Human papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers’ willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG). We conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9–12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting. A total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection. Demand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.

In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists. The study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers’ willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider’s perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective. A total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum–maximum] was US$1.23 [US$0.0–US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from ‘never’ to ‘rarely’) led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum–maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13–US$0.17] and US$0.41 [US$0.18–US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4–7.0). Test-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists’ interest and uptake of test-based malaria treatment.

Background: Telepharmacy as part of telehealth is an emerging concept in most developing countries with the need to understand the stakeholders' knowledge and acceptability of this concept, including patients' willingness to pay (WTP) for this service, which is critical for its successful implementation. Objective: This study aims to assess pharmacists' knowledge, attitude, perception, extent of practice, and perceived barriers to the practice of telepharmacy in Nigeria, as well as assess patients' acceptability and WTP for this service. Methods: A descriptive cross-sectional survey was carried out among 118 community pharmacists and 403 patients in Anambra State, Nigeria, using a well-structured and validated questionnaire. Collected data were descriptively and inferentially analyzed using SPSS version 23.0. Result: The surveyed community pharmacists had moderate knowledge of the telepharmacy concept (78.8%), with mean attitudinal, perception, and extent of practice scores of 74.2 ± 23.5%, 62.0 ± 22.8%, and 52.4 ± 21.4%, respectively. Lack of monetary motivation (73.7%), lack of software (56.8%), and operational difficulties (49.3%) were considered major barriers to its implementation. Over two-thirds of the participating patients (70.1%) considered the service very acceptable with 61.2% of the respondents willing to pay an average of US$ 2.76 ± 2.12 monthly for the services. Conclusion: Although community pharmacists in Anambra state, Nigeria showed a moderate knowledge of telepharmacy with a poor extent of the practice, they expressed a positive outlook on the concept. The study also revealed good acceptability of the concept by patients who were also willing to pay a moderately acceptable amount for the services.

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.

Prescribing practices for pediatric out-patients: A case study of two teaching hospitals in Nigeria

INTRODUCTION: Tertiary 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. METHODS: using 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. RESULTS: whereas 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. CONCLUSION: the 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.