Abstract
Introduction: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) have been the core drugs for the management of inflammatory pain.Aim: This thesis aimed to assess the prevalence and pattern of use of NSAIDs (i.e. diclofenac, ibuprofen, aspirin and piroxicam) in communities, pharmacy outlets, patent medicine shops (PMS) and outpatient clinics of the Federal Medical Centre in Bayelsa State, Nigeria.
Methods: Simple random and purposive sampling techniques were adopted across all volunteers surveyed. Self-reported questionnaires were designed for specific use in Nigeria and were tested in pilot studies before collecting data to investigate the pattern of NSAIDs prescribing, dispensing and use in three study settings. Ethical approval was obtained from King’s College London, Ministry of Health and Federal Medical Hospital in Bayelsa, Nigeria.
Results: In Study 1, after sampling from 4,074 potential recruits, a total of 1913 (93.9%) residents of Bayelsa council states completed the self-report questionnaire. NSAIDs were widely used and reported to be affordable by most participants. There was a statistically significant relationship between those who used NSAIDs within the last 28 days and occupational group across the council states (𝓧2 = 58.994; df = 12; p < 0.001) with farmers and students being the biggest users of NSAIDs. Well over half (55.4%) of the respondents used the recommended doses of NSAIDs. Most participants (84.9%) reported combining NSAIDs. The one-way ANOVA test conducted showed a statistically significant difference (F = 4.171, df = 3, p < 0.025) in comparing the four most frequently used NSAIDs: the order of use was ibuprofen > diclofenac > aspirin > piroxicam. The side effects that were reported as ‘always’ were in this order, stomach pain > chest/heart burn > ulcer > skin rashes > hypertension etc.; with a statistically significant difference (F = 13.376, df = 3, p Slightly more than half (50.9%) of the community participants reported poor knowledge of the correct way to use NSAIDs. There was a significant difference between educational level (𝓧2 = 43.487; df = 8; p < 0.001) and knowledge of NSAID use.
In Study 2, from a total of 313 volunteers representing the Community Pharmacies and PMS, 278 (98.2%) completed the study. Most of the community pharmacists (CPs) (90%) had adequate knowledge of NSAID dispensing. Knowledge about the dispensing of NSAIDs was significantly different between PMDs (F = 4.840, df = 2, p < 0.004), but there was no significant difference (F = 4.737, df = 2, p = 0.0091) among the CPs. The CPs also had better knowledge on drug interaction (62.6%), contraindications (90.9%) and ADRs (78.8%) for NSAIDs compared to the PMDs (9.0%, 33.7%, and 17.4 respectively). The CPs significantly provide more advice on NSAID use to customers than the PMDs (F = 57.21, df = 2, P < 0.0001).
Study 3 sampled doctors from Federal Medical Centre (52/54 medical staff). Most doctors (86.5%) had adequate knowledge of NSAID prescribing. However, NSAID over prescribing was identified for Piroxicam (36.4%) and Diclofenac (6.0%). Headache and/or arthritic pain were more likely than other conditions to be prescribed NSAIDs (F = 2.794. df = 4, P < 0.0491).
Discussion: In the three studies, NSAIDs were prescribed, dispensed, and used appropriately. Ibuprofen and diclofenac were the most used NSAIDs. There was no statistically significant difference in comparing the most frequently used, dispensed, and prescribed NSAIDs. Stomach pain was the most reported side effect among the NSAID users and patients treated by CPs/or PMDs, while ulcer was most reported among the doctors’ patients.
Conclusion: A larger study would clarify the picture further as we still do not know the NSAID use prevalence and pattern in other council states or area in the State and other regions in Nigeria. Education within the communities and training of those personnel dispensing NSAIDs would help reduce the adverse events associated with NSAID use in Bayelsa State and other regions of Nigeria.
| Date of Award | 1 Nov 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Kim Wolff (Supervisor) & Vivian Auyeung (Supervisor) |