Outpatients In Nigeria Research Articles

Impact of Covid-19 Pandemic on the Utilization and Delivery of Healthcare Services among Outpatients during the Early Phase of the Pandemic in Nigeria.

During the early phase of the COVID-19 pandemic, some infection control measures were implemented to keep people safe and control the spread of the virus. These measures however were observed to cause significant delay or interruption in the delivery and utilization of healthcare services. The purpose of this study was to determine the impact of the COVID-19 pandemic on the utilization and delivery of healthcare services by outpatients in Nigeria during the early phase of the pandemic. A retrospective cross-sectional study design was utilized. We sampled 373 outpatients who had received healthcare services before and during the pandemic in the University College Hospital, Ibadan using convenience sampling. Descriptive and inferential statistics (t-test) were carried out and the level of significance was set as P<0.05. Healthcare utilization was significantly impacted by the pandemic as there was a reduction in hospital visits by patients during the pandemic (P<0.0003). Restriction of movement and fear of contracting the virus was identified as reasons for the reduction in healthcare services utilization in about 59% of the participants. Patients rated the quality healthcare services delivered to them as 'average' during the pandemic as opposed to 'good' before the pandemic. The findings of this study showed that the COVID-19 pandemic had a significant impact on patients' utilization of healthcare services as well as the delivery of adequate healthcare services in the hospital during the early phases of the pandemic. Therefore, we recommend that efforts be made to improve hospitals and nationwide preparedness for future pandemics to prevent healthcare interference and delay.

Assessment of prescribing in under-five paediatric outpatients in Nigeria: an application of the POPI (Pediatrics: Omission of Prescription and Inappropriate Prescription) tool.

This study evaluated prescribing in children under the age of five attending paediatric outpatient clinics at three Central hospitals in Delta State, Nigeria and determined the conditions mostly associated with inappropriate prescriptions and omissions. This was a retrospective study of prescriptions made to children from 0 to 59 months who attended the clinics. Prescriptions were evaluated using the POPI tool, occurrence of potentially inappropriate prescriptions and prescribing omissions were reported as percentages and inappropriate prescription types and prescription omissions were also reported as frequencies. Relationship between inappropriate prescriptions, omissions of prescriptions and age group and gender were determined, P < 0.05 was considered significant. A total of 1327 prescriptions from the three centres were analyzed. There was a preponderance of infants (>1 month-12 months of age) in the study (43.0%) and a somewhat even gender distribution. Exactly 29.8% of all the prescriptions studied had at least one occurrence of inappropriate prescription. The use of H1 antagonists with sedative or atropine-like effects accounted for the majority of inappropriate prescriptions (49.5%), while the prescription of drinkable amoxicillin or other antibiotics in doses other than mg was the most frequent omission of prescription (97.2%). There was a significant relationship between the occurrence of inappropriate prescription and age group (P > 0.001). Inappropriate prescriptions and omissions of prescriptions were high and effectively detected by the POPI tool.

A Systematic Review of the Effect of Arts-Based Interventions on Patient Care in Nigeria.

The utilization of art for therapeutic purposes in the formal healthcare setting is gradually gaining prominence in Nigeria. However, there is a paucity of evidence on the effectiveness of these interventions. Therefore, we explored the pooled effect of the various arts-based interventions in managing clinical disorders in hospitalized and out-patients in Nigeria. An electronic search of PubMed, African Journal Online, Web of Science, Google Scholar, Cochrane Library, and Scopus databases was carried out from the inception of the databases to October 31, 2021. Three researchers using Rayyan QCRI software independently screened and de-duplicated the identified studies. Eight eligible studies were selected for this review, with a total of 541 participants. The earliest study was published in 2012. Seven of the eight studies were conducted in the Southern part of Nigeria. There were four quasi-experimental studies, two randomized controlled trials, and two comparative cross-sectional studies. The predominant art forms were music (three) and dance/movement (three), followed by visual art (two). The groups of patients in the identified studies were managed for mental health problems (two), hypertension (two), Parkinson's disease (one), spinal cord injury (one), autistic spectrum disorder (one), and chronic back pain (one). In all the studies, the art-based intervention significantly improved the overall outcome of the patients. The findings of the available studies have proven to yield a significant positive outcome in managing different health conditions. However, there is a need to conduct more high-quality research in this field in Nigeria.

Insulin initiation in Type 2 diabetes mellitus outpatients – data from the multicentre evaluation of type 2 diabetes mellitus outpatients on insulin therapy in Nigeria (METOIN study)

People living with type 2 diabetes mellitus (T2DM) have relative insulin deficiency and, therefore, have options to insulin therapy. To be on insulin alone or in combination with other therapies in type 2 DM outpatients is a choice made personalized for each patient. Published literature on the insulin initiation patterns among T2DM outpatients in Nigeria is scanty. The objective of this study, therefore, is to bridge this gap in knowledge. This was a prospective cross sectional study conducted in five tertiary health facilities in Nigeria in which consenting type 2 DM outpatients on insulin therapy alone or in combination with other therapies and who meet the inclusion criteria for the study were recruited. Relevant data relating to insulin use initiation by the patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A total of 268 outpatients living with type 2 DM on insulin therapy, made up of 116 (43.3%) male and 152 (56.7%) females participated in the study. Only 55 (20.5%) of the patients started insulin at onset of diagnosis of T2DM while 46 (17.2%) of the patients started insulin therapy after 5 years of living with T2DM. The duration of living with DM before insulin initiation and the patient's highest level of education were not statistically significant. Insulin initiation was delayed several months to years after diagnosis of T2DM by predominantly endocrinologists in tertiary health facilities but it was initiated in 19 (7.1%) of the T2DM outpatients by primary care physicians (GPs) in peripheral hospitals. It is recommended that diabetes education be intensified for T2DM patients to appreciate the key role of insulin therapy in diabetes care.&#x0D; Keywords: insulin initiation, type 2 diabetes mellitus outpatients, Nigeria.

Prevalence and correlates of negative disposition to marital homogamy among a sample of psychiatric outpatients in Nigeria

Objective: Persons with mental illness (PWMI) have reduced chances of getting married to individuals without mental illness, yet, so much controversy surrounds the propriety or otherwise of a psychiatric patient marrying another psychiatric patient (marital homogamy). The factors that are associated with patients' disposition towards homogamy have received little attention from researchers, creating a gap in literature. In this study, I intended to examine the proportion of psychiatric patients that are negatively disposed towards marrying another psychiatric patient and to find the factors that are associated with their disposition. Methods: A descriptive cross-sectional design was used, and participants included 208 consecutive attendees at the psychiatric outpatient clinic of a tertiary hospital in Benin City, Nigeria. Data were collected from the participants using a sociodemographic data collection sheet and three standard instruments - the Bogardus Social Distance Scale, the World Psychiatric Association Stigma Questionnaire, and the Brief Psychiatric Rating Scale. Results: About two-thirds of the patients (67.3%) were not willing to marry a psychiatric patient, citing concerns about heredity of mental illness; potential financial difficulty and lack of social/spousal support; and perceived dangerousness of psychiatric patients as the reasons. About two-thirds of them desired moderate to high social distance from another psychiatric patient. Three factors - the desire for low social distance (p < 0.001), belief that marriage is a necessity in life (p < 0.001), and belief that people with mental illness who recovered are eligible to marry (p < 0.001) - significantly differentiated between patients who were willing to marry a psychiatric patient and those not willing. Conclusion: Many patients in this study expressed a negative disposition toward marrying a psychiatric patient, yet previous researchers reported that they have reduced chances of marrying persons without mental illness. Appropriate intervention to address the factors that are related to their negative disposition may change their disposition and increase their chances of getting married, either to a nonmentally ill individual or a PWMI if they must not remain single all their life.

Prevalence of Multi Drug Resistant Bacteria among Urinary Tract Infection Outpatients Visiting Madonna University Teaching Hospital, Elele, Nigeria

Background: Urinary tract infections (UTIs) are among the most common infections in outpatients in Nigeria. However, antimicrobial drug resistance is a challenge in the treatment of UTIs and therefore, there is need for drug resistance surveillance to guide treatment.&#x0D; Aim: This study assessed the prevalence and antimicrobial susceptibility patterns of UTIs in a Nigeria population.&#x0D; Study Design: This was a cross-sectional study involving hospital outpatients.&#x0D; Place and Date of Study: The study was conducted between September 2012 and February 2013 at Madonna University Teaching Hospital, Elele, Nigeria.&#x0D; Methodology: Urine sample collected from 115 randomly selected patients was screened by microbial culture for the presence of microbial pathogens. Antimicrobial susceptibility testing was done for the identified isolates to assess the effectiveness of some selected routinely used antibiotics.&#x0D; Results: Among the 115 subjects, bacteria growth was observed in 49 subjects giving a prevalence of 42.6%. UTI was slightly higher in females (44.8%) than in males (40.4%). A total of 9 bacteria isolates of the following genus; staphylococcus, klebsiella, pseudomonas, Escherichia, enterococcus and proteus species were identified among which Staphyloccus aureus was the most prevalent. Ampicillin was the most effective antibiotics, followed by ciprofloxacin and erythromycin. Staphylococcus aureus, other Staphylococcus species and Escherichia coli were the most susceptible isolates. Most microbial pathogens were resistant to Nitrofurantoin, amoxicillin-clavulanic acid and amoxicillin.&#x0D; Conclusion: Urinary tract infection showed a high prevalence of 42.6% which was predominant in females. Staphylococcus aureus was the most prevalent bacterial isolate. Ampicillin was the most effective antibiotics followed by ciprofloxacin while most pathogens were resistant to nitrofurantoin, amoxicillin-clavulanic acid and amoxicillin.

Trihexyphenidyl abuse in psychiatric outpatient clinic of a general hospital in Northern Nigeria

Background: Concomitant prescription of anticholinergics with first generation antipsychotic medications is widely practiced in psychiatry to avert or abort extrapyramidal side effect resulting from the latter. Trihexyphenidyl (Benzhexol) is the most commonly prescribed and the most likely to be abused amidst the anticholinergics in Nigeria. Objectives: To explore the prevalence and the associated factors for Trihexyphenidyl abuse among psychiatric outpatients in Nigeria. Methodology: 64 stable outpatients who met the inclusion criteria were interviewed with a sociodemographic questionnaire and a ten items Drug Abuse Screening Test (DAST-10), other relevant data were obtained from their case notes at the psychiatric clinic of Sarkin Maska Shehu (SMASH) Hospital, Funtua, Katsina State. Data were tabulated and analysed with Microsoft Excel and version 11.65 of Window Program for Epidemiologist (WINPEPI).

Role of Extended Spectrum Beta Lactamases in Cephalosporin and Carbapenem Resistance in Escherichia coli from Inpatients and Outpatients in Nigeria

Role of Extended Spectrum Beta Lactamases in Cephalosporin and Carbapenem Resistance in Escherichia coli from Inpatients and Outpatients in Nigeria

Knowledge, awareness, perception and reporting of experienced adverse drug reactions among outpatients in Nigeria.

Background Higher incidence of adverse drug reactions (ADRs) remain a major cause of morbidity and mortality. Most targeted ADR reporting activities are mainly professional-centered with less attention to patients' knowledge, perception and selfreporting of experienced ADRs. Objectives To comprehensively evaluate patients' knowledge, awareness, perception and reporting of experienced ADRs. Setting Three public healthcare facilities in Ibadan, southwestern Nigeria. Method A questionnaire-guided cross-sectional interview of 1190 consented ambulatory adult patients consecutively recruited from various clinics of the selected hospitals between February and June 2018. The 32-item pretested questionnaire comprised open- and closed-ended questions, as well as open-ended questions with relevant prompts. Data were summarised using descriptive statistics, while Chi square was used to investigate association between relevant categorical variables at p < 0.05. Main outcome measure Knowledge, awareness, perception and reporting of experienced ADRs among patients. Results Response rate was 99.1%. Mean age was 40.6 ± 14.9years. Forty-nine (4.1%) patients were aware of pharmacovigilance. A total of 964 (81.0%) correctly understood what can be regarded as serious adverse drug reactions (ADRs), 444 (37.3%) had previously experienced ADRs, while 77 (6.5%) experienced reactions with current medication(s). Of this, 64 (83.1%) made a report largely to physician (52; 81.3%). Summarily, reported reactions were more with antimalarials (214; 49.1%), with itching (168; 78.5%) constituting the most frequently occurring reaction. Use of text message (276; 27.2%) and filling of ADR report form (248; 24.4%) were topmost on the list of suggested methods for ADR reporting. There was a significant association between patient's age and awareness of pharmacovigilance (p = 0.015), while educational qualification (p = 0.001) significantly influenced tendency to make a report of experienced ADRs. Conclusion Approximately four percent of patients were aware of pharmacovigilance, while more than three-quarters correctly understood the concept of serious adverse drug reactions. A little above one-quarter had previously experienced one form of reaction or the other, with majority reporting such reactions to physician. Continuous education of stakeholders in pharmacovigilance activities is advocated, while patient's active involvement in spontaneous reporting of ADRs should be carefully considered.

Patterns of drugs prescribed for dental outpatients in Nigeria: findings and implications

Objectives: There are concerns with inappropriate prescribing of medicines among dentists especially antimicrobials. It is more concerning if this increases resistance rates. This study aimed to address this by assessing patterns of drugs prescribed for outpatients attending a hospital dental clinic in Nigeria. The findings will be used to plan future interventions, particularly around antimicrobial prescribing, where there are concerns.Methods and materials: Medical records of patients attending the dental clinic of a leading teaching hospital in Nigeria were evaluated. Patients referred for admission, without a prescription, or prescribed medicines without a documented diagnosis were excluded.Results: Overall, 607 prescriptions were analysed, 314 (51.7%) were for females. Periodontal and gum diseases (414; 68.1%) were the most frequent diagnoses, followed by pulpitis (49; 8.2%), and dentoalveolar abscess (43; 7.1%). A total of 1798 medicines were prescribed for all patients with a mean of 3.0 ± 0.48 medicines per prescription. Antimicrobials (1178; 65.5%) and analgesics (620; 34.5%) were the two drug classes prescribed. Ascorbic acid and vitamin B complex were prescribed for 361 (59.5%) patients. Among antimicrobials, amoxicillin (564; 95.1%) either alone or combined with clavulanic acid was the most frequently prescribed, followed by metronidazole (561; 94.6%). Brand name prescribing was also appreciably higher than WHO recommendations.Conclusion: Polypharmacy, brand name prescriptions, and the frequent prescription of antimicrobials were common practices at the dental clinic of this teaching hospital in Nigeria. We suggest a review of the current standard treatment guidelines in Nigeria to guide dentists on current knowledge- and evidence-based treatment of common oral diseases.

Faecal carriage of extended-spectrum beta-lactamase (ESBL)-producing commensal Klebsiella pneumoniae and Escherichia coli from hospital out-patients in Southern Nigeria

Normal intestinal microflora is the major source from which common hospital- and community-acquired infections originate. This study aimed to determine faecal carriage of extended-spectrum beta-lactam (ESBL) resistant genes from commensals of out-patients in Nigeria. Non-duplicateKlebsiella pneumoniae and Escherichia coli from different hospitals were investigated for susceptibility to a panel of antibiotics, carriage of plasmid mediated β-lactam resistance, andanalysis of plasmids present, including replicon typing. The minimum inhibitory concentrations (MICs) for β-lactam antibiotics showed MIC90 of ≥256 µg/ml for all antibiotics. CTX-M carriage was 36.8% for the 114 strains; 30 of these were CTX-M-15 and 12 carried CTX-M-2. TEM-1genes were present in 102 isolates (89.5%), SHV-1 genes in 24 (21.1%), OXA-1 in 36 (31.6%) and 10 (8.8%) in AmpC genes detected. There was no significant difference in the proportion of ESBL genes detected in E. coli and K. pneumoniae (t test; p = 0.64; p > 0.05) and between hospitals (c2 = 0.35; p = 0.84; p > 0.05). IncF was the common plasmid encoding β-lactamases. High faecal carriage of ESBL genes in commensals, importantly classical CTX-M-15 in out-patients is a reflection of the prevalence from clinical specimens in diseased conditions in Nigeria. Key words: Faeces, bacteria, plasmid, extended-spectrum beta-lactam (ESBL) genes, Nigeria.

Perceived medication use challenges and coping strategies among medical outpatients in Nigeria

The use of medicines is an action that involves a change in behaviour and it is a complex construct involving reciprocal interactions between social, environmental and cognitive factors. This is particularly true when a patient uses medicines for asymptomatic chronic conditions, requiring life-long use. To identify patient-perceived medication use challenges, determine the coping strategies used and investigate the relationship between patient-perceived challenges and self-initiation of coping strategies. A premier 900-bed tertiary/teaching hospital located in Ibadan, Nigeria. Ten pharmacists conducted cross-sectional medication use interviews for a random sample of 324 medical outpatients in 4 weeks (25th October-19th November 2006). Patient-perceived challenges with prescribed medications, self-initiated coping strategies used and relationship between patient-perceived challenges and self-initiation of coping strategies Eighty-one percent (324) of the random sample of 400 patients consented and completed the interview. Of these, 50.3 % were males while 49.7 % were females with mean age (SD) of 51.5 (17.6) and 52.1 (17.4) years respectively. The most frequent diagnoses were hypertension (53 %) and type-2 diabetes + hypertension (14.5 %). Two hundred and twenty-four patients reported one or more perceived challenges. Of these, 43.8 % were 65 years or older and about half reported at least 3 challenges. The majority (95.6 %) of patients who reported perceived challenges initiated one or more coping strategies without the knowledge of their physicians or pharmacists. Of 100 patients who did not report any perceived challenge, 43 % admitted initiating strategies to maintain perceived "cure" of their medical conditions. Self-initiation and use of coping strategies was far more likely among patients who reported perceived challenges (OR: 28.4, 95 % CI 26.1-30.5). The number of coping strategies reported appeared strongly related to the number of perceived challenges (r = 0.91, p < 0.001). Perceived challenges associated with the use of prescribed medications and self-initiation of coping strategies appeared considerable among medical outpatients at a major teaching hospital in Nigeria. The risk of unauthorised initiation and use of varieties of coping strategies without the knowledge of clinicians was very high among patients who reported at least one perceived challenge.

Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria

To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria. Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria. A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index. Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review. Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P < 0.0001). Two hundred and twenty-six medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the major consequences of non-adherence. Potentially harmful drug-disease interactions were the most frequent medication use-related problems arising from self medication (40.4%). Potentially harmful medication use-related problems are frequently encountered among medical outpatients in Nigeria. The institutionalization of medication use review and the devolution of this task to pharmacists may prove beneficial in optimizing outcomes of medication use in Nigeria.

Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria

Objective The aim of this study was to assess the rate of adherence to medications amongst psychiatric outpatients in Nigeria and examine factors associated with medication nonadherence amongst this group. Method Psychiatric outpatients ( n=342) from three centres were assessed for medication adherence using the Morisky Medication Adherence Questionnaire. Details regarding sociodemographic variables (age, sex, education, religion, marital status, employment, income, medication cost), illness related variables (diagnosis, duration, number of episodes/admissions, insight, severity of symptoms, mental state, functional status), medication related variables (type, mode of administration, side effect, attitude to medication) and perception related variables (self-stigma, perceived causation and prognosis) were also obtained. Results There were 76 participants (22.2%) with good medication adherence, 102 (29.8%) with moderate adherence and 164 (48.0%) with poor adherence. The significant independent correlates of poor medication adherence included being employed [odds ratio (OR) 3.42, 95% confidence interval (95% CI) 2.17–5.39], poor social support (OR 5.86, 95% CI 2.87–12.17), high self-stigma (OR 4.70, 95% CI 2.24–9.96) and perceived spiritual causation of mental illness (OR 3.74, 95% CI 1.87–7.74). Conclusions The majority of psychiatric outpatients in southwestern Nigeria had poor medication adherence. Our findings stressed the importance of patients' perception and social environment in determining treatment adherence and the necessity of educating the patient. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.

Frequency and clinical features of urinary tract infection in paediatric out-patients in Nigeria.

A survey of urinary tract infections (UTI) was conducted in a paediatric out-patient department in Northern Nigeria over six months. The most common presenting complaints of UTI were pyrexia of unknown origin (PUO) and mild diarrhoea. The frequency of symptomatic UTI in out-patients was estimated at 0.4%. Asymptomatic UTI was common in children with nephrotic syndrome (16%) and severe malnutrition (23%). Abnormalities of the urinary tract were found on I.V.P. in four out of twelve boys and one out of nine girls with symptomatic infection. Micturating cystograms (MCUG) were of less value because even if severe ureteric reflux was found, long term follow-up was not practical. Follow-up could be maintained with greater success from local clinics.