Adekunle Olatayo Adeoti

The prescribing of generic medicines in Nigeria: knowledge, perceptions and attitudes of physicians.

ABSTRACT Generic medicines have the same efficacy and safety as originators at lower prices; however, there are concerns with their utilization in Nigeria. Objective was to evaluate physicians’ understanding and perception of generics. A questionnaire was administered among physicians working in tertiary healthcare facilities in four geo-political regions of Nigeria. Questionnaire response was 74.3% (191/257) among mainly males (85.9%). The mean knowledge score regarding generics was 5.3 (maximum of 9) with 36.6%, 36.1% and 27.2% having poor, average and good knowledge respectively. Cross-tabulation showed statistical significance (p = 0.047) with the duration of practice but not with position, subspecialty or sex. The majority of respondents did not believe that generic medicines are of lower quality than branded medicines. Therapeutic failure was a major concern in 82.7%, potentially discouraging the prescribing of generics, and a majority (63.9%) did not support generic substitution by pharmacists. Knowledge gaps were identified especially with the perception of generics, which need to be addressed.

Awareness of the Warning Signs, Risk Factors, and Treatment for Tuberculosis among Urban Nigerians

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.

Tuberculosis, before and after Antiretroviral Therapy among HIV-Infected Children in Nigeria: What Are the Risk Factors?

Introduction In Nigeria, there is a dearth of pediatric data on the risk factors associated with tuberculosis (TB), before and after antiretroviral therapy (ART). Methodology A retrospective observational cohort study, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. TB was noted among children less than 15 years of age at ART enrolment (prevalent TB-PrevTB), within 6 months (early incident tuberculosis-EITB) and after 6 months (late incident tuberculosis-LITB) of a 12-month follow-up on ART. Potential risk factors for PrevTB and incident TB were assessed using the multivariate logistic and Cox regression models respectively. Results Among 368 HIV-1 infected children, PrevTB was diagnosed in 73 children (19.8%). Twenty-eight EITB cases were diagnosed among 278 children over 132 person-years (py) with an EITB rate of 21.2/100 py. Twelve LITB cases were seen among 224 children over 221.9 py with a LITB rate of 5.4/100 py. A significant reduction in the incidence rates of TB was found over time (75%, p˂ 0.001). Young age of children (12–35 months, aOR; 24, 95% CI; 4.1–146.6, p ˂ 0.001; 36–59 months, aOR;21, 95%CI;4.0–114.3, p ˂ 0.001); history of TB in children (aOR; 29, 95% CI; 7.3–119.4, P˂ 0.001); severe immunosuppression (aOR;38, 95% CI;12–123.2,p ˂ 0.001); oropharyngeal candidiasis (aOR;3.3, 95% CI; 1.4–8.0, p = 0.009) and sepsis (aOR; 3.2, 95% CI;1.0–9.6, p = 0.043) increased the risk of PrevTB. Urban residency was protective against EITB (aHR; 0.1, 95% CI; 0.0–0.4, p = 0.001). Virological failure (aHR; 4.7, 95% CI; 1.3–16.5, p ˂ 0.001) and sepsis (aHR; 26, 95% CI; 5.3–131.9, p ˂ 0.001) increased the risk of LITB. Conclusions In our cohort of HIV-infected children, a significant reduction in cases of incident TB was seen following a 12-month use of ART. After ART initiation, TB screening should be optimized among children of rural residency, children with sepsis, and those with poor virological response to ART.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit

Background: To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline. Patients and Methods: We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015. Results: Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1-3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers. Conclusion: The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.

There is no cryptococcal antigenaemia among a cohort of children with advanced HIV infection in an antiretroviral therapy programme in Makurdi, Nigeria.

Introduction: Cryptococcal disease is an important opportunistic infection and a major contributor to mortality in HIV/AIDS. Unfortunately, there has been no data describing the burden of cryptococcosis in Nigerian HIV-infected children. Methods: A cross-sectional study between January 2013 to September 2013 at the Federal Medical Centre, Makurdi to determine the prevalence and risk factors of cryptococcal antigenaemia among a cohort of consecutive HIV-infected children (≤15 years of age) with a CD4 count of ≤200 cells/mm3, including treatment-naive and those on Antiretroviral Therapy (ART). The cryptococcal antigen Lateral Flow Assay method was used twice on each sample collected from the children. Results: A total of 699 children were seen but only 88 children had CD4 count of ≤200 cell/mm3. These 88 subjects included 47 Males and 41 Females (M: F, 1:0.9). The age range was from 12-168 months with a mean of 73.23 ± 41.06 months. The CD4 count was from 10 to 198 cells/mm3 with a median of 104 cells/mm3 (Interquartile range, IQR; 53- 157). Twenty (20/88, 22.7%) children had a CD4 count of less than 50 cells/mm3, 24 (27.3%) had CD4 counts between 51-100, and 44 children (50%) had CD4 counts between 101-198 cell/mm3. The median viral load was 3,016 copies/ ml with an IQR of 200-39,354 copies/ml. Only 11 (12.5%) children were not on HAART. There was no cryptococcal antigenaemia (0%) among the 88 children tested. Statistical analysis was thus limited to simple description. Conclusion: In our setting, cryptococcosis may not be a strong consideration in the differential diagnosis of severely immunosuppressed HIV-infected children (≤15 years of age) presenting with pneumonia and or meningoencephalitis

Risk factors for asthma hospitalization and emergency department visit in Nigeria: The role of symptoms frequency and drug utilization

Background: Substantial proportion of the economic cost of asthma care is due to hospitalization and emergency department (ED) visit. The objective of our study was to identify the role of frequency of asthma symptoms and drug utilization as risk factors for asthma related hospitalization and ED visit among adult patients in selected hospitals in Nigeria. Patients and Methods: We carried out a cross sectional study of a sample of adult patients in selected hospitals in Nigeria. Demographic, clinical information, and use of asthma medications were obtained from the patients that were hospitalized or visited ED and those not hospitalized or visited ED in previous 12 months. Results: A total of 102 patients participated in the study. Fifty (49.0%) of the patients were hospitalized or visited the ED and 52 (51.0%) were neither hospitalized nor visited ED. Asthma patients who experienced frequent nocturnal symptoms (relative risk (RR)-3.50, 95% confidence interval ( C I) 2.05-4.96), frequent use of rescue medication (RR-2.89, 95% CI 1.66-4.12), increased daytime (RR-2.32, 95% CI 1.32-3.32), and nasal symptoms (RR-2.30, 95% CI 1.11-3.48) were more likely to be hospitalized or visited ED. Patients who used oral theophylline (RR-2.19, 95% CI 1.35-2.33) without doctors prescription were two times more likely to be hospitalized or visited ED. The use of inhaled corticosteroids (ICS, RR-0.69, 95% CI 0.45-0.99) and oral corticosteroids (OCS; RR-0.73, 95% CI 0.00-1.59) were not associated asthma related hospitalization and ED visit. Conclusion: There is a need for pragmatic interventions in patients who reported increased asthma and nasal symptoms, increased use of rescue medication, and nonprescription use of oral theophylline in order to prevent acute asthma hospitalization and emergency visit.

Prevalence of Depression and Anxiety Disorders in People Living with HIV/AIDS in a Tertiary Hospital in South Western Nigeria

Background: In sub-Saharan Africa, HIV/AIDS constitutes a major burden with its attendant mental health related challenges. The aim of this study was to determine the prevalence of depression and anxiety disorder among HIV patients attending a tertiary institution in south western Nigeria. Method: A cross-sectional study conducted among HIV patients attending HIV/AIDS clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. A semi-structured questionnaire was administered to collect socio-demographic characteristics with the incorporation of Hospital anxiety depression questionnaire to assess the prevalence of depression and anxiety in the study and control groups. Results: A total of 424 HIV positive study participants were recruited. A corresponding age and sex matched 429 control subjects were also enrolled. The mean age of HIV positive patients and controls are 42.2 ± 9.5 years and 43.4 ± 12.4 years respectively. There was a female prepondence among both study populations. The prevalence of depression among PLHIV was 39.6% whereas depression was lower in the (22.0%) control group. Likewise anxiety was reported in PLHIV and control group as 32.6% and 28.7% respectively. Female gender, illiteracy, being divorced/widowed, unemployed and low income and low CD4 count were associated with depression while factors associated with anxiety disorder included lower age, female gender, low income, and low CD4 count. Conclusion: The prevalence of depression and anxiety are high in the HIV patients, hence proper integration of mental health care into the HIV programme is inevitable to give patients holistic care.

Respiratory-Related Medical Admissions in a Tertiary Institution in South-Western Nigeria

Background: Globally, respiratory diseases are common causes of medical admissions. Our objective was to determine the causes and outcome of respiratory diseases in our facility for health planning, policy formulation and allocation of resources.Method: A retrospective study of all respiratory-related admissions between January 2011 and December 2015. Classification of diseases was based on the ICD-10 coding system.Results: Respiratory-related admissions accounted for 460 (12%) of all medical cases with a slight male preponderance of 1.4 to 1. Mean age of patients was 50.4 ± 20.8 years. The majority 342 (74.3%) of these admissions were due to communicable respiratory diseases. Pulmonary tuberculosis (44.1%) and pneumonia (28.9%) accounted for the highest admissions which were closely followed by COPD (11.1%) and asthma (7.2%). The commonest co-morbidity was HIV/AIDS (12.3%) which also coexisted with other diseases in most cases of mortality. The median hospital-stay was 7 days. Most diseases had peak presentations during the dry season except bronchial asthma with rainy and dry peak seasons. The overall mortality was 17.6% and the highest mortalities were recorded in patients who had pulmonary tuberculosis (55.5%), pneumonia (20.9%) and COPD (8.6%).Conclusion: Communicable respiratory diseases are the leading causes of morbidity and mortality. Scaling up on coverage of the control programmes as well as the methodical integration of non-communicable diseases into already existing control programmes will further strengthen the health-care systems in resource-limited settings.

Drug promotional activities in Nigeria : impact on the prescribing patterns and practices of medical practitioners and the implications

ABSTRACT Objective: Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits. Methods: Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria. Results: 176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients’ clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry. Conclusion: Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.