*Background: Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea. Objective: To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice. Methods: This study was carried out using two instruments: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria. Results: The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms' management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits. Conclusions: Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.

Background Patients with chronic diseases exploit complementary and alternative treatment options to manage their conditions better and improve well-being. Objective To determine the prevalence and predictors of herbal medicine use among Type 2 Diabetes patients in Lagos, Nigeria. Setting Secondary healthcare facilities in Lagos state, Nigeria. Method The study design was a cross sectional survey. A two-stage sampling approach was used to select the health facilities and patients were recruited consecutively to attain the sample size. Data was collected using a structured and standardized interviewer-administered questionnaire. Characteristics, prevalence and predictors of herbal medicine use were assessed using descriptive statistics and multivariate regression analyses. Main outcome measure Herbal medicine use among Type 2 diabetes mellitus patients. Results 453 patients were surveyed, 305 (67.3%) reported herbal medicine use, among whom 108 (35.4%) used herbal and conventional medicines concurrently; 206 (67.5%) did not disclose use to their physician. Herbal medicine use was significantly associated with age (p = 0.045), educational level (p = 0.044), occupation (p = 0.013), duration of diabetes disease (p = 0.007), mode of diabetes management (p = 0.02), a positive history of diabetes (p = 0.011) and presence of diabetes complication (p = 0.033). Formulations or whole herbs of Vernonia amygdalina, Moringa oleifera, Ocimum gratissimum, Picralima nitida, and herbal mixtures were the commonest herbal medicine. Beliefs and perceptions about herbal medicine varied between the users and non-users. Conclusion The use of herbal medicine among Type 2 diabetes mellitus patients in Lagos, Nigeria is high. There is dire need for health care practitioners to frequently probe patients for herbal medicine use and be aware of their health behaviour and choices, with a view to manage the disease better.

The incidence rate of ADRs was 10.7%. ADRs which are predictable and preventable occur in hospitalized patients, such may be prevented or minimized by implementing measures to target specific drugs that are commonly suspected.

Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

Objective Excipients are needed in the formulation of oral liquid medicines intended for children; they have however been reported to trigger safety issues. This study evaluated the concentrations and prevalence of ethanol and other potentially harmful excipients in pediatric formulations marketed in South Eastern Nigeria in line with international labeling guidelines and allowable daily limits (ADL). The study sampled oral pediatric formulations offered for sale in registered pharmacies. Those with accessible information leaflets were assessed for the presence and quantity of previously flagged excipients with potential to harm the pediatric population. Result Of the 380 oral pediatric medicines, 140 provided access to list/quantity of ingredients. 47.9% (67) of the formulations contain at least one of the flagged excipients while the remaining only listed the active ingredients. Ethanol had the highest occurrence (62.7%) and was more in cough/cold medicines. A homeopathic cough and cold remedy had concentration of 90% v/v. Ethanol and sucrose in some formulations exhibited concentrations with a potential of crossing their approved daily intake (ADI) (1–90% v/v and 1.7 g–3.7 g/5 ml respectively). Ethanol use in studied pediatric formulations was quite high, with ethanol-containing formulations being prescribed for children 0–6 years and older. Only 26 (38.8%) completely satisfied the labelling requirements for ethanol containing formulations.

Background: Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse. Objectives: To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART. Method: We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-pos- itive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared. Results: of the 13,983 patients’ data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years. Conclusion: The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs. Keywords: Adverse drug events; antiretroviral therapy; drug toxicity; sub- Saharan Africa.

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Introduction: despite improved life expectancy for people living with HIV (PLWH), aging, comorbidities, and associated drug treatment increase the risk for drug therapy problems (DTPs). We assessed pharmacists´ identification and resolution of DTPs among PLWH. Methods: a prospective study was conducted among PLWH aged ≥10 years (N=100) in a Nigerian HIV clinic. Trained pharmacists delivered a six-step intervention that included the establishment of patient-provider relationship, gathering and validation of patient´s data, identification of DTPs, intervention, outcome identification, and documentation. Descriptive statistics were used to examine data collected via a pharmaceutical care assessment tool. Results: in all, 215 DTPs were identified and classified as unnecessary drug therapy [27.4% (n=59)], non-adherence [21.9% (n=47)], needs additional drug therapy [16.7% (n=36)], adverse drug reaction [(14.0% (n=30)], wrong drug [(10.7% (n=23)], and dosage variation [n=20 (9.3%)]. Within each DTP class, the most common cause was addiction/recreational drug use [39.0% (n=23)], drug product not available [63.8% (n=30)], untreated condition(s) [61.1% (n=22)], undesirable effects [66.7% (n=20)], condition refractory to drug [34.8% (n=8)], and drug interaction [45.0% (n=9)], respectively. The most common interventions were medication information/recommendation to patients/prescribers (30.4%) and initiation of drug therapy (22.2%). Six-month resolution rate was 90% (n=194) with the most common outcomes being improvement in patient adherence [23.6% (n=50)], addition of a drug [18.9% (n=40)], and reduction in drug overuse [15.6% (n=33)]. Conclusion: pharmacists´ intervention resulted in 90% resolution of detected DTPs, implying that pharmacists are crucial in improving antiretroviral treatment outcomes.