FACULTY OF PHARMACY
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Item Knowledge of Malaria Management in Pediatrics among Undergraduate Pharmacy Students in University of Ibadan, Nigeria(2022-09) Ipingbemi. A.E.; Akande-Sholabi,W.; Osarenmwinda, M.I.Background Falls are a major cause of morbidity and hospitalization in older people. Many drugs have been shown to increase the risk of falls in this population. Few empirical data exist on the use of fall-risk-increasing drugs among older people of sub-Saharan Africa countries. Objective This study aimed to assess the prevalence and predictors of falls, and the association between FRIDs, drugs causing orthostatic hypotension and falls. Setting Geriatric center, University College Hospital, Ibadan, Nigeria. Methods A cross-sectional study of 400 older patients aged ≥ 60 years selected consecutively at the geriatric centre, between September and November 2019, were interviewed using a semi-structured questionnaire. Socio-demographic information, medication utilization, and history of falls were obtained. Bivariate and multivariate analyses were carried out using SPSS 23. Alpha was set at 0.05. Main outcome measure Prevalence and predictors of falls among ambulatory older patients. Results The mean age of the older patients was 72.4 ± 7.3 years and 255 (63.7%) were females. The total number of FRIDs and ODs used by older patients was 578 (35.2%). The prevalence of fall was 181 (45.3%) which was signifcantly higher among the females compared with the males (51.8% vs 33.8%) p = 0.01. Classes of medications such as anti-Parkinson’s (p = 0.027), sedatives (p = 0.033), antipsychotics (p = 0.011) and anticholinergic (p = 0.027) were signifcantly associated with fall. Predictive factors for falls on logistic regression were female [OR = 2.375; 95% CI 0.274–3.704, p = 0.001] and use of antipsychotics [OR = 5.132; 95% CI 1.352–19.480, p = 0.016]. Conclusion The prevalence of falls was high and being a woman ≥ 60 years is a major risk factor for falling. Interventions to decrease falls in older patients by drug modifcation and deprescribing of FRIDs and ODs might reduce fall-related injuries. Thus, a multidisciplinary approach is essential for intervention to reduce the risk of falls and improve therapeutic outcomes among older patients.Item Treatment of malaria in pregnancy: Knowledge of community pharmacists in Ibadan, Nigeria(Original Research Article, 2019-11-14) Akande-Sholabi, W.; Ilesanmi,O. S.; Ayanleke,A.S.Purpose: To evaluate the knowledge of community pharmacists in the management of malaria in pregnancy and their adherence to the World Health Organisation (WHO) treatment guidelines. Methods: Questionnaires were administered to obtain information on knowledge and adherence to WHO guidelines. Respondents’ scores on a 12-item knowledge question on the management of malaria in pregnancy were categorized as good knowledge if ≥ 10, and poor knowledge if < 10. Descriptive statistics were used to summarise the data. Chi-square test was used to explore the association between sociodemographic characteristics and knowledge. Results: Pharmacists qualified within 10 years of the study period were 29 (48.3 %). Only 25 (31.3 %) of the pharmacists possessed an additional qualification to Bachelor of Pharmacy degree. Rapid diagnostic test kits (RDT) and light microscopy test (LMT) have been used by 51 (76.2 %) and 17 (28.8 %), respectively, to diagnose malaria. About three-quarters (71.3 %) had poor knowledge of the medication for the treatment of malaria in pregnancy. Knowledge score was neither significantly associated with the pharmacists’ years of qualification (p = 0.174) nor with possession of additional qualification (p = 0.334). Conclusions: There is a substantial gap in pharmacists’ knowledge on the management of malaria in pregnancy, revealing an urgent need for training and adherence of community pharmacists to World Health Organisation treatment guidelines to ensure the safety of pregnant women and the unborn baby.Item Toward pharmacy-based smoking cessation services in Nigeria: Knowledge, perception and practice of community pharmacists(2021) Akande-Sholabi,W.; Adebisi, Y.INTRODUCTION Worldwide, tobacco smoking is one of the leading causes of avoidable deaths. In Nigeria, there is currently no clinical guidelines for tobacco dependence treatment. However, globally, pharmacy-based smoking cessation intervention has been associated with improved cessation rates and quality of life. This study aims at assessing the knowledge and perception of community pharmacists about smoking cessation and tobacco harm reduction as well as barriers to the practice of pharmacybased smoking cessation intervention. METHODS A cross-sectional survey was carried out among 104 community pharmacists, between August and December 2019, using a self-administered paper questionnaire. Data entering, cleansing, and analysis were done using IBM SPSS (version 23). Descriptive statistics including frequencies and percentages were used to summarize the data. RESULTS Thirteen pharmacists (12.5%) were providing smoking cessation services. One-tenth (10.6%) of the pharmacists were aware of tobacco harm reduction. The majority (89.4%) were willing to attend smoking cessation training. Among the respondents, 65 (62.5%) had poor knowledge regarding smoking cessation and tobacco harm reduction. Lack of knowledge and skills were reported by all (100%) as a barrier to providing the service. However, 101 (97.1%) community pharmacists agreed that smoking cessation treatment is an important role of pharmacists. CONCLUSIONS A suboptimal level of knowledge of smoking cessation and tobacco harm reduction was noted among the community pharmacists. However, they believed smoking cessation intervention is an important role of pharmacists. It is advocated that smoking cessation training should be included as part of the Pharmacists’ Council of Nigeria Mandatory Continuing Professional Development Training. Thus, it is imperative to establish basic national smoking cessation guidelines that can be functional towards reducing mortality and morbidity associated with tobacco smoking in Nigeria.Item PROMOTING CESSATION AND A TOBACCO FREE FUTURE: KNOWLEDGE AND ATTITUDE OF PHARMACY STUDENTS REGARDING SMOKING CESSATION IN A NIGERIAN UNIVERSITY(penerbit, 2022) AKANDE-SHOLABI, W.; ADEBISI, Y. A.Tobacco smoking is a global public health threat and the largest single driver of health inequalities. Currently, there are over a billion smokers worldwide with approximately 80% of the smokers living in low-and-middle-income countries like Nigeria. Knowledge gaps on smoking cessation among pharmacy students might impact the quality of service these future pharmacists would provide in practice. Therefore, this study aimed to evaluate the knowledge and attitude of pharmacy students regarding smoking cessation in a Nigerian university. A University-based cross-sectional study was conducted among 277 pharmacy students of a Nigerian university using a pretested self-administered questionnaire between August and December 2019. Data were summarised descriptively using IBM SPSS (version 23). Most of the pharmacy students 203 (73.2%) agreed it is the pharmacists’ responsibility to support patients with smoking cessation. The majority of our respondents 226 (81.6%) reported pharmacy students need more training on smoking cessation. Thirty-three (11.9%) pharmacy students knew nicotine does not cause cancer. Less than one-tenth 27 (9.7%) of the pharmacy students were aware of smoking cessation products. Overall, 203 (73.2%) respondents had poor knowledge (score < 60%) and an average positive attitude about smoking cessation. Pharmacy students have suboptimal knowledge about smoking cessation. However, they revealed a positive attitude towards smoking cessation. Therefore, there is a need for educational interventions to address the deficit in smoking cessation knowledge, as well as equip future healthcare providers. Thus, improving the quality of public health especially among smokers in Nigeria.Item Prevalence, knowledge and perception of self medication practice among undergraduate healthcare students(Springer Nature, 2021) Akande Sholabi.W.; Ajamu, A. T.; Adisa, R.Background: Globally, self-medication is a common practice, and an increasingly perceived necessity to relieve bur dens on health services. However, inappropriate self-medication may result to reduced health outcomes, increased antimicrobial resistance and economic waste. Healthcare students are the future health professionals who will be consistently responsible for educating the public on rational use of medication. This study therefore aimed to assess the prevalence, knowledge and perception of self-medication practices among healthcare students. Methods: A cross-sectional study was carried out among 866 healthcare students in a Nigerian University, compris ing medical, nursing and pharmacy students. Information was garnered from respondents using a self-administered questionnaire. Data were summarized with descriptive statistics, while Chi-square and logistic regression tests were used for categorical variables at p< 0.05. Results: Mean age was 21±2.8 years, and female respondents were 447 (51.6%). Prevalence of self-medication among respondents was 473 (54.6%). A total of 288 (55.3%) demonstrated good knowledge of self-medication prac tices, comprising 250 (52.2%) among those who have previously self-medicated and 229 (47.8%) among those who had not. Reasons for engaging in self-medication practices were mentioned to include treatment of minor ailments (357; 32.4%), while 248 (22.5%) believed they had the medical knowledge of what to use. Analgesic (353; 30.1%), anti malarial (352; 30.0%), and antibiotics (182; 15.5%) were the commonest classes of medication used for self-medication. Headache (363; 18.4%), malaria (334; 16.9%), and cough (184; 9.3%) were the most frequently treated conditions. More than half (281; 59.4%) of the respondents’ purchased their self-medicated drugs from the community pharmacy. Gen der and respondents’ disciplines were found to be the independent predictors for good knowledge of self-medication practice. Conclusion: Prevalence of self-medication among the studied healthcare students is moderately high, while approximately half demonstrates good knowledge and perception of self-medication practices. Stimulation for selfmedication practice largely arise from the perception of treating minor ailments. This underscores a need for advo cacy on responsible self-medication practice during the formal training of these future health professionals, in order to avert its imminent/widespread negative consequences.Item Prescribing Pattern of Antihypertensive Medications in a Geriatric Center In South Western Nigeria(2019) Akande Sholabi.W.; Adebusoye, L. A.Background: Hypertension is a prominent public health problem, with considerable health consequences. Recommended guidelines encourage use of antihypertensive medications with the best evidence of reducing cardiovascular risk. Data on antihypertensive medications use among older Nigerians is limited. Objective: This study evaluated the antihypertensive medication use among older persons with hypertension in compliance with the Eighth Joint National Committee guidelines (JNC 8). Method: A retrospective cross-sectional study, of older patients diagnosed with hypertension between the 1st January 2017 and 31st December 2017 at the geriatric center, University College Hospital, Ibadan. Results: The mean age was 70.2 ± 7.2 years and 62% were female. The mean number of medications used by the patient was 4.5 ± 1.4. Of the patients, 56% were receiving combination therapy, 42% two drugs and 14% three drugs. Most patients were receiving calcium channel blockers (33.8%), followed by diuretics (29.6%), angiotensin receptor blockers (23.4%) and angiotensin-converting enzyme inhibitors (10.8%). Commonest combination therapy was calcium channel blockers and thiazide diuretics (28.3%), while the commonest multi-morbidities were osteoarthritis (32.7%), diabetes (17.3%) and dyslipidemia (8.7%). Conclusion: This study showed that more than half of older persons with hypertension were on combination therapy, and the most frequently used class of antihypertensive drugs were calcium channel blockers, followed by diuretics. The guidelines and data for black ≥60 years indicate that lower doses of combination therapy are more effective in achieving blood pressure target. Despite the numerous advantages of ACEIs, they remain underutilized.Item Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria(2020) AKANDE-SHOLABI,W.; ADEBUSOYE, L. A.; OLOWOOKERE,O.O.Objectives: To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients. Methods: Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05. Results: Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use. Conclusions: The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.Item Potentially inappropriate medication use in the elderly: physicians’ and hospital pharmacists knowledge, practice, confdence, and barriers(Springer Nature, 2020) Akande Sholabi.W.; Fafemi. A.Background: Inappropriate medication prescribing and dispensing by physicians and pharmacists is a preventable cause of morbidity and mortality in the elderly. Signifying the importance of healthcare professionals’ knowledge of potentially inappropriate prescribing tools/ guidelines which would improve overall health outcomes. Beers Criteria is one of the most used guidelines that list specifc potentially inappropriate medications (PIMs). This study aimed to investigate physicians’ and hospital pharmacists’ awareness, knowledge, practice, confdence, and barriers to the use of Beers criteria. Methods: A cross-sectional survey was carried out among 66 hospital pharmacists and 31 family medicine physi cians working in a teaching hospital in Nigeria, between May and September 2021 using a self-administered ques tionnaire. Knowledge of PIMs was assessed using 11 clinical vignettes based on the 2019 Beers Criteria. Practice behavior towards elderly patients was assessed using a 5-item statement with a 5-point Likert scale. Perceived barriers to the appropriate use of Beers Criteria were assessed using a 15-item statement. Descriptive and inferential statistics were used to analyze the data. Results: A total of 66 hospital pharmacists and 31 family medicine physicians participated in the study. Only (24; 36.4%) pharmacists and (4; 12.9%) physicians knew guidelines that listed specifc PIMs. In all (21; 31.8%) pharmacists and (11; 35.4%) physicians demonstrated good knowledge of Beers Criteria, while most pharmacists (55; 83.3%) and physicians (29; 93.5%) reported good practice when dealing with elderly patients in terms of asking relevant ques tions and considering their ages while dispensing medications. Knowledge scores were not signifcantly associated with hospital pharmacists’ socio-demographics. Most of the physicians and pharmacists were confdent in the care provided for geriatric patients. The majority (66; 100.0%) pharmacists and (28; 93.5%) physicians suggested training through seminar presentations as a measure to improve the use of Beers’ criteria. Lack of time to counsel patients was a major barrier recounted by both physicians and pharmacists. Conclusion: Healthcare professionals that participated in this study had satisfactory practice, although a gap in the knowledge of hospital pharmacists and family medicine physicians was noted. In addition to creating aware ness among healthcare professionals and training on PIMs and Beers’ criteria, a multidisciplinary approach to reduce potentially inappropriate prescribing and dispensing would greatly help reduce the incidence of potentially inappro priate medication use among elderly patients.Item Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern Nigeria: Beers criteria versus STOPP/START criteria(2020) Akande-Sholabi,W; Ajilore, O. C.; Showande, S. J.; Adebusoye, L. A.Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/ Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly. Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs). Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria. Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria.Item Polypharmacy and factors associated with their prevalence among older patients attending a geriatric centre in South-West Nigeria(2018) Akande-Sholabi,W.; Adebusoye,L.; Olowookere,O.Background: Polypharmacy among older people in Nigeria are prominent issues of public health dimension. Polypharmacy especially in older people with multiple diseases often results in poor health status and outcomes. Objectives: To determine the prevalence and factors associated with polypharmacy among older patients attending the geriatric clinic. Methods: Cross sectional study of 400 elderly patients aged 60 years and above who presented at geriatric clinic, UCH, Ibadan. Polypharmacy was taken as concurrent consumption of =5 medications. Sociodemographic characteristics, lifestyle habits, attitudinal factors on medication understanding, medication pattern and intake were assessed through a questionnaire. Bivariate and multivariate analyses were carried out using SPSS 20 and alpha was set at 0.05. Results: Mean age of the respondents was 70.2 ± 5.9 years and 240 (60.0%) were females. The point prevalence of polypharmacy was 23.8%. The averagemedications consumed were 4 without sex difference. Logistic regression analysis showed that taking too many prescription medications (OR = 2.188; 95% CI = 1.014 – 4.808, p = 0.05), intentionally skipping my medications because they are too many (OR = 3.756; 95% CI = 1.354 – 10.424, p = 0.01) and receiving prescriptions from more than one physicians on regular basis (OR = 2.336; 95% CI = 1.058 – 5.155, p = 0.04) were the most significant factors associated with polypharmacy. Conclusion: Polypharmacy is common among older people in this setting. Healthcare workers should address the attitudinal, social and health related factors, which could lead to polypharmacy.