nigeria.

UNLABELLED: Practice of self-medication has not been evaluated in hospitalized patients especially in Nigerian hospitals. OBJECTIVES: To evaluate the practice of self-medication among hospitalized patients with an aim to unearth some of the reasons for, and perceptions of benefits of this type of behaviour in secondary health care facilities. METHODS: This study was carried out among 197 in-patients admitted in three secondary health facilities in southwestern Nigeria using structured questionnaire. Effects of variables such as age, gender and marital status on the practice of self medication were also evaluated using the Fisher's Exact test at p<0.05 as level of significance. RESULTS: Response rate of the study was 93.8% with 174 respondents (88.3%) perceived that the medications prescribed for them were efficacious. Almost 38% of the respondents were self-medicating, with herbal medicines (29.2%) and western medicines (37%) partly due to side effects of the prescribed medicines. Thirty one (15.7%) respondents obtained medicines for self medication through relatives and friends. Prescription medicines used for self medication constituted 7.5%. Major reasons given for self medication included habit, availability and necessity. Ninety respondents (35.7%) had been informed by health care personnel about possible side effects of the medications. Ninety six respondents (48.7%) experienced side effects with the prescribed medications and was a major reason for self medication. Seventy six respondents (79.2%) who had side effects or other secondary symptoms informed healthcare personnel in the hospital while 16 (16.7%) informed relatives and friends. There was statistically significant association between age and the action taken on whom was informed (p=0.001). CONCLUSIONS: There is need for extra vigilance from health personnel directly responsible for care of hospitalized patients to look for incidences of self-medication and patient education on the negative aspects of administering undisclosed medicines to their health care givers especially while they are hospitalized.

Attitude and use of herbal medicines among pregnant women in Nigeria.

BACKGROUND: The use of herbal medicines among pregnant women in Nigeria has not been widely studied. METHODS: Opinion of 595 pregnant women in three geopolitical zones in Nigeria on the use of herbal medicines, safety on usage, knowledge of potential effects of herbal remedies on the fetus and potential benefits or harms that may be derived from combining herbal remedies with conventional therapies were obtained using a structured questionnaire between September 2007 and March 2008. Descriptive statistics and Fisher's exact tests were used at 95% confidence level to evaluate the data obtained. Level of significance was set at p<0.05. RESULTS: More than two-third of respondents [67.5%] had used herbal medicines in crude forms or as pharmaceutical prepackaged dosage forms, with 74.3% preferring self-prepared formulations. Almost 30% who were using herbal medicine at the time of the study believed that the use of herbal medicines during pregnancy is safe. Respondents' reasons for taking herbal medications were varied and included reasons such as herbs having better efficacy than conventional medicines [22.4%], herbs being natural, are safer to use during pregnancy than conventional medicines [21.1%], low efficacy of conventional medicines [19.7%], easier access to herbal medicines [11.2%], traditional and cultural belief in herbal medicines to cure many illnesses [12.5%], and comparatively low cost of herbal medicines [5.9%]. Over half the respondents, 56.6% did not support combining herbal medicines with conventional drugs to forestall drug-herb interaction. About 33.4% respondents believed herbal medicines possess no adverse effects while 181 [30.4%] were of the opinion that adverse/side effects of some herbal medicines could be dangerous. Marital status, geopolitical zones, and educational qualification of respondents had statistically significant effects on respondents views on side effects of herbal medicines [p<0.05)] while only geopolitical zones and educational qualifications seemed to have influence on respondents' opinion on the harmful effects of herbal medicines to the fetus [p<0.05]. CONCLUSION: The study emphasized the wide spread use of herbal medicines by pregnant women in Nigeria highlighting an urgent need for health care practitioners and other health care givers to be aware of this practice and make efforts in obtaining information about herb use during ante-natal care. This will help forestall possible interaction between herbal and conventional medicines.

Toxic effects of oral administration of extracts of dried calyx of Hibiscus sabdariffa Linn. (Malvaceae).

The effects of a 90-day oral administration of water and alcohol extracts of dried calyx of Hibiscus sabdariffa were evaluated in albino rats. Haematological, biochemical and histopathological changes were monitored every 30 days.The death of the animals was preceded by a severe loss in weight, accompanied with diarrhoea in animals on the 2000 mg/kg dose. There was an increase in food intake (g) per kg body weight per day in the aqueous (A) and ethanol (E) 300 mg/kg extract groups. Significant reductions in the erythrocyte count with no difference in total leucocyte count were observed. The activity of aspartate aminotransferase (AST) was enhanced by the administration of aqueous and 50% ethanol extract with a significant increase in its level at higher doses (p < 0.05). Alanine aminotransferase (ALT) and creatinine levels were significantly affected by all the extracts at the different dose levels. However, aqueous extracts exhibited a significant increase in creatinine levels (p < 0.05) at higher doses. The cholesterol levels were generally not significantly affected by the extracts. No significant histopathological changes were observed, although there was a significant reduction in the weight of the spleen of the animals administered with ethanol and water extracts when compared with the control (p < 0.01). Other organs were of the same relative weight.

Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria.

OBJECTIVE: The overall goal of the study was to evaluate the probable reasons for patients' nonadherence to prescribed oral hypoglycemic medications in an ambulatory care setting in Nigeria with a view to identifying points for necessary intervention to improve adherence and treatment outcomes. Also, the recommended non-drug management options for diabetes patients with emphasis on self monitoring of blood glucose were assessed. METHODS: A cross-sectional study was conducted at a 200-bed secondary health care facility in Southwestern Nigeria between 2(nd) April and 31(st) May 2008. Copies of pre-tested questionnaire were administered directly to 121 ambulatory patients with type 2 diabetes at the study site. Information on socio-demographic characteristic, probable barriers that affect adherence to prescribed oral hypoglycemic medications, non-drug treatment options for diabetes, and patients' self management efforts were obtained. Descriptive and chi-square statistics were used to evaluate the distribution of respondents' opinion. RESULTS: The response rate was almost 100%. The commonly cited intentional nonadherence practice included dose omission (70.2%). Almost 50% respondents were fed up with daily ingestion of drugs and 19.8% were inconvenienced with taking medications outside home and gave these as reasons for the dose omission. Forgetfulness (49.6%) and high cost of medication (35.5%) were mentioned as major non-intentional reasons for nonadherence. Aside oral medications, 82.6% and 95.0% of respondents respectively, reported moderate exercise and dietary restrictions as part of the prescribed treatment modalities. More than two third of respondents (81.8%) had never monitored blood glucose by themselves. Significant association exist between sex, occupation and patients' tendencies to forget doses of prescribed oral medications (p<0.05). CONCLUSION: Nonadherence behaviors among ambulatory patients with type 2 diabetes occur mostly, as omission and forgetfulness of doses of medication. Efforts are needed to increase the medication adherence and self management practices of these patients in Nigeria so they can realize the full benefits of prescribed therapies.