Clinical Pharmacy & Administration

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Assessment of the knowledge of community pharmacists regarding common phytopharmaceuticals sold in South Western Nigeria
(Pharmacotherapy Group, 2006-12) Adisa, R.; Fakeye, T.
Purpose: The study was carried out to assess the knowledge of community pharmacists who sell herbal/phytopharmaceutical formulations in pharmacy retail outlets. Method: Questionnaires were administered to the pharmacists to gather information on phytopharmaceuticals regarding their use, side effects, potential drug-herb interactions and contraindications of the phytopharmaceuticals sold in their retail outlets. Opinions on regulation, safety and efficacy of herbal remedies were also obtained. Descriptive statistical tests and median scores were used to evaluate the distribution of responses, opinions and perception of the pharmacists on their level of knowledge of the phytopharmaceuticals, and effects of demographic data on the pharmacists’ knowledge of the herbal remedies. Results: The study revealed that 31 (62%) sold imported herbal remedies and nutritional supplements. Seventy-two (72) % had received no postgraduate training on herbal medications. Most of the community pharmacists agreed that they did not possess adequate knowledge of potential interaction profiles and side effects of the herbal remedies sold. The training in pharmacy schools on herbal drugs and sale of phytopharmaceuticals in their outlets also had no influence (p>0.05) on desired knowledge. Community pharmacists with less than 10 years of experience in the practice however possessed better knowledge than pharmacists with more than ten years of professional practice (p=0.05) Conclusions: There was gross inadequacy in the pharmacists’ knowledge of the phytopharmaceuticals sold in pharmacies indicating an urgent need for intensive training in order to render better services to their clients.
Effects of Coadministration of Extract of Carica
(2007-03) Fakeye T.O.; Oladipupo T.; Showande O; Ogunremi Y.
Purpose: To investigate the interacting effects of co-administration of Carica papaya leaf extract on the hypoglycemic activity of metformin and glimepiride in an animal model. Method: Experimental factorial design was used to evaluate the individual and interaction influence of three variables ie nature (N), dose administered (C) and duration of administration (D), in a 23(=8) employed at two levels - ‘’high’’ and ‘‘low’’ - on blood glucose of diabetic rats on administration of ethanolic leaf extract of Carica papaya and two hypoglycemic agents, metformin and glimepiride.Unpaired t-test was used to test for significant difference due to administration of the combination Results: Extract of Carica papaya at 5.0 mg/kg produced significant blood glucose reduction with no significant reduction at the higher dose of 10 mg/kg (p>0.05). Changing nature from “low” (Carica papaya extract) to “high” (glimepiride or metformin) did not significantly change hypoglycemic activity.Generally, the ranking of the interacting effects was ND>CD>>NC for glimepiride/extract, and CD>ND>NC for metformin/extract. Administration of higher dose of the extract led to significant (p<0.01) increase in onset of activity of glimepiride. The onset of activity of metformin was not affected, but a significant lowering (p<0.05) of blood glucose was observed at 24 hr with all combinations of extract and metformin. Conclusion: Leaf extract of Carica papaya significantly delays the onset of hypoglycaemic activity of glimepiride, and increases the hypoglycaemic effect of metformin with the variables interacting differently for each drug-extract combinations
Evaluation of Adverse Drug Reactions to Artemisininbased Combination Therapy in a Nigeria University Community
(Pharmacotherapy Group, 2008-06) Adisa, R.; Fakeye, T. O.; Dike, D.
Purpose: The study was carried out to evaluate the incidence of adverse reactions to antimalarial drugs among residents of a Nigeria university community with a focus on artemisinin-based combination therapy (ACT). Specifically, the profile of use, and the reporting culture of people with respect to experienced reactions were noted. Method: Questionnaires were administered to respondents at the university health centre between November 2006 and January 2007. Information on demographic characteristics, nature of experienced adverse reactions and the most frequently used ACT, among other questions, were collected. Descriptive statistics and Fisher’s Exact test were used to evaluate the distribution of respondent’s opinion. Result: The study achieved a response rate of 86%. The results revealed that 210 (70.0 %) of respondents said they had used artemisinin-based combination drugs while 134 (44.7 %) said they used artemisinin derivatives alone as monotherapy for malaria treatment. Artesunate plus amodiaquine 94 (31.3%) as a co-packaged product was the most commonly used ACT. Incidence of the experienced adverse reactions to ACT was reported to be generally mild and well tolerated. Conclusion: Efforts to improve the use of ACT in the management of acute uncomplicated P. falciparum malaria is recommended. Furthermore, an effective mechanism to improve reporting of adverse effects of ACT is also recommended
Attitude and use of herbal medicines among pregnant women in Nigeria
(Biomed central ltd, 2009-12) Fakeye, T. O.; Adisa, R.; Musa, I. E.
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.
A survey of antimalarial drug use practices among urban dwellers in Abeokuta, Nigeria
(2010-01) Omole, M. K.; Onademuren, O. T.
Drug-use pattern of anti-malarial has been associated with development of resistant strain and therapeutic failure. This descriptive cross-sectional study was carried out to assess anti-malarial drug-use practices among dwellers of Adigbe communities within Abeokuta environment. The study documented the knowledge, the attitude and behaviour of three hundred and fifty (350) respondents in terms of drug preference, attitude to drug use and the effects of non-compliance to antimalarial drug. Structured questionnaires were used for data collection, as total of 370 questionnaires were distributed and 350 questionnaires were retrieved for analysis. One hundred and twenty five (125) (35.71) of the respondents frequently experienced malaria attack and practiced self-medication. One hundred and fifteen (115) (32.86%) of the respondents treated their malaria episode with Sulphadoxine-Pyrimethamine (SP) combination while 90 (25.71%) of the respondents frequently purchased Artesunate as monotherapy for malaria treatment due to cost-implication of the newer and available Artemisinin combination therapy (ACT’s). The finding reveals that 43 (12.29%) of the respondents only purchased Artemisinin-Combination Therapy (ACTs). One hundred and eight can 118 (33.71%) of the respondents practiced self-medication with anti-malarial drug. The results revealed therapeutic failure to conventional use of Sulphadoxine-Pyrimethamine (SP) by the respondents as One hundred and thirty nine (139) (33.71%) of the respondents experienced no cure and have to repeat the treatment with anti-malarias. If drug-use pattern of anti-malarials is not monitored, there is possibility of early emergence of resistance to the highly effective anti-malarial drugs presently in use.
Patient medication knowledge governing adherence to asthma pharmacotherapy: A survey in rural Lagos, Nigeria
(2010-05) Omole, M.K.; Ilesanmi, N. A.
Asthma is a chronic disease and often requires complex management. This study was undertaken in four pharmacies–V-Ninat Pharmacy, Videc Chemists, Tomabel Pharmacy and Josbet Chemists, all in Isolo, Lagos, to determine the level of adherence to the anti-asthmatic drugs by asthmatic patients who participated in the study. Data was collected using structured questionnaires administered to patients coming into the pharmacies. The questionnaire was administered during a one-on-one interview. Times of recruitment were varied in an attempt to avoid any bias or restriction of the sample in relation to gender, age, or employment status such as trading and teaching. There were 73 participants in the study. The participation rate was 67 (92%) of those individuals eligible. The mean age of participants was 57(± 17.7) years. 30 (45.2%) of respondents were males and 37 (54.8%) were females. The mean number of occasion of exercise per week was 28.26. Twenty six (26) (39.0%) of patients used “preventer” medication, that is medication that prevents asthmatic attack on those who frequently suffer from asthma, and 5 (7%) never used it. Participants offered a number of reasons explaining their non-adherence, the most common 24 (58.5%) were those who forgot to take “preventer” medication. Nine (9) (21.9%) were too busy, 5 (12.2%) were concerned about side effects and 3 (7.3%) did not believe it was effective. Other responses were offered only by individual participants and were not endorsed by the participant sample. Older patients adhered to their medication regimen more closely than younger patients. Fifty (50) (68%) patients used “preventer” medication and 17 (26%) patients used “reliever” that is, agent that relieves asthmatic attack on those who frequently suffer from asthma. Based on these findings and the result of hypothesis testing (p < 0.05), the study established poor medication knowledge, suboptimal device technique, and disturbing levels of patients adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcome. Further, strategies should be employed to motivate patients to use “preventer” medications during the times they feel well.
Medication Adherence Among Ambulatory Patients With Type 2 Diabetes in a Tertiary Healthcare Setting in Southwestern Nigeria
(2011-04) Adisa, R.; Fakeye, T.O; Fasanmade, A.
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 *Rasaq ADISA. B.Pharm, M.Pharm. Lecturer 1. Department of Clinical Pharmacy &Pharmacy Administration, Faculty of Pharmacy, University of Ibadan (Nigeria). Titilayo O. FAKEYE. B.Pharm, M.Sc, PhD. Senior Lecturer. Department of Clinical Pharmacy &Pharmacy Administration, Faculty of Pharmacy, University of Ibadan (Nigeria). Adesoji FASANMADE. MBBS, FWACP. Consultant endocrinologist. Department of Medicine, Endocrinology unit, College of Medicine, University of Ibadan, (Nigeria). 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 improve medication adherence should be considered.
Attitude and opinion of nigerian community pharmacists to self medication practices
(2012) Fakeye T. O.; Adisa R.; Showande S. J. S.
This study evaluated the attitude and opinion of Nigerian community pharmacists on self medication practices with respect to the definition, advantages and disadvantages of self medication, ailments for which self medication should be allowed, as well as measures that may be instituted to ensure appropriate self medication practices. Pretested structured questionnaires were administered to licensed community pharmacists practicing in Southwestern Nigeria between December, 2009 and July, 2010. Descriptive statistics were used to summarize the data. Mann Whitney U and Kruskal Wallis tests were used to evaluate the respondents’ opinions in ordinal variables with p < 0.05 considered statistically significant. Respondents with postgraduate qualification (p < 0.05) believed that self medication solely done by patients without guidance of a health care professional may lead to mismanagement or subtherapeutic management of diseases (66; 91.66%), medication errors and likelihood of disease complications (68; 93.15%). Years of practice had a significant effect on community pharmacists’ perception of advantages of self medication (p < 0.05). Rigorous monitoring of drug advertisement in the media might help in controlling the practice of self medication (63, 86.30%). Respondents believed that keeping the identity of the medications (29; 39.73%) and diagnosis details (19; 27.14%) unknown to patients is unethical. Self medication may be acceptable for fever (53; 74.65%), diarrhea (46; 67.65%) and cough (39; 53.62%), but with specific time limits, for patients on chronic medication who have stable clinical conditions, including asthma (46; 66.67%), hypertension (36; 51.43%) and diabetes (37; 52.86%). Community pharmacists in Southwestern Nigeria possess a good understanding of the concept of self medication, believed the practice should not be discouraged in totality, but should be practiced under controlled conditions, and that public enlightenment may help to ensure safe self medication practices.
Assessment of compliance to treatment among ambulatory asthmatic patients in a secondary health care facility in nigeria
(2012) Obasan A.A.; Showande S.J.; Fakeye T.O.
This study assessed the level of compliance using three different methods: pill count, self report and peak expiratory flow rate, in asthmatic patients attending a secondary health care facility. Self report (using a pre-tested structured questionnaire), peak expiratory flow rate and pill count were used to assess patient’s compliance and identify the factors which may be responsible for non compliance. Measurement of peak expiratory flow rate and the pill count were done at two different occasions. The data obtained was analysed using descriptive statistics. The study showed that the patients were prescribed a range of one to four drugs: 54% (3 drugs), 32% (2 drugs), 8% (4 drugs) and 2% (1 drug). The levels of compliance were 86.57% for self report and 83.56% for pill count (p > 0.05). Reasons given for non compliance were: apparent wellness (33.31%), forgetfulness (26.67%), cost of drugs (6.67%), dysphagia (6.67%), presence of non-disturbing symptoms (6.67%), side effects (6.67%), ignorance/fear of addiction (6.67%), perceived lack of benefit from treatment (6.67%), and lethargy towards chronic medication (6.67%). However, there was a significant difference in the readings of the peak expiratory flow rate measured at two different occasions (p < 0.05). The study showed no significant difference in the methods used to assess the level of compliance. Non compliance can be overcome by proper education of patients on the importance of complying with the administration of medication and proper usage of metered dose devices.
In vitro inhibitory activities of the extract of hibiscus sabdariffa l.
(2013) Showande S.J.; Fakeye T.O; Tolonen A; Hokkanen J.
Literature is scanty on the interaction potential of Hibiscus sabdariffa L., plant extract with other drugs and the affected targets. This study was conducted to investigate the cytochrome P450 (CYP) isoforms that are inhibited by the extract of Hibiscus sabdariffa L. in vitro. The inhibition towards the major drug metabolizing CYP isoforms by the plant extract were estimated in human liver microsomal incubations, by monitoring the CYP-specific model reactions through previously validated N-in-one assay method. The ethanolic extract of Hibiscus sabdariffa showed inhibitory activities against nine selected CYP isoforms: CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4. The concentrations of the extract which produced 50% inhibition of the CYP isoforms ranged from 306 µg/ml to 1660 µg/ml, and the degree of inhibition based on the IC50 values for each CYP isoform was in the following order: CYP1A2 > CYP2C8 > CYP2D6 > CYP2B6 > CYP2E1 > CYP2C19 > CYP3A4 >> CYP2C9 >> CYP2A6. Ethanolic extract of Hibiscus sabdariffa caused inhibition of CYP isoforms in vitro. These observed inhibitions may not cause clinically significant herb-drug interactions; however, caution may need to be taken in co-administering the water extract of Hibiscus sabdariffa with other drugs until clinical studies are available to further clarify these findings.
Use of antibiotics among non-medical students in a nigerian university
(2013) Sanya T.E; Titilayo O.F; Adisa R; Showande J.S
Background: Antibiotic misuse is a major contributory factor to treatment failure, antibiotic resistance and high healthcare costs. Objectives: To evaluate level of self-reported antibiotic misuse among non-medical undergraduate students of a Nigerian university. Methods: Respondents’ knowledge of antibiotics and disposal system for left-over antibiotics were explored using a structured questionnaire. Data were summarized with descriptive statistics. Chi square was used to evaluate relationship between specific categorical variables and respondents’ opinions with p<0.05. Results: More than half the respondents obtained their antibiotics through doctor’s prescriptions (273; 68.3%). The study revealed gross antibiotic misuse with majority, (298;74.5%) either by keeping left-over antibiotics for future use or throwing it away with refuse. Respondents (289; 72.3%) sometimes forgot to take the antibiotics. Financial constraints (73; 18.3%), long duration of treatment (70; 17.5%), side effects experienced (60;15.0%), polypharmacy (56;14.0%), tablet size (45;11.3%), and perceived low level of confidence in the prescriber (11; 2.8%) were major reasons for non-adherence. Course of study of respondents had no significant effect on respondents’ knowledge or adherence (p>0.05). Conclusion: Misuse of antibiotics among non-medical undergraduate students in a Nigerian university setting is pervasive suggesting an urgent need for enlightenment on rational use and disposal of antibiotics.
Community Pharmacists’ Perception of the Relevance of Drug Package Insert as Source of Drug Information in Southwestern Nigeria
(Pharmacotherapy Group, 2013-04) Adisa, R.; Omitogun, T. I.
Purpose: To evaluate the opinions of community pharmacists on the usefulness and reliability of drug package inserts (DPI) as drug information source, and necessary modifications needed to improve their contents. Methods: A prospective cross-sectional study using a pretested questionnaire was administered to sixty-one superintendent community pharmacists (CP) across two cities in southwestern Nigeria. Descriptive statistics was used to summarize the data and evaluate respondents’ opinion. Kruskal-Wallis test was used to evaluate the rank variables with p < 0.05 considered significant. Results: A majority of CP believed that information from DPI was precise and may be helpful in achieving therapeutic success (n = 42; 72.8 %). CP believed there is need for the modification of DPI content with respect to patient-related information (n = 52; 92.8 %) and health provider-related information (n = 52; 94.5%), non-uniformity of information on the same generic medicines (n = 31; 50.8%), and ambiguity of content (n = 29; 47.5 %). Years of experience in practice significantly influenced respondents’ perception of precision and satisfaction with DPI as source of information. Conclusions: Community pharmacists in southwestern Nigeria believed that a properly modified drug package insert could be a useful and reliable source of drug information in daily practice.
Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria
(2013-07) Adisa, R.; Fakeye T. O.
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 anti diabetes 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 multiplemedications for type 2 diabetes.
Treatment Non-Adherence Among Patients With Poorly Controlled Type 2 Diabetes Am¬bulatory Care Settings In Southwestern Nigeria
(2014) Adisa, R.; Fakeye, T . O
Background: Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which un¬dermines 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 in¬dication 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.
Evaluation of the extent and pattern of use of herbal
(2014) Showande S.J; Amokeodo O.S.
Purpose: To evaluate the extent and pattern of use of herbal bitters among students. Methods: This was a cross-sectional study where pre-tested structured questionnaires were administered to 1000 students. The questionnaire elicited information on the extent and pattern of use, self-reported indications, side effects experienced and possible drugs that were concomitantly coadministered with herbal bitters. Pearson Chi square, Fisher exact test and Relative risk ratio were used to detect association between gender and self-reported indications and side effects experienced with herbal bitters at a level of significance of p < 0.05. Results: The response rate and extent of use were 96 % and 40.9 % respectively. Herbal bitters were used for claims such as cleansers 88 (40.2 %), anti-infectives 48 (21.1 %), for rejuvenation 32 (14.0 %), and for weight loss 14 (6.1 %). Self-reported side effects included dizziness 49 (22.0 %), loss of taste 46 (20.6 %) and nausea and vomiting 22 (9.7 %). Herbal bitters were also co-administered with antimalarials 22 (6.3 %); analgesics 16 (4.5 %) and herbal supplements 13 (3.7 %). Reports of students using two different types of herbal bitter concurrently 15 (3.9 %) were also garnered. Male students experienced more side effects than females (p < 0.05). Conclusion: The co-administration of herbal bitters with allopathic medicines and the use of more than one herbal bitter at a time reported in this study can be addressed by the appropriate health authorities through proper educational programme.
PRESCRIBING ERRORS AND INTERVENTION OUTCOMES IN SELECTED TERTIARY HOSPITALS IN NIGERIA
(2014-11) AJEMIGBITSE, ADETUTU ADEBAMBO
Prescribing errors, particularly in the medical and paediatric specialties have been reported globally to affect up to 52.0% of hospitalized patients with potential to cause harm. Prescribing errors have however not been adequately investigated in Nigeria. This study was designed to carry out an in-depth evaluation of the nature, severity and causes of prescribing errors in three purposively selected tertiary hospitals in Nigeria with a view to providing pharmacist-led evidence-based recommendations for their prevention. A retrospective review of 8270 out-patient prescriptions and 1200 in-patient records from medical and paediatric units between January and December 2010 in National Hospital, Abuja (NHA) with University of Abuja Teaching Hospital, Gwagwalada (UATH) and University College Hospital, Ibadan (UCH) as controls. Baseline prescribing pattern was measured using the British National Formulary and Nigeria Standard Prescribing Guidelines. Causes of prescribing errors were investigated using a prospective qualitative approach involving semi-structured face-to-face interviews and questionnaires guided by the Reason’s accident causation model. Error rates were studied in the three tertiary hospitals while intervention was carried out at NHA. Interventions involved educational outreaches consisting of structured teaching and training. Data collected compared error rates pre- and post- intervention, to determine impact of the intervention. Data were analysed using descriptive and Chi-square statistics. Prescribing error rates were 24.6 ± 1.4 (UATH), 5.7 ± 1.2 (NHA) and 6.7 ± 2.3 (UCH) for out-patient prescriptions and 28.7 ± 2.3 (UATH), 26.3 ± 2.1 (NHA) and 41.0 ± 3.1 (UCH) for in-patient prescriptions. Non-inclusion of direction of use (38.1%, UATH); missing signature and/or name of prescriber (66.6%, NHA) and omitting end date of therapy (54.4%, UCH) were the commonest errors in out-patient prescriptions. The most common in-patient prescribing error was missing end date of therapy: 71.3% (UATH), 65.9% (NHA) and 86.0% (UCH). The highest proportion of medications was ordered at admission: 57.3% (UATH), 44.3% (NHA) and 44.7% (UCH) while time of discharge was associated with the highest error rates of 37.8% (UATH), 58.6% (NHA) and 80.8% (UCH). Severity of prescribing error rates for in-patients was 4.9% (UATH), 2.8% (NHA) and 1.3% (UCH). Prescriptions involving antimicrobials contained the highest prescribing UNIVERSITY OF IBADAN LIBRARY iii errors 53.8% (UATH), 37.9% (NHA), and 36.3% (UCH). Risk factors identified in error causation included organisational (91.0%), environment (50.0%), individual (45.0%), task (45.0%) and team (36.0%) factors. Absence of self-awareness of errors and organisational factors identified included inadequate training and experience and absence of reference materials. Defences against errors, particularly pharmacists’ involvement, were deficient. There was no change in overall error rates 5.8%, pre- and post- intervention (p = 0.98). However, there were reductions in drug-drug interactions 1.2% to 0.4% (p<0.001), omission of drug route 0.3% to 0.1% (p<0.001) and ambiguous orders 0.2% to 0.0% (p<0.001) at the NHA. Prescribing errors were common in the 3 facilities resulting from writing prescriptions that lacked details and slips in attention. Majority of the errors, though of minor severity, had potential of causing harm. Continuing prescriber education and training will likely result in error reduction. Pharmacists’ involvement in prescribing error prevention should be an on-going process. Key words: Prescribing errors, Reason’s accident causation model, In- and out-patients. Word count: 500
Evaluation of prescription pattern and patients’ opinion on healthcare practices in selected primary healthcare facilities in Ibadan, South-Western Nigeria
(2015) Adisa, R.; Fakeye, T. O.; Aindero, V. O.
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
Remedies for glucose intolerance – are traditional herbal concoctions for diabetes effective?
(2015) Showande S.J.; Bello J.J
Background:Preventing or delaying the onset of diabetes in prediabetes has the potential to reduce the disease prevalence. Objective:The effectiveness of traditional herbal concoctions for diabetes in ameliorating glucose intolerance was investigated. Material and Methods:Oral glucose tolerance test (OGTT) was carried out by giving 500 mg/kg and 1000 mg/kg of individual plant extract and their aqueous herbal concoctions made from Musa sapientum + Allium sativum + Tetracarpidium conophorum; Gongronema latifolia + Bauhinia monandra; and Alstonia boonei + Mangifera indica to groups of rats, 30 and 60 minutes respectively prior to 3 g/kg of glucose load. Blood glucose levels were determined at 0, 10, 20, 30, 45, 60, 90, and 120 minutes post administration. Area under the curve (AUC) for OGTT and glycemic index were calculated and compared with the vehicle control and metformin (100 mg/kg). Level of significance was set at P<0.05. Results:Oral glucose tolerance test AUCs of individual plants were significantly lower than that of the vehicle control (P<0.05) but comparable with that of metformin (P>0.05) when given 30 minutes prior to glucose load. The OGTT curve AUCs of the three herbal concoctions were significantly higher than the two controls (P>0.05). Glycemic index of the concoctions were significantly higher than that of metformin (P>0.05) Conclusion:The herbal concoctions were not effective in ameliorating glucose intolerance. Individual plants were more effective when administered 30 minutes prior to glucose load. The individual herbs showed potentials to delay the onset of diabetes. Further investigations should be conducted on the numerous herbal concoctions used for diabetes.
Developing a model for teaching and learning clinical pharmacy components of the pharmacy curriculum in Nigeria
(International pharmaceutical Federation, 2017-01) Fakeye, T. O.; Adisa, R.; Erhun, W. O.
Background: Increasing clinical roles of pharmacists necessitate the need for adopting innovative teaching and learning methods that will enhance pharmacist’s clinical skills especially in developing countries. Aim: To develop appropriate model(s) for teaching clinical pharmacy in Nigeria. Method: The study consisted of focus group discussions (FGDs) with final year pharmacy students of a Nigerian university investigating their preferred methods for learning clinical pharmacy. The FGDs resulted in a 50-item questionnaire exploring appropriate models for teaching clinical pharmacy among the teachers. Data was evaluated using thematic analysis and descriptive statistics. Result: Integrated and interactive active-learning teaching models were proposed in the FGDs. Models proposed included Direct Instruction (DI), Guided Design (GD) Cognitive apprenticeship (CA), Cooperative Learning (CL) and Problem-based learning (PBL) with clinical pharmacy teachers ranking them GD=DI>CA>>CL=PBL for teaching clinical pharmacy components Conclusion: FGDs preferred low structure while the teachers preferred moderate to high structure of learning.
Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria
(2018) Adisa, R.; Orherhe, O. M.; Fakeye, T. O.
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.