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Crossopteryx febrifuga is one of the plants used for the local treatment of some disease conditions by the people of Nigeria via its leaf, root and bark without knowing the toxic nature of the plant recipes. This research was designed to ascertain the toxicity profiles of the plant leaf. Acute toxicity was determined in two phases using rats. In sub-acute toxicity studies, haematology, histopathology and evaluation of liver function indices were conducted. In the first phase of the toxicity study, the mice showed no observable toxic effects as high as at 1000 mg/kg. However, it caused sluggishness, respiratory distress at higher doses in the second phase. On haematological indices, white blood cell, lymphocyte, erythrocytes, haemoglobin, haematocrit rose significantly across the doses administered. The liver function test revealed significant increase in serum alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), albumin, total protein and conjugated bilirubin while 800 mg/kg extract reduced the aspartate transaminase. On histopathology, liver revealed normal hepatocytes but dilated central vein while in kidney, renal corpuscle, glomeruli and tubule were normal. On heart, revealed was active vascular congestion with normal bundle of myocardial fibres and coronary artery while in aorta, it revealed normal architecture. With the nature of the toxicity profile revealed especially at doses less than 500 mg/kg of C. febrifuga extract, the plant could be considered to be relatively safe. This study is significant as it provides information that may suggest some safe doses out of the doses used for clinical trial and application

Nociceptive pain is a sensational discomfort that is usually associated with injury or illness found affecting the body either internally or externally. Crossopteryx febrifuga is one of the medicinal plants which are locally used in the management of pain especially in the North Central Region of Nigeria. Many conventional drugs which are being applied in managing pain aside being not affordable and readily accessible by the majority of people at rural areas have one side effect or the other. Therefore, this research was conducted to evaluate the potentiality of aqueous extract of C. febrifuga in alleviating pain in Wistar rats. The study was carried out using acetic acid induced writhing and Edson hot plate methods. On acetic acid induced pain, the aqueous extract at 50 and 100 mg/kg inhibited pain significantly by reducing the number of writhing by average of 3.9 per minute while at 200 mg/kg, the extract reduced pain by reducing the number of writhing by average of 4.2 per minute. Similarly, the extract at all doses administered in hot plate induced method inhibited pain by increasing the time the rats took to jump off the hot plate. The data obtained from the analgesic study of C. febrifuga aqueous extract suggests that it has anti-nociceptive property as evident in both models. This, therefore revealed that the plant leaf aqueous extract possessed both the peripherally and centrally mediated analgesic properties. For this reason, the plant leaf could be a potential antinociceptive agent if subjected to clinical trial and proved

In this paper, we adopt the general method of interpolation and collocation in Linear Multistep Methods in deriving some numerical schemes for solving second order ordinary differential equations. Different choices of the interpolating function in the form of shifted Legendre, shifted Chebyshev and Lucas polynomials with the same interpolation and collocation points are considered in order to establish uniformity or otherwise of the derived schemes for the various polynomials. Furthermore, probable disparities in the derived schemes for varied choices of interpolation and collocation points are also investigated. Results indicate that all the polynomials yield exactly the same schemes for the same choice of interpolation and collocation points but different schemes for different choices of interpolation and collocation points. However, numerical examples considered showed that all the derived schemes performed exactly in the same manner in terms of accuracy, regardless of the choices of interpolation or collocation points. Nevertheless, the derived schemes perform admirably better when compared with existing methods in literature

We offer global evidence on the macroeconomic effects of climate change for a panel of 22 countries classified by economic groupings. We show that: globally, climate change is inflationary; the negative impacts of climate change on the exchange rate markets is only evident in emerging economies; stock markets could hedge natural climate risks but fail to hedge climate risks due to policy uncertainty.

Africa is lagging in infrastructural development including Information and Communication Technology (ICT). As there are rising employment opportunities in the ICT-intensive industries globally including Africa, enhanced knowledge and use of ICT may tend to reduce youth unemployment in Africa. Thus, this study investigates the effect of ICT on youth unemployment in Africa using a sample of 41 African countries between 2003 and 2018. The study employs a dynamic Generalized Method of Moment (GMM) approach and constructs a composite ICT index to combine key indicators of ICT, using the principal component approach. We also account for the interactive role of education in the ICT-youth unemployment nexus. Relying on the Phillip curve theoretical model, the effect of inflation, physical capital accumulation, level of corruption, and economic growth are also examined. The results show that youth unemployment in Africa can be reduced by higher ICT deployment and usage, which confirms our hypothesis in this study. There is also evidence that education enhances the potential of ICT usage to reduce youth unemployment. Furthermore, we find that the Phillip curve hypothesis holds, as the inflation rate has a negative effect on youth unemployment. More so, there is evidence that youth unemployment in Africa can be reduced by higher physical capital accumulation, lower level of corruption, and higher economic growth. With falling economic growth and looming economic recession in many African countries, governments would need to revise educational curricula to include ICT-based training to reduce the level of youth unemployment in the medium to long term period.

Africa is responsible for two-thirds of the global total of new HIV infections. South Africa, Nigeria, Mozambique, Uganda, Tanzania, Zambia, Zimbabwe, Kenya, Malawi, and Ethiopia were responsible for 80% of HIV cases in Africa in 2014 according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). This study assesses antiretroviral coverage strategies implemented by these countries after the initiation of the "Fast-Track strategy to end the AIDS epidemic by 2030." Data reported in this review were obtained from different e-bibliographic including PubMed, Google Scholar, and Research Gate. Key terms were "Antiretroviral therapy," "Antiretroviral treatment," "HIV treatment," "HIV medication," "HIV/AIDS therapy," "HIV/AIDS treatment" + each of the countries listed earlier. We also extracted data on antiretroviral therapy (ART) coverage from the UNAIDS database. About 50 papers published from 2015 to 2021 met the inclusion criteria. All 10 countries have experienced an increase in ART coverage from 2015 to 2020 with an average of 47.6% increment. Nigeria recorded the highest increase in the rate of ART coverage (72% increase) while Ethiopia had the least (30%). New strategies adopted to increase ART coverage and retention in most countries were community-based models and the use of mobile health technology rather than clinic-based. These strategies focus on promoting task shifting, door-to-door access to HIV services, and a long-term supply of antiretroviral medications. Most of these strategies are still in the piloting stage. However, some new strategies and frameworks have been adopted nationwide in countries like Mozambique, Tanzania, Zambia, Zimbabwe, Kenya, and Malawi. Identified challenges include lack of funding, inadequate testing and surveillance services, poor digital penetration, and cultural/religious beliefs. The adoption of community-based and digital health strategies could have contributed to increased ART coverage and retention. African countries should facilitate nationwide scaling of ART coverage strategies to attain the 95-95-95 goal by 2030.

In this paper, we develop a four-step block method for solution of first order initial value problems of ordinary differential equations. The collocation and interpolation approach is adopted to obtain a continuous scheme for the derived method via Shifted Chebyshev Polynomials, truncated after sufficient terms. The properties of the proposed scheme such as order, zero-stability, consistency and convergence are also investigated. The derived scheme is implemented to obtain numerical solutions of some test problems, the result shows that the new scheme competes favorably with exact solution and some existing methods.

This research on Kigelia africana was conducted in order to ascertain its ability to relax excited vascular smooth muscle in rat aorta. Preliminary investigation on whether the plant exhibits antihypertensive property was done before the evaluation of in vitro vasorelaxant effect. The vasorelaxant activity was determined using in vitro method on rat aorta with the aid of perfusion apparatus with a detachable organ bath. The administration of potassium chloride (KCl) raised the tension from 1.0 to 1.31 indicating that the aorta got to its peak of contraction. At 10 and 20mg/kg, the tension dropped significantly, showing relaxation of the smooth muscle while at 5mg/kg, drop in tension was insignificant at p˂0.05. However, at some of the doses, towards the end of experiment, there was steady resurge in tension showing that the aorta resumed contraction. On the application of phenylephrine (PE), the tension rose to 1.18g. On administration of the extract, the tension dropped slightly showing mild vascular smooth muscle relaxation. From the results obtained, there was seeming similarity in the action of the K. africana compared to amlodipine/Ramipril in KCl and PE induced tension in aorta respectively. However, at 10 and 20mg/kg, a substantial decrease in tension was noted indicating that the extract action is dose dependent. Thus, from this in-vitro smooth muscle relaxation study in rats, the methanol extract of K. africana has depressant property that was likely expressed by enhancing the closing of voltage operated calcium channel and ACE inhibiting activity in KCl and Phenylephrine induced tension respectively.

Tracking of computer network system attacks is a proactive measure to protect against attacks on data, that are basically encrypted for confidential security reasons, while in transit on the computer information channel. Cyber security threat continues to increase in direct proportion to the rate at which internet based services are deployed. In this systematic review, 53 research papers from reputable publishers were downloaded out of which 41 papers that are closely related to tracking of malicious attackers on encrypted data online were review under the consideration of attacks on encrypted data, and tracking malicious attacks; with respect to proposed technique, problem addressed, comparison to existing methodology, parameters used, major findings and then limitations and future knowledge. The authors then deduce the classification of four varying types of attacks (Keyword Guessing Attack, Selective opening attacks, Leakage-Abuse Attacks, and Key Reinstallation Attacks) from the review, to narrow down research into the future countermeasures for these attacks. 11 research papers actual discuss countermeasures for these classification types, with Keyword Guessing Attack being the focus of 6 research work, Selective Opening Attacks have 3 papers trying to solve vulnerabilities permitting such attacks, 2 papers aimed research solutions at Leakage-Abuse Attacks, and Key Reinstallation Attacks, has mention but none of the papers reviewed proffer mitigation techniques. The remaining 30 papers concentrated discussions on general attacks on encrypted data. Inclining future research attention to the four kinds of attacks against encrypted data will improve attack detection contrary to the commonly post-mortem approach.

Background New medicines have become available for the treatment of drug-resistant tuberculosis (DR-TB) and are introduced in sub-Saharan Africa (SSA) by the national TB programs (NTPs) through special access schemes. Pharmacovigilance is typically the task of national medicines regulatory agencies (NMRAs), but the active drug safety monitoring and management (aDSM) recommended for the new TB medicines and regimens was introduced through the NTPs. We assessed the strengths and challenges of pharmacovigilance systems in Eswatini, Ethiopia, Nigeria and Tanzania, focusing on their capacity to monitor safety of medicines registered and not registered by the NMRAs for the treatment of DR-TB. Methods Assessment visits were conducted to all four countries by a multidisciplinary team. We used a pharmacovigilance indicator tool derived from existing tools, interviewed key stakeholders, and visited health facilities where DR-TB patients were treated with new medicines. Assessment results were verified with the local NMRAs and NTPs. Results Most countries have enabling laws, regulations and guidelines for the conduct of pharmacovigilance by the NMRAs. The relative success of NTP-NMRA collaboration is much influenced by interpersonal relationships between staff. Division of roles and responsibilities is not always clear and leads to duplication and unfulfilled tasks (e.g. causality assessment). The introduction of aDSM has increased awareness among DR-TB healthcare providers. Conclusion aDSM has created awareness about the importance of pharmacovigilance among NTPs. In the future, a push for conducting pharmacovigilance through public health programs seems useful, but this needs to coincide with increased collaboration with between public health programs and NMRAs with clear formulation of roles and responsibilities.

Purpose: The purpose of this study is to derive a numerical solver for first order initial value problems of ordinary differential equation via the combination of Chebyshev polynomial and exponential function.Methodology: A new numerical method for solving Initial Value Problems of first order ordinary differential equation is developed. The method is based on finite difference method with a combination of Chebyshev polynomials and exponential function as interpolant. The accuracy, stability, consistency and convergence of the derived scheme were investigated. Numerical experiment was carried out by solving some test problems using the derived scheme.Findings: Results of the numerical experiment revealed that the derived method compared favourably with exact solutions and also performs better than some existing methods for solving initial value problems of first order. Unique Contribution to theory, practice and policy: The study therefore concludes that the method solves problems to expected level of accuracy and can thus be considered among the numerous methods suitable for solving IVPs of first order.

Nigeria is yet to achieve the internationally recommended number of Adverse Drug Reactions (ADRs) reports.This study evaluated the impact of an educational lecture followed by repeated text messages via the Short Messaging System (SMS) on ADR reporting.Six teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and non-intervention hospitals. The intervention hospitals received an educational lecture followed by monthly SMS reinforcements over 12 months. The number and quality of ADR reports from the local pharmacovigilance centers of each teaching hospital over the 12 months before and after the intervention were described.A total of 4912 healthcare professionals were working in the 6 hospitals at the time of the study (3099 in the intervention and 1813 in the control) and the educational intervention was conducted between January and March 2016. In the intervention hospitals, the number of ADR reports increased from 57 in the pre-intervention period (from January 1st 2015) to 75 in the post- intervention period. However, the proportion of serious ADRs decreased slightly from 26(45.6%) to 33(44%). Post-intervention, the report of suspected drug details in the ADR report form also improved.There was a trend to increased absolute number and quality of reports following educational intervention and SMS reminders.Le Nigéria n’a pas encore atteint le nombre recommandé au niveau international de rapports sur les effets indésirables des médicaments (EIM).Cette étude a évalué l’impact d’une conférence éducative suivie par les messages texte répétés via le système de messagerie courte (SMS) sur les rapports d’ADR.Six hôpitaux universitaires de la zone Sud-Sud du Nigeria ont été randomisés dans un rapport 1:1 en hôpitaux d’intervention et de non-intervention. Les hôpitaux d’intervention ont reçu une conférence pédagogique suivie de renforcements SMS mensuels sur 12 mois. Le nombre et la qualité des rapports d’EIM des centres locaux de pharmacovigilance de chaque hôpital universitaire au cours des 12 mois avant et après l’intervention ont été décrits.Au total, 4912 professionnels de santé travaillaient dans les 6 hôpitaux au moment de l’étude (3099 dans l’intervention et 1813 dans le contrôle) et l’intervention éducative a été menée entre janvier et mars 2016. Dans les hôpitaux d’intervention, le nombre des notifications d’EIM sont passés de 57 dans la période pré-intervention (à partir du 1er janvier 2015) à 75 dans la période post-intervention. Cependant, la proportion d’effets indésirables graves a légèrement diminué, passant de 26 (45,6 %) à 33 (44 %). Après l’intervention, le rapport des détails sur les médicaments suspects dans le formulaire de rapport d’EIM s’est également amélioré.Il y avait une tendance à l’augmentation du nombre absolu et de la qualité des rapports après une intervention éducative et des rappels par SMS.Effet indésirable médicamenteux, Intervention éducative, Professionnels de santé, Rappels SMS, Hôpitaux universitaires, Nigéria.

Background: Pharmacological interventions sometimes carry inherent significant risks which include adverse drug reactions (ADRs), drug interactions (DIs) and other consequences of inappropriate medication use. An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used in man for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high incidence and prevalence. Aim: The main aim of this study was to evaluate and highlight the pattern of medications most frequently involved in ADRs and the predisposing risk factors among adult medical in-patients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven (507) patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). The drugs most frequently involved in ADRs were insulin in 14 (27.5%) patients, Non-steroidal Anti-inflammatory drugs in 10 (19.6%) patients, antihypertensives in 8 (15.7%) patients, antimalarials in 5 (9.8%) patients, herbal medications in 4 (7.8%) patients and antibacterials in 3 (5.9%) patients. Furthermore, four (4) fatal ADRs were observed during the study; in which herbal medications caused two (2) deaths, sulfadoxine/pyrimethamine combination (maloxine®) caused one (1) death, and Iron dextran caused one (1) death. The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the Antidiabetic drug-insulin use causing neuroglycopenic symptoms and Non-steroidal Anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. The elderly age group (≥ 65 years), presence of polypharmacy (taking more than 5 different pharmacologically active medications by a particular patient at the same time) and the presence of multiple comorbidities in a particular patient are clinically proven and significant risk factors found to be associated with and predisposed adult medical in-patients to ADRs in this study. Conclusion: The negative health burden and consequences of ADRs with the predisposing risk factors were significantly high among these adult medical in-patients. In this study, ADRs increase patients morbidity, mortality and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care and continuous monitoring must be implemented during the course of treating patients with these drugs in order to optimize their clinical efficacy and prevent the occurrence of ADRs in them.

Background: An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high prevalence. Aim: The main aim of this study was to adequately evaluate the economic burden, impact, and consequence of ADRs among adult medical inpatients in clinical practice, to highlight the pattern of medications most frequently involved in ADRs, and to estimate the economic cost implication of treating ADRs in such clinical practice setting. Methods: The patients admitted into the adult medical wards of a Nigerian university teaching hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, out of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median: 46 years). Most ADRs were mild and moderate in 21 (41.2%) cases and 24 (47.1%) cases, respectively. Severe ADRs occurred in 2 (3.9%) cases, while four (7.8%) cases were fatal ADRs. The economic cost implication of treating ADRs was ₦ 161,668.00 ($1243.60), equivalent to about 1.9% of the total cost of all medications used by all admitted medical inpatients during admission. The cost of treating ADRs per patient with ADRs was ₦ 3169.96 ± ₦ 6348.77 ($24.38 ± $48.84), while the mean ADR treatment cost per admitted medical inpatient was ₦ 318.87 ($2.45). The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the antidiabetic drug – insulin use causing neuroglycopenic symptoms and nonsteroidal anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. Conclusions: The economic burden, impact, and consequence of ADRs were significantly high among these adult medical inpatients. In this study, ADRs increase patients' morbidity, mortality, cost of health care, and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care, and continuous monitoring must be implemented during the course of treating patients with these drugs to optimize their clinical efficacy and prevent the occurrence of ADRs in them.

Background: The World Health Organization (WHO) and the Global Alliance for Vaccines and Immunizations (GAVI) recommended the use of Pentavelent vaccines in Nigeria and other developing countries to replace the DPT (Diphtheria, pertusis and tetanus) vaccine. This was done to increase the uptake of the hepatitis B (HB) and Haemophilus influenza type b (Hib) vaccines in these countries by capitalising on the uptake of DPT vaccine. Objective: This study aims to assess the attitude and use of pentavalent vaccine in pregnant women attending antenatal care in a Tertiary Hospital in Jos, Plateau State. Methods: The study was carried out among pregnant women receiving antenatal care in Plateau Specialist hospital, Jos using a descriptive cross sectional study design. The study was done over a period of four (4) months (August 2018 to December 2018). Simple Random Sampling was used to select 397 women who participated in the study. Results: Respondents were predominantly Christians 283 (71.3%) while Muslims represent about 114 (28.7%) of respondents. About 373 (94%) respondents were married, While 24 (6.0%) percent of the respondents were single parents. Also 213 (53.7%) were business women, Only 48 (12.1%) were civil servants while 85 (21.4%) of the respondents had no form of employment. Majority 257(97.0%) of them had a positive attitude towards the vaccine while only a few 8(3.0%) had a negative attitude.Eighty eight (32.2%) felt pentavalent vaccines were not important. A similar proportion 88 (3.2%) also stated that they would not give their child the vaccine. Most women 252 (95.1%) agreed that mothers should be encouraged to attend immunization regularly. Side effect experienced by children were fever 69 (87.3%), swelling at injection site 21 (26.6%), rash 6 (7.6%). Conclusion and recommendations: All most all pregnant women had a positive attitude towards the vaccine while only a few had a negative attitude. Nine in ten women had children who had received pentavalent vaccine.Health workers should improve efforts at health education on immunization especially on adverse effects following immunization (AEFI), reasons for missed opportunities, coverage of hard to reach areas or distant areas via special immunization or home visiting to administer vaccine.

Objectives: The Nigerian hypertension guideline (2005) was based on 1999 ISH/WHO and the 2003 Sub-Saharan Africa hypertension guidelines. The changes in the prescribing pattern of physicians before and following the introduction of these guidelines as well as physicians' awareness of the guidelines in Southern Nigeria are unknown. Subjects and Methods: A retrospective study of antihypertensive prescriptions and a cross-sectional descriptive study of the physicians' awareness of the guidelines. The study was carried out at a tertiary health facility in Southern Nigeria and reviewed the case records (1999–2008) of 3379 hypertensive patients who had attended the medical outpatient clinic; it also assessed the awareness of 48 postregistration doctors working in the same hospital using a self-administered questionnaire. Results: Calcium channel blockers were the most prescribed class over the entire period (44.7%–69.2%) while angiotensin-converting enzyme inhibitors prescriptions increased by 325% (11.8%–51.5%). Annual prescriptions of diuretics increased steadily from 38% in 1999 to a peak of 58% in 2005. A total of 37/48 doctors responded, and a high proportion (32/37; 86.5%) were aware of the national guidelines, but only 13/37 (35.1%) were satisfied with the recommendations. Diuretics were stated as the most preferred class of antihypertensive medicines by 26/37 (70.3%) of respondents. Conclusions: The findings suggest disconnect in the prescribers' knowledge of recommendations in the guidelines, their stated preferences for medicines, and the observed findings in the case records. This may be due in part to the observed dissatisfaction of doctors with the guidelines.

Background/Purpose Morbidity patterns vary for different age groups. As people grow older, chronic noncommunicable diseases become prominent causes of diseases. Our aim was to determine the frequency of occurrence and the patterns of chronic diseases and multimorbidity among elderly inpatients. Methods A longitudinal prospective survey was conducted among patients aged ≥ 65 years who were admitted to the medical wards of a tertiary hospital (Nnewi, Nigeria) over a period of 12 months. Chronic diseases were defined and counted using the World Health Organization definition, and multimorbidity was defined as the co-occurrence of two or more chronic diseases in the same individual, at a given time. Results The records of 345 patients aged between 65 years and 92 years were reviewed. There were 221 (64.1%) males and 124 (35.9%) females. A total of 223 (64.6%) patients were aged 65–74 years (early elderly), and 122 (35.4%) patients were aged ≥ 75 years (late elderly). Chronic morbidities were present in 92.5% ( n = 319/345) of the patients, whereas 49.0% ( n = 169/345) had multimorbidity. The diseases of the circulatory system and endocrine and metabolic diseases ranked the highest among the chronic diseases. Conclusion The high frequency of occurrence of multiple chronic diseases in the same individual highlights the challenges awaiting the current healthcare delivery system in developing countries as the populations in these parts of the world grow older.

Background: The Nigerian National Standard Treatment Guidelines (NSTG) was introduced in 2008 and the second edition was launched in 2017. This study evaluated the level of awareness, acceptance, and use of this tool within the Nigerian health-care system. Methodology: This study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria. A semistructured questionnaire was administered to doctors in the hospital. Information sought included the biodata, awareness of the STG, publication and use of the STG, the perceived advantages and disadvantages, and suggestions on how to improve its use. Results: There were 155 respondents with a mean age of 34.1 ± 6.4 years and response rate of 77.5%. The level of awareness was 46.5%, with 21.9% having received lessons on the subject; 53.0% received lessons as students. Awareness of the date of the initial introduction of the STG at the national level was 4.5% with 1.3% aware of the current edition of the NSTG. The description of the STG was satisfactory in 27.7% participants. Again only 20.6% currently use the NSTG, with 12.3% rating the entire STG utilization as successful. Conclusion: There is low awareness and poor utilization of the STG among doctors in the facility which may be a reflection of the situation in other health facilities in the country. There is need to encourage the use of this clinical tool to ensure appropriate use of medicines and delivery of health care in resource-limited settings.

International audience; Background: Our aim in this study was to evaluate the effect of a combined educational intervention and year-long monthly text message reinforcements via the Short Messaging System (SMS) on the knowledge, attitude and practice (KAP) of healthcare professionals (HCPs) towards pharmacovigilance.Methods: Six randomly selected teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and control groups. The educational intervention consisted of delivering a seminar followed by sending monthly texts message reinforcements via SMS over 12 months. Then a semi-structured questionnaire regarding the KAP of pharmacovigilance was completed by HCPs working in the hospitals after the intervention. Data was analysed descriptively and inferentially.Results: A total of 931 HCPs participated in the post intervention study (596 in the intervention and 335 in the control). The M:F ratio was 1:1.5. According to the KAP questionnaire, a significant difference was observed between the intervention and control groups, regarding knowledge of the types of adverse drug reactions (ADRs). ADR resulting from pharmacological action of the drug (85.6% versus 77%, p = 0.001), the fact that ADRs can persist for a long time; (60.1% versus 53.4%, p = 0.024) and a higher awareness of the ADR reporting form (48.7% versus 18.8%, p < 0.001). Most respondents in the intervention group (68.5% versus 60.6%, p = 0.001) believed they should report ADRs even if they were unsure an ADR has occurred, a greater proportion of HCPs from the intervention group had significantly observed an ADR (82% versus 73.4%, p = 0.001). Furthermore, of the 188 who had ever reported an ADR, 41% from the intervention group used the national ADR reporting form compared with 19.8% from the controls (p < 0.001). Conclusion: This educational intervention and the use of SMS as a reinforcement tool appeared to have positively impacted on the knowledge and practice of pharmacovigilance in South-South Nigeria with a less-than-impressive change in attitude. Continuous medical education may be required to effect long-lasting changes.

Nigeria was admitted into the WHO International Drug Monitoring Programme in 2004. That marked a new era of pharmacovigilance in Nigeria. Nigeria is a large country in sub-Saharan Africa with essentially a homogenous black population of over 170 million people, a significant disease burden (communicable and non-communicable) and consequent medication use. Inevitably, the need for medicine safety is becoming increasingly appreciated by the government, health-care workers and patients. Pharmacovigilance activities in Nigeria are coordinated by the National Pharmacovigilance Centre (NPC) situated in the National Agency for Food and Drug Administration and Control (NAFDAC—the drug regulatory agency in Nigeria). NPC serves as a repository for reported adverse drug reactions from health workers and also liaises with other international groups such as the WHO, US Food and Drug Administration and the European Medicines Agency in improving drug safety in Nigeria. Increasing participation of the public in drug safety is also a major thrust of the NPC and the contributions of public-health programmes in this resource-poor setting to pharmacovigilance cannot be overemphasised. The provisions of a unique policy to define the responsibilities of the stakeholders in pharmacovigilance, as well as training of the health-care workers, are a few of the achievements of the agency in charge of pharmacovigilance in Nigeria.

Background WHO pharmacovigilance indicators have been recommended as a useful tool towards improving pharmacovigilance activities. Nigeria with a myriad of medicines related issues is encouraging the growth of pharmacovigilance at peripheral centres. This study evaluated the status of pharmacovigilance in tertiary hospitals in the South-South zone of Nigeria with a view towards improving the pharmacovigilance system in the zone. Methods A cross-sectional descriptive survey was conducted in six randomly selected tertiary hospitals in the South-South zone of the country. The data was collected using the WHO core pharmacovigilance indicators. The language of assessment was phrased and adapted in this study for use in a tertiary hospital setting. Data is presented quantitatively and qualitatively. Results A total of six hospitals were visited and all institutions had a pharmacovigilance centre, only three could however be described as functional or partially functional. Only one centre had a financial provision for pharmacovigilance activities. Of note was the absence of the national adverse drug reaction reporting form in one of the hospitals. The number of adverse drug reaction reports found in the databases of the centres ranged from none to 26 for the previous year and only one centre had fully committed their reports to the National Pharmacovigilance Centre. There were few documented medicines related admissions ranging from 0.0985/1000 to 1.67/1000 and poor documentation of pharmacovigilance activities characterised all centres. Conclusion This study has shown an urgent need to strengthen the pharmacovigilance systems in the South-South zone of Nigeria. Improvement in medical record documentation as well as increased institutionalization of pharmacovigilance may be the first steps to improve pharmacovigilance activities in the tertiary hospitals. Electronic supplementary material The online version of this article (10.1186/s40360-018-0217-2) contains supplementary material, which is available to authorized users.

Irrational prescription of medicine is a common problem in medical practice. This is more so in the immediate post admission period. The aim of this study was to characterize drug prescriptions patterns for elderly patients at hospital discharge and to detect areas of irrational and inappropriate prescription.This was a longitudinal prospective study of drugs prescribed at hospital discharge for patients aged 65years and above. The World Health Organization (WHO) drug use indicators were used to characterize the drug prescription. The drugs prescribed were classified using the Anatomical Therapeutic Chemical (ATC) classification systemwhile potentially inappropriate medications were determined using the Beers criteria by the American Geriatric Society.A total of 1,679 drugs were prescribed in 269 patient encounters surveyed. The average number of drugs prescribed per encounter was 6.2 ± 2.1. Vitamins and antihypertensive agents accounted for 23.2% (n=390/1,679) and 15.2% (n=256/1,679) of prescribed drugs respectively. At least one potentially inappropriate medicationwas prescribed for 48 patients giving a rate of 17.8%(48/269) and the non-steroidal anti-inflammatory drugs (NSAIDs)were the most frequently prescribed potentially inappropriate medications.The average number of medicines per patient encounter which is a measure of the degree of polypharmacywas high in the study and suggests irrational drug prescription. Thefrequent prescription of potentially inappropriate medicines noted in the study further highlights the need forfurther training of the prescriberson geriatric drug prescriptions.

Introduction: Public health programs (PHPs) provide unique opportunities for addressing health issues in resource-limited settings. A major challenge to the implementation of existing PHPs in Nigeria is the absence of effective monitoring of the safety of medicines and vaccines. The introduction of the World Health Organization (WHO) pharmacovigilance (PV) indicators provides a useful tool to address this challenge. Objective: The objective is to assess the structures, processes, and outcomes of PV activities in three selected PHPs (the National Malaria, tuberculosis [TB], and HIV/AIDS) in Nigeria using the WHO PV indicators and identify possible challenges to achieving the outcomes. Materials and Methods: A cross-sectional mixed method study of the PV system in selected PHPs. Data sources were from the Federal Ministry of Health, the National PV Center (NPC), the National Malaria/TB, and HIV/AIDS Control Programs and official documents were reviewed. Data were collected quantitatively using the WHO PV and PHP indicator questionnaires and qualitatively using key informant interviews. Results: The basic structures and tools for carrying out PV activities in the PHPs were in existence but optimal implementation was lacking. Of the 790 adverse drug reaction (ADR) reports from the PHPs to the NPC ADR database, 77% were from the HIV/AIDS Control Programs, 14% from the malaria control program, and 9% from TB program. The interview with representatives of the different programs revealed a consensus of opinion around lack of adequate human resource for PV, poor funding, poor stakeholders' coordination to improve PV reporting across all three programs as well as in the NPC. Conclusion: This study highlighted the magnitude of suboptimal implementation of PV activities evident by the number of reports as against the expected.

Background: Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV. Low coverage of prevention of mother-to-child transmission (PMTCT) interventions, adherence, and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV (MTCT) rates. In Nigeria, rural areas, served largely by primary health care facilities, have particularly poor indicators of PMTCT coverage. Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients, provide guidance, and support in keeping appointments and promoting antiretroviral adherence and retention-in-care. The Mother Mentor (MoMent) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria. Design and Methods: A prospective cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive standard-of-care, informal peer support. Study sites are 20 primary health care centers (10 intervention, 10 control) in rural North-Central Nigeria. The study population is HIV-positive mothers and exposed infant pairs (MIPs) (N = 480; 240 MIPs per study arm). Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months, and the proportion of MIPs retained in care at 6 months postpartum. Secondary outcome measures examine antiretroviral adherence, 12-month postpartum MIP retention, and MTCT rates. This article presents details of the study design, the structured Mentor Mother programs, and how their impact on PMTCT outcomes will be assessed.

Background Following a change in the policy for malaria treatment in Nigeria, artemisinin-based combination therapies (ACTs) were adopted in 2005 as first-line therapy instead of chloroquine due to reports of resistance. We assessed the pattern of prescription of antimalarial drugs in a tertiary institution before and after the policy change. Methods The prescription pattern of antimalarials was assessed by systematic random sampling between January 2001 and December 2008, after obtaining ethics permission from the University of Benin Teaching Hospital, Benin City, Nigeria. Key findings Of the 4000 prescriptions for antimalarial drugs assessed, 2041 (51.03%) and 1959 (48.98%) prescriptions were utilized before and after the policy change, respectively. The prescriptions consisted of 19 different types of antimalarial drug. Chloroquine (847, 41.58%) was the most frequently prescribed drug before the policy change whereas artemether/lumefantrine (394, 20.11%) was most frequently prescribed after the policy change. There was a significant difference in their pattern of prescription (P

A pilot programme of Cohort Event Monitoring (CEM) was conducted across the six geopolitical zones of Nigeria on patients treated for uncomplicated malaria with artemisinin-based combination therapy (ACT). The emergence and spread of malaria parasites resistant to commonly available antimalarial drugs necessitated a shift in policy for malaria treatment by the Federal Government from the use of chloroquine and sulphadoxine-pyrimethamine (SP) as first-line treatments to ACTs. Initial reports following deployment of ACTs in clinical settings raised safety concerns regarding their use. Although artemisinin and its derivatives are generally thought to be safe, there are currently few or no data on their safety among populations in Nigeria. The main objectives of the CEM programme were to proactively determine the adverse event (AE) profile of artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) in real-life settings and to find out the factors predisposing to AEs. The CEM study was observational, longitudinal, prospective, and inceptional. Patients were observed in real-life situations. It was conducted in six public health facilities in Nigeria on patients with a clinical diagnosis of uncomplicated malaria treated with ACTs. Patients were prescribed one of the ACTs on an alternate basis as they enrolled into the programme. Follow-up reviews were undertaken on days 3 and 7 following commencement of ACT treatment. At follow-up, patients were evaluated for any clinical event that they might have experienced following the use of the ACTs. We report the result of this initial pilot in which 3,010 patients treated for uncomplicated malaria with AA or AL were enrolled. The seven most common AEs seen were general body weakness 25.0/36.6 % (AL/AA); dizziness 11.9/17.2 % (AL/AA); vomiting 8.0/10.2 % (AL/AA); abdominal pain 8.5/7.2 % (AL/AA); insomnia 6.3/5.9 % (AL/AA); body pains 3.4/5.2 (AL/AA) %; anorexia 8.5/4.6 % (AL/AA). Most adverse events occurred from day 1 and peaked by day 2 and 3 of medication with the mean duration of events being 3 days. By the end of the follow-up visit on day 7, the AEs had resolved in the majority of patients. Adverse events were more common in the AA group than AL revealing a better safety profile for AL (p

Aims and Objectives: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. Patients and Methods: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. Results: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9

Artemisinin‐based combination antimalarial therapy (ACTs), is still highly effective in uncomplicated falciparum malaria, however, there remain some concerns in relation to its safety and tolerability. Comorbid disease conditions may influence susceptibility to adverse drug reactions (ADRs) as the presence of multiple disease conditions may predisposes patients to ADRs due to the use of many medicines. There is therefore need to assess the impact of comorbidities on the ADR profile of malaria patients treated with ACTs. The study was carried out in health care facilities spread across Nigeria. From the database of over 10,000 patients recruited into an initial cohort, data for 1000 patients with comorbidities was extracted and matched with a control group of 1000 randomly selected patients with no comorbidity. There were 1105 adverse drug reactions in all, of which 66.2% were recorded in patients with comorbidity, and 34% are patients without comorbidity. The mean age of patients with comorbidities was 38.3 ± 17.5 years and 23.8 ± 17.2 for those without comorbidity. Out of the 979 patients with comorbidity, 36% were hypertensive, 2.2% hypertensive‐diabetes, 16.4% peptic ulcer disease, 10.4% HIV/AIDS, 4.4% diabetes and 4.3% were asthmatic. Patients with comorbidity were three times more likely to have adverse drug reaction than those without comorbidity (Odds ration = 2.96; 95% CI = 2.23–3.93). HIV/AIDS and osteoarthritis were significantly associated with development of adverse drug reactions. Probability was