Medication Adherence in Type 2 Diabetes Mellitus: A Qualitative Exploration of Barriers and Facilitators From Socioecological Perspectives.

Adherence to antidiabetic medications (ADMs) remains a serious challenge among type 2 diabetes mellitus (T2DM) patients. Factors affecting medication adherence are not fully understood in Nigeria. This qualitative study explored patients' views on barriers and facilitators of medication adherence. Data collection was through face-to-face, semistructured, in-depth interviews conducted on 25 purposively sampled patients attending a public tertiary hospital. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis based on socioecological framework. NVIVO version 10 identified more codes. Most commonly identified barriers were organizational (clinic structure), personal (perception of T2DM as a dangerous illness), interpersonal (lack of spousal support), and community (concerns about taking ADMs in social gatherings). It was observed that female patients received more spousal support than the males. The facilitators of adherence include perceiving medication-taking a routine, the need to live longer, having savings for ADMs, purchasing medications to last until the next clinic visit. This study identified barriers and facilitators unique to Nigerian T2DM patients. Interventions anchored on these factors would improve medication adherence.

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

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

Differential Reactions of Soybean Isolines With Combinations of Aphid Resistance Genes Rag1 , Rag2 , and Rag3 to Four Soybean Aphid Biotypes.

With the discovery of the soybean aphid ( Aphis glycines Matsumura) as a devastating insect pest of soybean ( Glycine max (L.) Merr.) in the United States, host resistance was recognized as an important management option. However, the identification of soybean aphid isolates exhibiting strong virulence against aphid resistance genes ( Rag genes) has highlighted the need for pyramiding genes to help ensure the durability of host resistance as a control strategy. In this study, soybean isolines with all possible combinations of the resistance and susceptibility alleles at Rag1 , Rag2 , and Rag3 were evaluated for their effectiveness against the four characterized soybean aphid biotypes. All soybean isolines, including the susceptible check carrying none of the resistance alleles (S1/S2/S3), were infested with each biotype in no-choice greenhouse tests, and the aphid populations developed on each isoline were enumerated 14 d after infestation. All gene combinations, with the exception of Rag3 alone, provided excellent protection against biotype 1. Isolines with Rag2 alone or in combination with Rag1 and Rag3 had greater levels of resistance to biotype 2 than those with either Rag1 alone, Rag3 alone, or the Rag1/3 pyramid. For biotype 3, the Rag1/3 and Rag1/2/3 pyramided lines significantly reduced aphid populations compared with all other gene combinations, while the Rag1/2/3 pyramid provided the greatest protection against biotype 4. Overall, the Rag1/2/3 pyramided line conferred the greatest protection against all four biotypes.

Review of ciprofloxacin use in children.

BACKGROUND: The frequency of prescriptions for ciprofloxacin use in children is high despite the caution recommended. OBJECTIVE: To assess frequency of ciprofloxacin prescriptions in a pediatric unit and review the literature on use of ciprofloxacin in children. METHODS: Patient case notes in a pediatric general ward of a tertiary hospital were reviewed. Electronic databases were searched for articles published in English between January2001 and December2011. RESULTS: Ciprofloxacin was prescribed for 20% of the children in our preliminary study. In all the studies reviewed ciprofloxacin was used as a second line treatment in life-threatening cases and only for organisms that were susceptible on culture. Adverse events such as arthralgia, gastro intestinal disturbances and CNS reactions were recorded; they were reversible and often did not warrant discontinuation of therapy. CONCLUSION: Ciprofloxacin may be used in children as second line treatment, in life-threatening cases, for susceptible organisms when the benefit outweighs the risk.