FACULTY OF PHARMACY
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Item Extent of misuse and dependence of codeine-containing products among medical and pharmacy students in a Nigerian University(Springer Open, 2019) Akande-Sholabi, W.; Adisa, R.; Ilesanmi, O.S.; Bello, A. E.Background: Misuse and dependency of opioids especially codeine-containing products is of increasing global concern. Inappropriate use of opioids among healthcare students could affect quality of service and ethical conducts of these future professionals, thereby putting the society at risk. This study aimed to evaluate knowledge and perception of medical and pharmacy students in a Nigerian tertiary University on use of opioids with focus on codeine-containing products. Methods: A cross-sectional survey among 335-medical and 185-pharmacy students from University of Ibadan, Nigeria, between September and December 2018, using a self-administered semi-structured questionnaire. Results: A total of 178 (34.2%) in multiple responses had used opioid-containing products among the respondents, of this, 171 (96.1%) used codeine-containing formulation. Precisely, 146 (28.1%) of the students had used codeine-containing products before, of this, 16 (11.0%) used the products for non-medical or recreational purpose regarded as a misuse/ abuse. In all, 201 (38.7%) had good knowledge of opioid use, with 51 (34.9%) among those who had used opioids and 150 (40.1%) among those who had not used opioids (X2 = 1.186; p = 0.276). Majority (469; 90.2%) had good perception of risks associated with opioid use; comprising (130; 89.0%) among those who had taken opioids and (339; 90.6%) among those who had not taken opioids before (X2 = 0.304; p = 0.508). Logistic-regression shows that students who experienced some side effects to be experienced again 22.1 [AOR = 22.1, 95% CI: (5.98–81.72)] as well as those pressured into using codeine-containing products 10.6 [AOR = 10.6, 95% CI: (1.36–82.39)] had more tendency of misuse. Conclusion: There is a potential for misuse of codeine-containing products among medical and pharmacy students. Peer-influence and experience of some side effects are possible predictors of misuse among the students. Thus, healthcare students’ curriculum should incorporate preventive programme, while public education and policy that favours peer-support programme on medication misuse is advocated for healthcare students.Item Treatment Non-Adherence Among Patients With Poorly Controlled Type 2 Diabetes Am¬bulatory Care Settings In Southwestern Nigeria(2014) Adisa, R.; Fakeye, T . OBackground: 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.Item Pharmacists’ knowledge, Attitude and Involvement in Palliative Care in Selected Tertiary Hospitals in Southwestern Nigeria(2019) Adisa, R.; Anifowose, A.TBackground: The growing number of people living with life-limiting illness is a global health concern. This study therefore aimed to explore the involvement of pharmacists in selected tertiary hospitals in Nigeria in palliative care (PC). It also sought to evaluate their knowledge and attitude to PC as well as factors that hinder pharmacists’ participation in PC. Method: Questionnaire-guided survey among pharmacists working in three-tertiary hospitals in southwestern Nigeria. The self-administered questionnaire comprised 18-item general knowledge questions related to PC, attitude statements with 5-point Likert-scale options and question-items that clarify extent of involvement in PC and barriers to participation. Overall score by pharmacists in the knowledge and attitude domains developed for the purpose of this study was assigned into binary categories of “adequate” and “inadequate” knowledge (score > 75% versus≤75%), as well as “positive” and “negative” attitude (ranked score > 75% versus≤75%), respectively. Descriptive statistics, Mann-Whitney-U and Kruskal-Wallis tests were used for analysis at p < 0.05. Results: All the 110 pharmacists enrolled responded to the questionnaire, given a response rate of 100%. Overall, our study showed that 23(21.1%) had adequate general knowledge in PC, while 14(12.8%) demonstrated positive attitude, with 45(41.3%) who enjoyed working in PC. Counselling on therapy adherence (100;90.9%) was the most frequently engaged activity by pharmacists; attending clinical meetings to advise health team members (45;40.9%) and giving educational sessions (47;42.7%) were largely cited as occasionally performed duties, while patient home visit was mostly cited (60;54.5%) as a duty not done at all. Pharmacists’ unawareness of their need in PC (86;79.6%) was a major factor hindering participation, while pharmacists with PC training significantly felt more relaxed around people receiving PC compared to those without training (p = 0.003). Conclusion: Hospital pharmacists in selected tertiary care institutions demonstrate inadequate knowledge, as well as negative attitude towards PC. Also, extent of involvement in core PC service is generally low, with pharmacists’ unawareness of their need in PC constituting a major barrier. Thus, a need for inclusion of PC concept into pharmacy education curriculum, while mandatory professional development programme for pharmacists shouldnalso incorporate aspects detailing fundamental principles of PC, in order to bridge the knowledge and practice gaps.Item 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.Item Extent of misuse and dependence of codeinecontaining products among medical and pharmacy students in a Nigerian University(Research Square, 2019-08) Akande-Shola, W.; Adisa, R.; llesanmi, O. S.Background Misuse and dependency of opioids especially codeine-containing products is of increasing global concern. Inappropriate use of opioids among healthcare students could affect quality of service and ethical conducts of these future professionals, thereby putting the society at risk. Objectives To evaluate knowledge and perception of medical and pharmacy students in a Nigerian tertiary University on use of opioids with focus on codeine-containing products. Methods A cross-sectional survey among 335- medical and 185-pharmacy students from University of Ibadan, Nigeria, between September and December 2018, using a semi-structured questionnaire. Results Codeine-containing cough syrup was the most commonly used opioid-products (163;31.3%) among the students. Majority (469;90.2%) had good perception about codeine-containing products, while 319(61.3%) had poor knowledge of opioids usage. Logistic-regression shows that students who experienced some side-effects they would like to experience again, 36.31[AOR=36.31, 95% CI: (10.89-121.12)] and those pressured into using codeine-containing products, 11.77[AOR=11.77, CI=95% (2.50-55.38)] had more tendency of misuse. Conclusion Misuse of codeine-containing products among medical and pharmacy students is obvious. Peer-influence and experience of some effects are significant predictors of misuse among the students. Thus, healthcare curriculum should incorporate preventive program on medication misuse, while policy that favours peersupport program on medication misuse is advocated for healthcare students.Item 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 improvementItem 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.Item 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 recommendedItem 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.Item 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.