Background As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables. Methods We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria. We assessed drug quality based on (1) the level of active pharmaceutical ingredients (APIs), which identified falsely labeled drug samples; and (2) the amount of impurities, which revealed substandard drug samples in accordance with the international pharmacopoeia guidelines. Good-quality drugs met specifications for both API and impurity. Results Of the 102 drug samples collected, 30 (29.3%) were falsely labeled, 76 (74.5%) were substandard,78 (76.5%) were of poor quality and 24 (23.5%) were of good quality.Among the falsely labeled drugs, 2 samples met standards set for purity while 28 did not. Among the 76 substandard drug samples, 28 were also falsely labeled. Of the falsely labeled drugs, 17 (56.7%) came from LGAs with low socioeconomic status, and 40 (52.6%) of the substandard drug samples came from LGAs with high socioeconomic status. Most of the good-quality drug samples, 14 (58.3%), were from LGAs with low socioeconomic status. Eighteen (60%) of the falsely labeled samples, 37 (48.7%) of the substandard samples, and 15 (62.5%) of the good-quality drug samples were from manufacturers based in Asia. The average price was 375.67 Nigerian naira (NGN) for falsely labeled drugs, 383.33 NGN for substandard drugs, and 375.67 NGN for good-quality drugs. The prevalence of falsely labeled and substandard drug samples did not differ by LGA-level socioeconomic status ( P = .39) or region of manufacturer ( P = .24); however, there was a trend for a difference by price ( P = .06). Conclusion The prevalence of falsely labeled and substandard drug samples was high in Lagos. Treatment of noncommunicable diseases in this setting will require efforts to monitor and assure drug quality.
Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P < 0.001), respectively]. In Lagos, the private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P < 0.001)]. Results indicate that the technical quality of private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.
The availability of routine health information is critical for effective health planning, especially in resource-limited countries. Nigeria adopted the web-based District Health Information System [DHIS], to harmonize the collection, analysis, and storage of data for informed decision-making. However, only 44% of all private hospitals in Lagos state reported to the DHIS, despite constituting 90% of all health facilities in the state. To bridge this gap, this study implemented targeted interventions. This paper describes [i] the implemented interventions, [ii] the effects of the interventions on data reporting on DHIS during the intervention period, and [iii] the evaluation of data reporting on DHIS after the intervention period in select private hospitals in Lagos state. A five-pronged intervention was implemented in 55 private hospitals [intervention hospitals], which entailed stakeholder engagement, on-the-job training, in-facility mentoring, and the provision of data tools and job aids, to improve data reporting on DHIS from 2014 to 2017. A controlled before and after study design was employed to assess the effectiveness of implemented interventions. A comparable cohort of 55 non-intervention private hospitals was selected and data were extracted from both groups. Data analysis was conducted using paired and independent T-tests to assess the effect and measure the difference between both groups of hospitals respectively. An average increase of 65.28% [p < 0.01] in reporting rate and 50.31% [p < 0.01] in the timeliness of reporting on DHIS was seen among intervention hospitals. Similarly, the difference between intervention and non-intervention hospitals post-intervention was significantly different for both data reporting [mean difference= −22.38, p < 0.01] and timeliness [mean difference= −18.81, p < 0.01]. respectively. Furthermore, a sustained improvement in data reporting and timeliness of reporting on DHIS was observed among intervention hospitals 24 months after interventions. Thus, implementing targeted interventions can strengthen routine data reporting for better performance and informed decision-making.
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