Background Expired or unused medicines are potentially toxic substances that should be managed effectively to avoid accumulation of potentially toxic pharmaceuticals in the environment. In Nigeria, there is currently limited literature on the methods and protocols used by community pharmacists in the disposal of expired drugs. This study assessed disposal practices of expired and unused medications by pharmacists in Anambra State and compared them to the National Agency for Food and Drug Administration and Control (NAFDAC) guideline on disposal of expired drugs. Methods A questionnaire survey and key informant interview (KII) was used for the study. The pre-tested revised and adapted questionnaires were sent to all the 103 community pharmacies in Pharmacists Council of Nigeria (PCN) 2015 record of registered pharmacies in Anambra State. The participants were asked questions about how they disposed of expired and unused medications. The respondents that used NAFDAC or drug wholesalers were asked questions on how the third party destroys their expired drugs. In addition to the use of a questionnaire, KII was conducted to assess relevant professionals and stakeholders in this area. Results The study recorded 77 successfully returned questionnaires out of the 103 distributed and a response rate of 74.8%. The various disposal methods were: through NAFDAC 28.0 (31.8%), drug distributors 21.0 (23.9%), rubbish bins 8.0 (9.1%); this was mainly for solid dosage forms. However, 6.0(7.1%) reported that they used the sink to dispose of their liquid dosage forms and 24.0 (29.6%) noted they do not stock Class B controlled drugs. A lesser proportion of respondents 18.0 (23.4%) complied fully with the national guideline on disposal of expired drugs, while 17.0 (22.1%) complied partially and 42.0 (54.5%) did not comply. Some of the respondents 17.0 (22.1%) reported that NAFDAC uses incineration or other forms of heat to dispose of expired drugs, but 19.0 (24.7%) reported they do not know how NAFDAC dispose of their expired drugs. Majority of the respondents 55.0 (71.4%) suggested the state-run disposal system. Conclusion Poor compliance with the national guideline for medication disposal increases the potential risk of contamination of our environment and increases the possibility of ingesting toxic pharmaceutical wastes by humans and animals. This underscores the need for improvement on expired drugs management protocols to prevent contaminations and the attendant health hazards.

Background Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers’ perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers’ perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. Methods A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies’ quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. Results After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study’s limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers’ understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. Conclusions This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

ObjectivesThe Nigerian health sector battles with control of infectious diseases and emerging non-communicable diseases. Number of healthcare personnel involved in public health programs need to be boosted to contain the health challenges of the country. Therefore, it is important to assess whether community pharmacists in Nigeria could be engaged in the promotion and delivery of various public health interventions. This study aimed to assess level of knowledge, attitude and practice of public health by community pharmacists.MethodsThe cross sectional survey was carried out in Enugu metropolis. Questionnaire items were developed from expert literature. Percentage satisfactory knowledge and practice were obtained by determining the percentage of community pharmacists that were able to list more than 2 activities or that stated the correct answer. Attitude score represents the average score on the 5 point Likert scale for each item. Chi square and Fisher’s exact test were used to test for statistically significant difference in knowledge, attitude and practice of public health between different groups of community pharmacists.ResultsForty pharmacists participated in the survey. About one third of the participants had satisfactory knowledge of public health. With the exception of one item in attitude assessment, average item score ranged from ‘agreed’ to ‘strongly agreed’. Study participants scored below satisfactory on practice of public health. Knowledge, attitude and practice of public health were not influenced by years of practice, qualification and prior public health experience. Reported barriers to the practice of public health include inadequate funds, lack of time, lack of space, cooperation of clients, inadequate staff, government regulation, insufficient knowledge, and remuneration.ConclusionsLevel of knowledge and practice of public health by community pharmacists were not satisfactory although they had a positive attitude towards practice of public health. The findings highlight the importance of educational interventions targeted towards practicing community pharmacists to improve their knowledge level on public health issues. Providing incentives for public health services rendered could increase community pharmacists’ engagement in public health activities.

BackgroundAdolescent HIV patients face enormous difficulty in accessing HIV care services. Given their vulnerability to risk-taking behaviour, this group also have worse treatment outcomes compared to other age groups. Poor treatment outcomes will impact negatively on HIV/AIDS management and control particularly in sub-Saharan Africa (SSA) as more than eight out of ten of the world’s HIV-infected adolescents live in this region of the world. Limited evidence exists on the effectiveness of service delivery interventions to support adolescents’ retention on antiretroviral therapy (ART) and adherence to ART. This trial is designed to evaluate the impact of conditional economic incentive and motivational interviewing on adolescents’ retention in HIV care and adherence to ART in Anambra State, Southeast Nigeria.Methods/designThe study will be a cluster randomised controlled trial that will be conducted in selected HIV treatment hospitals in Anambra State, Nigeria. Based on sample size calculation, 12 HIV treatment hospitals from Anambra will be selected for the study. Six HIV treatment hospitals each will be randomised to either the intervention or the control arm. A structured adherence support scheme termed the ‘Incentive Scheme’ will be applied to the intervention arm while the control arm will receive routine HIV care (usual care). Additionally, patients in the intervention arm will receive motivational interviewing at baseline and following initiation of antiretroviral therapy (ART), they will receive a gift voucher of US$5.6 when HIV viral load (VL) is < 20 copies/mL at 12 weeks, a gift voucher of US$2.8 if the VL remains suppressed for the next 3 months, and the next 6 months, and finally a gift voucher of US$5.6 if the VL remains < 20 copies/mL at 1 year. All gift vouchers will be conditional not only on VL results but attending the motivational interviews. The primary outcome for the trial will be the difference between groups in the proportion with HIV VL suppression (≤ 20 copies/mL) by 12 months and then 24 months after withdrawal of incentive.DiscussionThe findings of this proposed trial will provide evidence on the feasibility of applying conditional economic incentives combined with motivational interviewing to improve retention and adherence to antiretroviral therapy of adolescents living with HIV in Nigeria and possibly in other sub-Saharan African countries.Trial registrationRegistered in the Pan African Clinical Trials Registry, ID: PACTR201806003040425. Registered on 2 February 2018.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3095-4) contains supplementary material, which is available to authorized users.

Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

Rationale:The pharmacist charged with the responsibility of drug administration and counseling should have the basic knowledge and skills necessary to demonstrate the use of metered dose inhalers (MDIs) to asthma patients for the maximization of treatment outcomes.Objective:This study was designed to evaluate the community pharmacists’ knowledge of the appropriate use of MDIs in Anambra State, Nigeria.Methods:The study was carried out in two major cities in Anambra State, Nigeria, using 41 registered community pharmacists. A simulated patient approach utilizing two adequately trained pharmacy students were used. Obtained data were analyzed using independent t-test and one-way ANOVA through SPSS version 18.Results:The pharmacists had a mean demonstration score of 45.45%. Step number seven of the correct use of MDI, which involves breathing in and depressing the canister was the most demonstrated step (90.2%) while step 4 which involves tilting the head back slightly was the least demonstrated (14.6%) by the pharmacists. Among five identified critical steps in asthma guideline used, two were well demonstrated (75.6% and 90.2%): one averagely demonstrated (51.2%) and two poorly demonstrated (39% and 31.7%). Sociodemographic characteristics did not influence the demonstration ability of the pharmacists in this study.Conclusion:The study indicated that community pharmacists lacked the adequate knowledge of appropriate use of MDI. Training programs for pharmacists focusing on the use of such devices will enable them to educate patients on the effective use of MDIs in patients with asthma.

BackgroundCommunity pharmacists are very accessible to most patients yet; they have been underutilized in the aspect of providing HIV care and services. The World Health Organisation recently recommended expanding community pharmacists’ roles to address the increasing complexity of antiretroviral agents and co-infection drug regimen. This study therefore was designed to assess the readiness and willingness of community pharmacists in Nigeria to participate in the care of people living with HIV/AIDS and the possible inclusion of their pharmacy premises as sites for HIV care services.MethodsA descriptive cross sectional survey was carried out among 205 community pharmacists in south east, Nigeria between October, 2016 and February, 2017. Two hundred and five self-administered questionnaires were distributed to conveniently selected community pharmacists in the region. Data collected were analysed using SPSS version 23. Descriptive statistics was conducted for the demographics and percentage mean scores for each domain were computed. The variables in each domain were categorised into groups and simple percentages were used to show the percentage distribution of the variables. Cross tabulation was also carried out to show the relationship between the variables and groups’ differences were explored using analysis of variance and P-values <0.05 were considered significant.ResultsAll distributed questionnaires were filled and retrieved. The overall knowledge of HIV among the surveyed pharmacists was seen to be high (70.41%). Although the percentage attitude score of the respondents towards HIV care services was on the average (57%), they were highly willing and ready to use their premise to offer HIV services with a percentage mean readiness score of 87.32%. However, their perceived skills in carrying out these services were observed to be low.ConclusionCommunity pharmacists in the south eastern part of Nigeria have high knowledge of HIV and a somewhat attitude towards HIV care services with high willingness and readiness to be involved in HIV care and services. Despite efforts to engage community pharmacists in HIV services more is needed in the aspect of making adequate policies to further empower more community pharmacists in this aspect of care.Electronic supplementary materialThe online version of this article (10.1186/s40545-017-0122-x) contains supplementary material, which is available to authorized users.

IntroductionTertiary Institutions’ Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students’ knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students’ knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre.MethodsUsing a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software.ResultsWhereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3%) have never benefited from the scheme with 52.8% showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9%) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation.ConclusionThe study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme.