Patent And Proprietary Medicine Vendors Research Articles

Implementing Community Antimicrobial Stewardship Model in Nigeria: Lessons Learned from AMS Outpatient Setting among Community Pharmacists/Patent and Proprietary Medicine

Antimicrobial resistance (AMR) is a growing global concern primarily driven by the overuse and inappropriate utilization of antimicrobials. In Nigeria, AMR is exacerbated by the routine sale of prescription-only medicines, including antimicrobials, without proper monitoring. The National Action Plan for Antimicrobial Resistance (2017-2022) highlighted widespread inappropriate antibiotic use, with significant proportions obtained without prescriptions. Antimicrobial stewardship (AMS) in outpatient settings is a novel concept in Nigeria. This interventional study sought to contribute to the reduction of inappropriate antibiotic dispensing and use in community/outpatient settings in Nigeria, focusing on enhancing the skills and capacity of improved rational antibiotic therapy among community pharmacists and Patent and Proprietary Medicine Vendors (PPMVs), with the sole aim of improving patient health outcomes. The CAMS interventional study involves education, quality improvement capacity building, patient empowerment, and a multifaceted AMS strategy. Results from the CFID’s CAMS model indicated a significant improvement in the rational dispensing and use of antimicrobials within the intervention group, emphasizing the effectiveness of CAMS. Notable variations in post-visit actions between the intervention and monitoring groups further support the positive impact of the intervention. Variation in attitudes towards sharing of antibiotic to friends and relatives was reduced among the intervention group, offering clear understanding into the potential impact of CFID AMS outpatient setting (CAMS) intervention. The study’s conclusion underscores the pivotal role of implementing AMS in outpatient and community settings such as the CAMS interventional model in improving antibiotic-related practices in both urban and rural communities in Nigeria, emphasizing its relevance and impact.

Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria

IntroductionAn Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses.MethodsLongitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance.ResultsMore than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter.ConclusionThe study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.

Antimicrobial Prescription Habits among Community Pharmacists and Patent and Proprietary Medicine Vendors in Nigeria: A Rational Use of Drugs Survey

Introduction Antimicrobial Resistance (AMR) poses a global health threat, exacerbated by the misuse and overuse of antimicrobials. The need to investigate knowledge, attitudes, and practices among Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) in Nigeria cannot be overemphasized. This study addresses the gaps in understanding antimicrobial dispensing practices among CPs and PPMVs in Nigeria. Materials/Methods A Community-based Antimicrobial Stewardship survey was conducted across five Nigerian states. A total of 384 PPMVs and 135 CPs were interviewed using a well-structured questionnaire covering demographic information, knowledge, attitudes, and practices related to antimicrobial use. The survey utilized descriptive statistics, and the data were analyzed to identify strengths, weaknesses, threats, and opportunities in addressing AMR. Results The study revealed inadequate knowledge regarding AMR among both PPMVs and CPs. Despite educational backgrounds, a significant proportion believed antibiotics were the best treatment for fever and diarrhea. Dispensing practices included selling antibiotics without prescriptions and, in some cases, dispensing medicines by proxy. The Safety Net Protocol, involving patient education and follow-up, was often neglected by both PPMVs and CPs. Conclusion The findings underscore the importance of enhancing knowledge, attitudes, and practices related to antimicrobial prescription among PPMVs and CPs in Nigeria. Regulatory authorities should enforce strict guidelines to curb non-prescription antibiotic sales. Patient education and follow-up initiatives should be prioritized to mitigate AMR risks. In order to develop strategies to improve antimicrobial dispensing practices we recommend the following: AMR education for PPMVs and CPs, Enforce rules to prevent antibiotic sales without prescriptions through regulatory compliance, public awareness on antibiotic risks and prescription importance, implement Safety Net Protocol for post-purchase education to prevent antibiotic misuse and provision of ongoing professional development for PPMVs and CPs with updated practices that will sustain learning.

A REVIEW OF CROSS-FUNCTIONAL COLLABORATIONS IN ENHANCING HEALTHCARE DELIVERY IN NIGERIA

This study aimed to explore the dynamics and implications of cross-functional collaborations in Nigeria’s healthcare sector, particularly in the context of global health crises and the unique challenges faced by the nation. Utilizing a systematic approach, data were extracted from selected sources using a structured form, capturing study objectives, methodology, key findings, and implications specific to Nigeria’s healthcare landscape. The extracted data underwent thematic analysis, identifying patterns and themes that provide a nuanced understanding of healthcare collaborations in Nigeria. The findings underscore the transformative power of cross-functional collaborations, especially evident during the COVID-19 pandemic, where diverse disciplines converged towards a shared objective. The study also highlighted the critical role of patent and proprietary medicine vendors (PPMVs) in Nigeria’s healthcare provision, emphasizing the need for their continuous training and regulation. Collaborative initiatives, such as responses to disease outbreaks and the push for Universal Health Coverage (UHC), were identified as pivotal strategies to address the multifaceted challenges facing Nigeria’s health system. In conclusion, cross-functional collaborations in Nigeria’s healthcare sector present a promising avenue to address systemic challenges, drive innovation, and improve patient outcomes. Recommendations include strengthening regulatory frameworks, prioritizing technological integration, enhancing interdisciplinary training, and addressing systemic barriers to effective collaboration.

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study.

Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18-49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ 2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%-89%) and Kaduna (66%-82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna.

Nigerian stakeholders’ perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services

BackgroundCommunity Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria’s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project.MethodsTwo rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted.ResultsFifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs.ConclusionScale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services.

Assessment of the Capacity of Patent and Proprietary Medicine Vendors to Provide Contraceptive Services to Adolescents in Kaduna State, Nigeria

The contraceptive Prevalence Rate among adolescents has remained extremely low in Kaduna State due to limited access to health facilities with youth-friendly services. Patent and Proprietary Medicine Vendors (PPMV) are the most widespread health facilities and the first point of access for family planning commodities in Nigeria. Providing contraceptive services to adolescents requires specific sets of skills and an environment that are youth friendly. This study examines the capacity of PPMV to offer contraceptive services to adolescents. The study used a cross-sectional descriptive design. We interviewed 462 PPMV selected from urban and sub-urban Local Government Areas (LGA) of Kaduna State using a multistage random sampling technique. Data analysis was based on percentages conducted with SPSS software, version 20. Findings from the assessment show that PPMV are a mix of professionals and lay providers. 43.1% possess a qualification in Nursing, midwifery, or community health, and 18.8% have received specific training on contraceptive services. 91.6% are dispensing contraceptives that are suitable for adolescents, and 97.4% are willing to acquire additional training to provide adolescent-friendly contraceptive services for both the married and unmarried. The study equally shows that most PPMVs have private space (70.1%) for confidential counselling and operate seven days a week (86.6%) and twelve or more hours a day (83.3%). Pharmacists Council of Nigeria should consider expanding the scope of contraceptive services that PPMV can provide based on their training.

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.

Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria

BackgroundThe trio of commonest illnesses and causes mortality among children under five (Malaria, Pneumonia and Diarrhea) are easily treatable through timely exposure to cost effective interventions at the community level. Patent and proprietary medicine vendors (PPMVs) are a leading source of care for illnesses among under-five children in Nigeria. This study was designed to explore child health services offering, particularly commodity stocking patterns and case management knowledge for common childhood illnesses among PPMVs in Ebonyi and Kaduna States.MethodsA descriptive cross-sectional study was conducted among PPMVs in four local government areas across Ebonyi and Kaduna States. Data was collected using semi-structured interviewer-administered questionnaires. Information was obtained on medicine and supplies, knowledge of common childhood illnesses management and referral practices.ResultsA total of 374 PPMVs were interviewed; the mean age was 33.7 ± 9.8 years. Among the 132 health trained respondents, 59.0% offer treatment services for sick children while 83.5% of the non-health trained respondents offer the same service. At least, 88.0% of the respondents keep stock ACTs, Amoxycilin DT, ORS and Zinc. About 38.5% reported stock-out of ACTs in the month preceding the study, 55.1% reported stock out lasting only 0 to 6 days. Only 83 (22.2%) of respondents knew the correct diagnosis of fast breathing among children aged 2 to less than 12 months old. Education and health training background were associated with a good knowledge of common childhood illnesses management (X2 = 44.88, p < 0.001; X2 = 27.14, p < 0.001).ConclusionThe relative constant availability of medicines and commodities for managing childhood illnesses positions PPMVs as a preferred source of care for these illnesses. There is a need to complement steady stock availability with provision of quality services by exposing PPMVs to trainings on integrated community case management of childhood illnesses and implementation of robust supervision mechanism to monitor them.

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.

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.

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.

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.

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.

Exploration of Barriers to the Recommendation of Oral Rehydration Salts and Zinc Tablets for Acute Diarrhoea by Patent Medicine Vendors in Lagos State, Nigeria.

Background: Diarrhoea has remained a global burden and leading cause of morbidity and mortality among under-five children especially in low and middle-income countries in spite of availability of oral rehydration salts and zinc tablets (ORS/Zn,), which are the proven and recommended treatments. This persistent global burden indicates possible barriers in the prescription, recommendation or use of ORS/Zn among stakeholders. Objective: This study explored the factors that act as barriers to the recommendation of ORS/Zn in the management of childhood acute watery diarrhoea (AWD) by Patent and Proprietary Medicine Vendors (PPMVs) License holders in Lagos State. Methods: A qualitative study carried out through interviews of PPMVs. A purposive recruitment of 24 PPMVs was done with 18 of them finally participating in the study. Thematic analysis through peer coding was employed to extract the findings of the study presented in themes and subthemes. Results: Three themes associated with barriers to recommending ORS/Zn emerged: rejection of ORS/Zn by parents of children with AWD, misconception about ORS/Zn and difficulties with ORS/Zn preparation. The enhancement of the taste of ORS was the major theme associated with factors that could facilitate recommendation of ORS/Zn. Conclusion: This study revealed that PPMVs knew that they should recommend ORS/Zn for AWD but encountered barriers such as rejection of ORS/Zn by parents, misconception of ORS/Zn and difficulties in the preparation of ORS. They opined that enhancement of the taste of ORS may facilitate acceptance by parents.

The effect of job aids on knowledge retention among Patent and Proprietary Medicine Vendors trained to administer injectable contraceptives: longitudinal results from implementation science in Nigeria

BackgroundTo increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs’ knowledge of injectable contraceptives 9 months after receiving a standardized training.MethodsOne hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training.ResultsOver half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4–5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2–4.6) and side effects (AOR: 2.5; 95% CI: 1.3–4.8).ConclusionPPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.

Improving access to appropriate case management for common childhood illnesses in hard-to-reach areas of Abia State, Nigeria

# Background Studies have demonstrated that trained community health workers can improve access to quality health services for under five children. Under the World Health Organization's Rapid Access Expansion Progamme, integrated community case management of childhood illnesses (iCCM) was introduced in Abia and Niger States, Nigeria in 2013. The objective of the program was to increase the number of children 2-59 months receiving quality life-saving treatment for malaria, pneumonia and diarrhoea by extending case management through community-oriented resource persons (CORPs). We present findings from household surveys comparing baseline and endline data to assess changes in sick child care-seeking, assessment, and treatment coverage provided over the project period in Abia State. # Methods A baseline household survey was conducted in May 2014 and an endline survey in February 2017. The surveys used multi-stage cluster sampling of primary caregivers of children aged 2-59 months who had been recently sick with diarrhoea, fever, or cough with difficult breathing. # Results Care-seeking from an appropriate provider improved significantly from 69% at baseline to 77% at endline (*P*\<0.01). At baseline, patent and proprietary medicine vendors (PPMVs) (55%) and health centers (34%) were the main providers of care for iCCM services; by endline, CORPs became the main source (48%), followed by PPMVs (36%) and health centers (25%). # Conclusions Overall, the findings demonstrate improvements in care-seeking. Care-seeking practices shifted over the course of the project, with more caregivers seeking care from CORPs by the end of the project. The findings suggest that scaling up iCCM in Nigeria may improve access to appropriate treatment for under five children living in hard-to-reach areas.

Using 'Theories of Change' and responsive feedback to design a digital service business for patent and proprietary medicine vendors in Nigeria.

In a paper titled "Responsive feedback: Towards a new paradigm to enhance intervention effectiveness", Viswanath et al. argue that dominant models of intervention design do not account for the complexity and unpredictability of implementation challenges. Particularly in the behavioural sciences, intervention designs need to consider many factors that will be uncertain, or unknown, at the beginning of a new project. This letter describes how we were able to respond to feedback during the design phase of a proof-of-concept project to create a digital service business for Nigerian patent and proprietary medicine vendors (PPMVs). Our approach was to create an initial 'Theory of Change' (ToC) based on a similar project with Kenyan shopkeepers. This ToC was revised following user feedback and a landscape analysis with key stakeholders. The new ToC required us to access additional funding to create a 'digital ordering' facility for the PPMVs. Digital ordering provides a mechanism whereby we can reduce the prevalence of counterfeit medicines, offer the PPMVs credit and group-buying facilities, and reduce supply chain costs through co-distribution with fast-moving consumer goods. An important learning point was that while our focus was on designing a platform to meet users' needs, changes in regulation meant that we spent considerably more time than anticipated meeting the needs of multiple stakeholders. However, the importance of ensuring stakeholders' continued buy-in cannot be underestimated and has likely increased the sustainability of the project in the longer term. As Viswanath et al. suggest, for responsive approaches to be widely adopted needs more flexibility than exists in current funding models and project plans. Both funding bodies and grantees will need to be more responsive to feedback coming from the field.

Malaria testing and treatment knowledge among selected rural patent and proprietary medicine vendors (PPMV) in Nigeria

BackgroundMalaria is a leading cause of illness and death in Nigeria, but access of poor people to quality anti-malarial services remains low especially in the rural areas. Patent and proprietary medicine vendors (PPMVs) provide the majority of malaria treatment in rural areas, but little is known about their knowledge of malaria testing and treatment of uncomplicated malaria as recommended in the 2011 National Malaria Control Programme policy.MethodsA cross-sectional survey was conducted in two purposively selected states (Oyo and Bayelsa) in Nigeria with each state representing a different geographic and linguistic–ethnic region in the southern part of the country. Two rural LGAs were randomly selected from each state and data were collected from 160 randomly selected PPMVS (40 per LGA) using a structured questionnaire. Data were analysed using descriptive statistics.ResultsThe 2011 National Policy on Malaria Diagnosis and Treatment is mostly unknown to PPMVs. Although most PPMVs (89%) knew that artemisinin-based combination therapy (ACT) is recommended in the national policy, 91% also thought non-ACT were endorsed. The proportion of PPMVs who stated they would treat a malaria case with an artemisinin-based combination at the correct dose was 33% for a child under five, 47% for an adult male and 14% for a pregnant woman in her second trimester. The proportion of PPMVs who reported they would diagnose a case of malaria prior to treatment using a malaria rapid diagnostic test (RDT) kit was 1.9% for children under five, 7.5% for adult males and 3.1% for pregnant women in their first trimester due to lack of knowledge. Almost two-thirds (65.6%) would correctly refer children with severe malaria to health facility.ConclusionsSubstantial knowledge gaps on the use of RDTs and treatment with artemisinin-based combinations exist among rural PPMVs. Given existing evidence regarding the effectiveness of private retail outlets in malaria case management, PPMVs should be provided with competency-based training and supervision to improve the quality of care they provide.