Medicine Vendors Research Articles

Malaria prevention and treatment awareness and practice among patent medicine vendors (PMVs) in Gombe Metropolis, Nigeria

Malaria prevention and treatment awareness and practice among patent medicine vendors (PMVs) in Gombe Metropolis, Nigeria

Malaria prevention and treatment awareness and practice among patent medicine vendors (PMVs) in Gombe Metropolis, Nigeria

The ravaging consequences of Malaria in Sub-Saharan Africa (SSA) have been a subject of serious concern to every stakeholder. Literature and anecdotal evidence shows that around 60% of Nigerians seek fever treatment from Patent Medicine Vendors (PMVs) despite the limited formal dispensing knowledge most possess. This study attempts to establish a base line of knowledge, attitude and practices of Malaria control among PMVs in Gombe Metropolis, North Eastern Nigeria. The study was a descriptive cross sectional survey based on structured questionnaires used to collect relevant information from 109 PMVs selected by purposive sampling technique. The result show that 85.3% of the participants in this study correctly identified fever or high body temperature as the common sign of uncomplicated (UC) Malaria, while 70.6% recognized convulsion as one of the main symptoms of severe Malaria. Furthermore, 86.2% of the PMVs also knew that sleeping inside treated nets constitute one of the best ways to prevent Malaria. In the same vein, awareness of change in Malaria treatment policy from monotherapy to Artemisinin based combination therapy (ACT) was high (73.3%) among them. However, those PMVs that had ever undergone some degree of drug dispensing training exhibited a significantly higher level of awareness of change in malaria treatment policy (X2 =17.903, P = 0.000). Although 85.3% of PMVs frequently recommend Arthemeter Lumefantrine (AL) as treatment of uncomplicated Malaria, only 39.4% of the participants would refer severe malaria cases. Even though most Malaria control awareness and practice variables were found to be fairly good among the participants, it is clear from the study that there is the need for enhanced training, monitoring and supervision by the relevant authorities so as to fully harness the vast potential in PMVs.

Promoting the integrated community case management of pneumonia in children under 5\xa0years in Nigeria through the proprietary and patent medicine vendors: a cost-effectiveness analysis

BackgroundWhile evidence-based recommendations for the management pneumonia in under-5-year-olds at the community level with amoxicillin dispersible tablets (DT) were made by the World Health Organisation, initiatives to promote the integrated community case management (iCCM) of pneumonia through the proprietary and patent medicine vendors (PPMVs) have been poorly utilized in Nigeria, possibly due to low financial support and perceived benefit. This study provides costs, benefits and cost-effectiveness estimates and implications of promoting the iCCM through the PPMVs’ education and support. The outcome of this study will help inform healthcare decisions in Nigeria.MethodsThis study was a cost-effectiveness analysis using a simulation-based Markov model. Two approaches were compared, the ‘no promotion’ and the ‘promotion’ scenarios. The health outcomes include disability-adjusted life years averted and severe pneumonia hospitalisation cost averted. The costs were expressed in 2019 US dollars.ResultsThe promotion of iCCM through the PPMVs was very cost effective with an incremental cost-effectiveness ratio of US$143.77 (95% CI US$137.42–150.50)/DALY averted. The promotion will prevent 28,359 cases of severe pneumonia hospitalisation with an estimated healthcare cost of US$390,578. It will also avert 900 deaths in a year.ConclusionPromoting the iCCM for the treatment of pneumonia in children under 5 years through education and support of the PPMVs holds promise to harness the benefits of amoxicillin DT and provide a high return on investment. A nationwide promotion exercise should be considered especially in remote areas of the country.

What medicines do households keep in their cabinets? Understanding the possession and use of medicines at home and the role of health insurance in Nigeria.

BackgroundGlobally, the possession of medicines stored at home is increasing. However, little is known about the determinants of possessing medicines, their usage according to clinical purpose, which we term ‘correct drug match’, and the role of health insurance.MethodsThis study uses data from a 2013 survey evaluating a health insurance program in Kwara State, Nigeria, which upgraded health facilities and subsidized insurance premiums. The final dataset includes 1,090 households and 4,641 individuals. Multilevel mixed-effects logistic regressions were conducted at both the individual level and at the level of the medicines kept in respondents’ homes to understand the determinants of medicine possession and correct drug match, respectively, and to investigate the effect of health insurance on both.ResultsA total of 9,266 medicines were classified with 61.2% correct match according to self-reported use, 11.9% incorrect match and 26.9% indeterminate. Most medicines (73.0%) were obtained from patent proprietary medicine vendors (PPMVs). At 36.6%, analgesics were the most common medicine held at home, while anti-malarial use had the highest correct match at 96.1%. Antihistamines, vitamins and minerals, expectorants, and antibiotics were most likely to have an incorrect match at respectively 35.8%, 33.6%, 31.9%, and 26.6%. Medicines were less likely to have a correct match when found with the uneducated and obtained from public facilities. Enrolment in the insurance program increased correct matches for specific medicines, notably antihypertensives and antibiotics (odds ratio: 25.15 and 3.60, respectively).ConclusionSince PPMVs serve as both the most popular and better channel compared to the public sector to obtain medicines, we recommend that policymakers strengthen their focus on these vendors to educate communities on medicine types and their correct use. Health insurance programs that provide affordable access to improved-quality health facilities represent another important avenue for reducing the burden of incorrect drug use. This appears increasingly important in view of the global rise in antimicrobial resistance.

Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial

The rate of diagnostic testing for malaria is still very low in Nigeria despite the scale-up of malaria rapid diagnostic test (MRDT) availability, following WHO's recommendation of universal diagnostic testing in 2010. We investigated whether a social group sensitisation and education intervention (social group intervention) and a social group intervention plus health-care provider training intervention would increase the demand (use or request, or both) for MRDTs among community members in Ebonyi state, Nigeria. We did a three-arm, parallel, open-label, stratified cluster-randomised controlled trial in Ebonyi state, Nigeria, to evaluate the effects of two interventions compared with a control. We randomly assigned geographical clusters that were accessible (close to a road that was drivable even during the rainy seasons) and had at least one eligible public primary health facility and patent medicine vendor (those that offered MRDT services) in a 1:1:1 allocation to the control arm (receiving no intervention), social group arm (receiving sensitisation and education about MRDT), or social group plus provider arm (receiving the social group intervention plus provider training in health communication about MRDT). Investigators, participants (social groups, providers, respondents), and interviewers could not be masked to group assignments. The primary outcome was the proportion of children younger than 5 years with fever or malaria-like illness, in the 2 weeks preceding a household survey, who received an MRDT, and the coprimary outcome was the same outcome but among children aged 5 years and older (ie, up to and including 17 years) and adults (excluding pregnant women). The outcomes were measured at an individual level via household surveys before the interventions and 3 months after the end of the interventions. All analyses were done using a cluster-level method on an intention-to-treat basis. This trial is registered with ISRCTN, number ISRCTN14046444. We carried out eligibility screening and recruitment of participants (clusters, social groups, and providers) between July 2 and Sept 27, 2018. 34 clusters met the eligibility criteria and 18 were randomly selected to participate and randomly assigned to arms (six clusters per arm). A mean proportion of 40·6% (SD 14·5) of eligible children younger than 5 years in the control arm received an MRDT, versus 66·7% (11·7) in the social group arm (adjusted risk difference [aRD] 28·8%, 95% CI 21·9-35·7, p<0·0001) and 71·7% (19·8) in the social group plus provider arm (aRD 32·7%, 24·9-40·5, p<0·0001), with no significant difference between the social group arm and the social group plus provider arm. A mean proportion of 36·3% (18·5) of eligible children aged 5 years and older in the control arm received an MRDT, versus 60·7% (14·0) in the social group arm (aRD 25·6%, 16·8-34·4, p=0·0004), and 59·5% (18·3) in the social group plus provider arm (aRD 28·0%, 19·5-36·5, p=0·0002), with no significant difference between the social group arm and the social group plus provider arm. The sensitisation and education of social groups about MRDTs can significantly increase the demand for MRDTs. This intervention is pragmatic and could be applied within malaria control or elimination programmes, in Nigeria and in other high-burden countries, to enhance diagnostic testing for patients suspected of having malaria. There was no funding source for this study.

Practices toward presumptive tuberculosis clients among patent medicine vendors in Ebonyi State Nigeria.

Tuberculosis (TB) is a major cause of ill-health and death globally but a serious challenge to its control is low case notification. In low- and middle-income countries, most patients with symptoms of the disease first seek care from patent medicine vendors (PMVs) who are not formerly trained to manage TB. The practices of PMVs toward presumptive TB are pivotal to control of TB. The aim of this study was to describe the pattern of practices toward presumptive TB and assess their determinants among PMVs. The study was carried out in Ebonyi State Nigeria using descriptive cross-sectional design. Through a multistage sampling, 250 PMVs were selected and interviewed. Data were collected using pretested interviewer-administered questionnaire and analyzed with IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Chi-square test and binary logistic regression were used to determine factors associated with practices toward presumptive TB with P value set at 0.05 for statistical significance. Almost half (48.8%) of the respondents engaged in poor practices by inadequate referral of clients (45.2%), delayed referral (69.6%), and unstandardized treatment with antibiotics (56.4%). There was no statistically significant association between independent variables and practice and none of the variables significantly predicted practice. There were poor practices toward presumptive TB shown in inadequate referral, delayed referral, and unstandardized treatment of clients. We recommend that PMVs should be trained and regularly sensitized about TB to improve their practices and that regulatory authorities should enforce policies on antibiotics distribution and sale.

How do fertility intentions lead to contraceptive continuation among a cohort of family planning users who received services from the private sector in Nigeria.

Background: The Federal Ministry of Health of Nigeria is exploring task sharing family planning (FP) services to Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs). Yet few studies have explored contraceptive continuation of clients who received FP services from pharmacies and drug shops. This paper uses longitudinal data and looks at women's contraceptive continuation approximately nine months after they received FP services from CPs and PPMVs in Kaduna and Lagos states. Methods: Longitudinal data for this analysis come from an evaluation of the IntegratE project. 491 women were interviewed within 10 days after receiving a FP service from an IntegratE CP or PPMV and approximately nine months later. The dependent variable is contraceptive continuation at the follow-up interview and the independent variable is fertility intentions as reported at enrollment. Multivariate logistic regression models were used to assess the association between fertility intentions and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who intended to have a child in more than two years were significantly more likely to continue using contraception compared to women who intended to have a child within two-years (AOR 2.6; 95% CI 1.1-6.1). Among women who were asked about the quality of care received, 93% said the CP/PPMV asked whether they wanted to have a/another child in the future and 85% said they were asked when they would like to have that child. Conclusion: The fertility intentions of women who seek FP services from CPs and PPMVs in Nigeria can predict contraceptive continuation. As Nigeria task shares FP services to CPs and PPMVs, training on comprehensive FP counseling will be essential for scale-up. Since many women continued using FP, CPs and PPMVs have the potential to expand access to, and support women's continued use of, FP.

PATENT MEDICINE VENDORS’ PREPAREDNESS AND RESPONSE FOR THE PREVENTION AND CONTROL OF COVID-19 INFECTION IN A NORTH-CENTRAL STATE IN NIGERIA

Objective: This report aimed to determine the immediate effect of the IPC training on the knowledge and role of patent medicine vendors (PMV) in the COVID-19 outbreak response in Nigeria.&#x0D; Methods: We conducted a quasi-experimental study before and after the IPC training among 1076 PMV in Ilorin, Kwara state, Nigeria. Data analysis was done using SPSS version 23. Eight questions were asked, for which each was assigned a score of “1”. Participants who had scored&lt;50% were categorized as “Fail”, while those with scores ≥50% were categorized as “Pass” in both the pre and post-tests. The Chi-square test was used to test for the association between sociodemographic characteristics and performance of respondents in the pre-and post-IPC knowledge results, and paired t-test to test for significant differences between the pre and post-tests mean scores. The level of significance was set at p&lt;0.05 for all statistical tests.&#x0D; Results: The mean age of the 1076 respondents was 37.06±10.96, 463(43%) passed the pre-test, while 617 (57.3%) passed the post-test. The mean pre-test IPC training score was 3.1310±1.5631, while the mean post-test IPC training score was 3.7351±1.6028 (t=-11.337, p=&lt;0.001). In all, 617(57.3%) scored higher in posttest. Overall, 560 (92.41%) identified community sensitization and health education on COVID-19 preventive measures as roles of PMV.&#x0D; Conclusion: Regular trainings on COVID-19 preventive practices among PMV should be conducted. PMV should be empowered to sensitize and educate their clients on the prevention of COVID-19.

Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria

BackgroundInnovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria.MethodsThis before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20.ResultsDuring the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%).ConclusionCommunity-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.

Effect of health seeking behaviour of caregivers on severe malaria outcome in under-fives seen in a tertiary health institution in Nigeria.

Recognition of the symptoms and seeking prompt treatment in a health facility is a major means of reducing morbidity and prevention of mortality from severe malaria in under-fives. To document the effect of health-seeking behaviour of caregivers and severe malaria outcome in underfives seen in a tertiary health institution in Nigeria. A descriptive cross-sectional study carried out from July 2012 - June 2013. Data were obtained using a researcher-administered questionnaire. Caregivers and children (6 - 59 months) who presented with features of severe malaria according to World Health Organization criteria. Of the 120 caregivers mean [SD] age (31.4 [7.0] years) /child pairs (24 [14.7] months), 35 (29%) caregivers had appropriate health-seeking behaviour. The commonest place visited for initial healthcare before presentation was the patent medicine vendors by 87 (73%) caregivers. Seventy-seven per cent of caregivers who did not have appropriate health-seeking behaviour were from the lower family social class (p = 0.03). Caregivers whose children presented with severe anaemia were significantly more likely to have appropriate health-seeking behaviour (p =0.00). The mortality rate of severe malaria was 15 per 1000; of which 94% were children whose caregivers did not have appropriate health-seeking behaviour. Age younger than 2 years (p = 0.02), cerebral malaria (p = 0.01) and jaundice (p = 0.03) significantly predicted mortality in the children irrespective of the caregivers' health-seeking behaviour status. Less than a third of the caregivers had appropriate health-seeking behaviour for their under-fives with severe malaria, and the majority of these were from the lower family social class. Cerebral malaria and jaundice significantly predicted mortality in children with severe malaria irrespective of caregivers' health-seeking behaviour status. The study was self-sponsored by the authors.

Stocking pattern for anti-malarial medications among proprietary patent medicine vendors in Akinyele Local Government Area, Ibadan, Nigeria

BackgroundPolicymakers have recognized that proprietary patent medicine vendors (PPMVs) can provide an opportunity for effective scaling up of artemisinin-based combination therapy (ACT) since they constitute a major source of malaria treatment in Nigeria. This study was designed to determine the stocking pattern for anti-malarial medications, knowledge of the recommended anti-malarial medicine among PPMVs in Akinyele Local Government Area (LGA) of Oyo State, Nigeria and their perception on ways to improve PPMV adherence to stocking ACT medicines.MethodsA cross-sectional survey was conducted among 320 PPMVs using a mixed method of data collection. Survey respondents were consecutively selected as a complete listing of all the PPMVs was not available. A pretested interviewer-administered questionnaire was used to collect quantitative data and two focus group discussions (FGD) were conducted among PPMVs using a pretested FGD guide.ResultsMost PPMVs stocked artemether-lumefantrine (90.9%), dihydroartemisinin-piperaquine (5.3%) and artesunate-amodiaquine (2.8%). Drugs contrary to the policy, which included sulfadoxine-pyrimethamine, chloroquine, quinine, halofantrine, artesunate, and artemether were stocked by 93.8, 22.8, 0.6, 1.3, 6.6, and 7.8% of the PPMVs, respectively. Most PPMVs (96.3%) had good knowledge of artemether-lumefantrine as the first-line treatment for malaria and 2.8% had good knowledge of artesunate-amodiaquine as the alternate treatment for malaria. The major factors influencing stocking decision were government recommendations (41.3%) and consumer demand (40.30%).ConclusionStocking of artemisinin-based combinations was high among PPMVs, although they also stocked and dispensed other anti-malarial drugs and this has serious implications for drug resistance development. The PPMVs had considerable knowledge of the recommended treatment for uncomplicated malaria and stocking decisions were overwhelmingly driven by consumer demand. However, there is a need for more enlightenment on discontinuation of government-banned anti-malarial drugs.

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

IntroductionWith COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider...

Market Concentration and Its Relevance in Pharmaceutical Health Care Access in Rural Communities in Nigeria

Background: Universal Health Coverage (UHC) of populations is now a key objective of global health systems. UHC seeks to provide equitable access to essential health care for all who need health care without financial hardship. Unfortunately, the 21 st century has rolled off with the majority of Nigerians still unable to have adequate access to affordable essential medicines for preventing, mitigating or curing diseases from formal sources, particularly in rural communities. In these settings, informal pharmaceutical entrepreneurs (called patent medicine vendors) are often the sole sources of modern medicines and sometimes double as prescribers as well. There are a number of studies about these entrepreneurs, but none that examines the market structure. The study seeks to gain insight into the structure and conduct of this market in order to improve its performance. Method: A cross-sectional, mixed method design based on the structure-conduct-performance (S-C-P) paradigm was used to collect quantitative and qualitative data from patent medicine vendor operators and clients in Kastina-Ala local government council of Benue State, Nigeria. Quantitative data was analyzed using statistical package for social sciences (SPSS) version 20.0, while qualitative data was manually analyzed guided by aproiri themes. Findings: Sellers in the market were small sized, selling branded and generic drugs, with none capable of price leadership. There were low entry barriers, with an overall inverse HHI of 0.01 and a shop per capita of 1:2,669 populations, signifying inadequate access to essential medicines, Conclusion: We conclude that focusing on market concentration as a marker of market efficiency may not always result in the socially desirable health system goal of adequate access to care. Greater emphasis should be placed on developing new health care market policy frameworks that embed both competition and access dimensions in guiding health care market operations. Keywords: Pharmaceuticals; Market concentration; Health care access; Rural communities; Nigeria DOI: 10.7176/JESD/10-14-10 Publication date: July 31 st 2020

The potential role of patent and proprietary medicine vendors\u2019 associations in improving the quality of services in Nigeria\u2019s drug shops

BackgroundPatent and Proprietary Medicine Vendors (PPMVs) play a major role in Nigeria’s health care delivery but regulation and monitoring of their practice needs appreciable improvement to ensure they deliver quality services. Most PPMVs belong to associations which may be useful in improving their regulation. However, little is known about how the PPMV associations function and how they can partner with relevant regulatory agencies to ensure members’ compliance and observance of good practice. This study sought to describe the PPMV associations’ structure and operations and the regulatory environment in which PPMVs function. With this information we explore ways in which the associations could help improve the coverage of Nigeria’s population with basic quality health care services.MethodsA mixed methods study was conducted across four rural local government areas (LGAs) (districts) in two Nigerian states of Bayelsa and Oyo. The study comprises a quantitative data collection of 160 randomly selected PPMVs and their shops, eight PPMV focus group discussions, in-depth interviews with 26 PPMV association executives and eight regulatory agency representatives overseeing PPMVs’ practice.ResultsThe majority of the PPMVs in the four LGAs belonged to the local chapters of National Association of Patent and Proprietary Medicine Dealers (NAPPMED). The associations were led by executive members and had regular monthly meetings. NAPPMED monitored members’ activities, provided professional and social support, and offered protection from regulatory agencies. More than 80% of PPMVs received at least one monitoring visit in the previous 6 months and local NAPPMED was the organization that monitored PPMVs the most, having visited 68.8% of respondents. The three major regulators, who reached 30.0–36.3% of PPMVs reported lack of human and financial resources as the main challenge they faced in regulation.ConclusionsQuality services at drug shops would benefit from stronger monitoring and regulation. The PPMV associations already play a role in monitoring their members. Regulatory agencies and other organizations could partner with the PPMV associations to strengthen the regulatory environment and expand access to basic quality health services at PPMV shops in Nigeria.

Factors influencing non-prescription sales of antibiotics among patent and proprietary medicine vendors in Kano, Nigeria: a cross-sectional study.

Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It's unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27-3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.

Documenting the heritage along the Silk Road: An ethnobotanical study of medicinal teas used in Southern Xinjiang, China

Ethnopharmacological relevancePeople in Southern Xinjiang, China have been consuming medicinal teas for healthcare since before the ancient Silk Road markets began. Several pharmaceutical studies have illustrated the potential healthcare benefits of medicinal teas used in Southern Xinjiang, China. However, little information is available from the literature about the diversity of the species used and related traditional knowledge of these medicinal teas. Aims of the study(i) create a comprehensive record of medicinal tea plant species (MTPS) and combinations used with related traditional knowledge for healthcare in Southern Xinjiang, China; (ii) assess safety of MTPS, and (iii) address conservation status for sustainable use of MTPS. Materials and methodsWe employed both field and market surveys from 2014 to 2019 in 10 counties/cities and four main medicinal tea markets by using semi-structured interviews. We interviewed 236 informants and 70 medicinal tea shop vendors. The commonly used MTPS were ranked by Frequency of Citation. Safety issues were assessed based on expert knowledge and with reference to the official list of Medicinal Plants Used as Food. Conservation implications of plant use were assessed as part of the interviews and this was cross referenced with official records. ResultsThe surveys revealed 145 different plants from 65 families used for making medicinal teas, expanding the list of known Chinese herbal tea species from 782 to 884. Leguminosae, Rosaceae, Lamiaceae and Apiaceae were dominant families. Herbs (60.7%, 88 species) were the most commonly used plant types; fruits (23.1%, 50 species) and seeds (22.2%, 48 species) were commonly used parts. Nearly half (42.1%) of the plant species were introduced from abroad. Respondents reported more than 50 types of healthcare uses of medicinal teas. Tonic (13.7%, 71 species) and promoting digestion (9.6%, 50 species) were the most frequently mentioned healthcare uses. The majority of commonly used plant species were spices (20 species, 50%) and aromatic plants (10 species, 25%). Cinnamomum cassia (L.) J.Presl, Piper longum L. Syzygium aromaticum (L.) Merr. & L. M. Perry and Gardenia jasminoides J. Ellis were the most cited species. High doses of Piper longum L., Crocus sativus L., Curcuma longa L, and Senna alexandrina Mill. May have negative health implications. Assessments of conservation status and sustainable use of tea species indicate that wild harvesting of Nardostachys jatamansi (D. Don) DC. and Pterocarpus indicus Willd. Should be controlled and cultivation technologies should be improved. ConclusionsWe found high plant species diversity and rich traditional knowledge of medicinal teas used in Southern Xinjiang, China. The traditional healthcare uses of some of the medicinal teas are also supported by pharmaceutical evidence. Others should be investigated further. Conservation pressures exist for commonly used wild species. China's ‘Healthy China 2030’ policy should do more to take traditional cultural practices into account. In doing so, both local and national government agendas may seek to promote sustainable harvest and to protect traditional knowledge so that this cultural heritage continues to serve human well-being into the future.

PIN73 KNOWLEDGE OF TUBERCULOSIS AMONG PATENT AND PROPRIETARY MEDICINE VENDORS IN RURAL AREAS OF ENUGU STATE IN SOUTHEAST NIGERIA

The study assessed the knowledge of tuberculosis (TB) among Patent and Proprietary Medicine Vendors (PPMV) to generate data for interventions and policy. the study was a questionnaire based cross-sectional descriptive survey which lasted from January 2017 to March, 2019. A total of 400 respondents took part in the study. A multi-stage sampling method was used in this study. The structured questionnaire was face, construct and content validated and was self-administered. It was pilot tested among 10 PPMV who did not take part in the survey. In the first stage, selection of the three senatorial zones was done. In the second stage, a simple random sampling technique was used to select one local government area each from the three senatorial zones. Thereafter, interviewer-administered semi-structured questionnaire was used to get the responses of the respondents. Data collected was analyzed with descriptive statistics. The p-value of < 0.05 was considered significant. The results of this study showed that majority of respondents had age range 18-51 years, with mean age of 39±13.4 and 40±14.7 respectively with a mean scores of 14.1±6.76 on knowledge and 2.63±1.84 for management of tuberculosis. Correct signs or symptoms of TB, p= 0.025, TB infection spread easily when infected people cough, p=0.001, TB drugs are given free at health centers, p=0.001. However there was insignificant difference on correct method of prevention (p=0.975), whether TB is a very serious infection (p=0.146) and preventable (p=0.351). The study revealed low level of tuberculosis knowledge among the respondents. Intervention studies targeted at improving their knowledge of TB will be essential in promoting care and timely referral to promote better treatment outcomes and improved TB prevention.

Investigating barriers and challenges to the integrated management of neglected tropical skin diseases in an endemic setting in Nigeria.

BackgroundThere is a dearth of experience in and evidence for cost-effective integrated community-based management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria.Methods/Principal findingsThis exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief in witchcraft and herbal remedies; as well as the occurrence of physical, social and economic distress.ConclusionsOur study helped quantify the information gaps that need to be addressed in order to create demand for integrated skin NTDs services in an endemic setting in Nigeria. Individual, structural and socioeconomic challenges to access and delivery of services were identified. Community and health care workers’ empowerment and engagement through outreach and regular training, respectively may alleviate these challenges.

Knowledge and recommendation of oral rehydration solution and zinc for management of childhood diarrhoea among patent and proprietary medicine vendors in Port Harcourt, Nigeria

Background In Nigeria, where patent and proprietary medicine vendors (PPMVs) provide care in 55% of common paediatric illnesses, child deaths from diarrhoeal diseases stands at 104000; 14% of total all-cause child mortality. Our aim was to investigate PPMVs knowledge of presentation, cause, treatment and prevention of childhood diarrhoea, and their recommendation of oral rehydration solution (ORS) and zinc in the treatment of sick children in Port Harcourt, Nigeria. Methods A cross-sectional design, structured questionnaires were administered to 200 PPMVs over six weeks with a 94% response rate. The main outcome variables were knowledge of childhood diarrhoea, and recommendation of ORS and zinc. Knowledge scores were analysed numerically and categorized as satisfactory (score ≥15) and unsatisfactory (score &lt; 15). Multivariate Poisson loglinear regression was used to analyse score ratios. Binomial logistic regression was used to assess the determinants of recommendation of ORS as well as recommendation of zinc. Results Overall knowledge of childhood diarrhoea was satisfactory among 47% of PPMVs. Eighty six percent of them reported consistent recommendation of ORS, while 63% of PPMVs consistently recommended zinc. Secondary education (Score Ratio (SR) =1.26, 95% Confidence Interval (CI) =1.01–1.56, P=0.039) and post-secondary education (SR=1.37, 95% CI=1.09 –1.72, P=0.008) were associated with significantly higher knowledge scores. Recommendation of ORS was significantly associated with knowledge score (Adjusted Odds Ratio (AOR) =1.41, 95% CI=1.19–1.66, P&lt;0.001), availability of ORS (AOR=7.26, 95% CI=1.73-30.54, P=0.007) and prescribing of zinc (AOR=5.82, 95% CI=2.03–16.66, P=0.001). Recommendation of zinc was significantly associated with awareness of ORS/zinc guidelines (AOR=5.60, 95% CI=1.07–29.26, P=0.041. Conclusions With the low knowledge of presentation, cause, treatment and prevention of childhood diarrhoea among PPMVs, management of childhood diarrhoea by them in the community is unlikely to be optimal. The reported recommendation of ORS and zinc will need to be further investigated and confirmed by direct observation. Educational requirement for PPMVs to operate a drug shop should be increased to at least secondary education level, and supply of ORS/zinc made reliable as these have shown to be important factors in the recommendation of the products.

Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study

ABSTRACT Background Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it. Methods We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique. Results A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 – 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others. Conclusion This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs.