Paul Nwani | Nnamdi Azikiwe University, Awka (original) (raw)

Papers by Paul Nwani

PubMed, Jun 29, 2023

Background: The introduction and operationalization of the Essential Medicines (EM) concept remai... more Background: The introduction and operationalization of the Essential Medicines (EM) concept remains a major achievement of the WHO. This study assessed the current knowledge, utilization, and perception of the Essential Medicines programme in Nigeria. Methods: This was a cross-sectional study conducted across six tertiary health institutions in Southern Nigeria from January to July 2018. A total of 750 semi-structured questionnaires were administered to doctors, pharmacists, and nurses. The information sought included the demographic characteristics of respondents, knowledge of definition of the essential medicines concept, date of launch at the national level, current edition, current use, the advantages and disadvantages of the EM List (EML). The data were analyzed qualitatively and presented descriptively as means (SD) and percentage frequencies. Results: A total of 748 respondents (487 doctors, 208 nurses, and 53 pharmacists) participated in the study. Healthcare professionals' (HCP) knowledge of the EM concept and list was poor (15%), as determined by their ability to define or describe the concept of the EML, with less than 3% of respondents aware of the current edition of the EML in use in Nigeria. Less than 20% of all respondents used the EML during their internship, with nurses using it the least and only 8% using it during their first year of practice. Over 70% of respondents could not identify notable advantages of the EML and only 14.6% agreed that the program had been successful in Nigeria. Conclusion: The initial global momentum following the introduction of the EM program appears to have declined with the new generation of HCPs, likely due to lack of educational reinforcement. This negatively impacts the drug use scenario within our healthcare system.

Zenodo (CERN European Organization for Nuclear Research), Nov 4, 2022

Background: Epilepsy is not only one of the oldest known neurological disorder but also one of th... more Background: Epilepsy is not only one of the oldest known neurological disorder but also one of the most prevalent chronic brain disorder worldwide. The social pathology associated with epilepsy drives the people with epilepsy (PWE) and their families into the shadows and widens epilepsy treatment gap. How much the social aspects of epilepsy and epilepsy care has changed in rural African communities in the globalized world is yet to be fully elucidated. This study aims Objectives: to determine the level of knowledge and attitude towards epilepsy and the people living with epilepsy (PWE) by adult inhabitants of a rural southeastern Nigerian community. This was a cross sectional Methodology: door-to-door population survey. Interview on select aspects of knowledge and attitude to epilepsy was conducted using a pretested semi-structured questionnaire. Three hundred and seven (90.3%) of the Results: respondents reported awareness of epilepsy, 61(18%) had good knowledge on epilepsy but attitude towards epilepsy was negative. The key source of information on epilepsy for 133 (43.3%) respondents was health workers, while 125 (40.7%) reported that epilepsy was a medical disease. Associations existed between level of knowledge on epilepsy and gender (p=0.0023); marital status (p=0.0012) and educational attainment (p= 0.0476). Awareness of epilepsy though high among the Conclusions: rural inhabitants yet a wide gap still exist regarding the knowledge and attitude towards epilepsy. It is hoped that with adequate culturally appropriate educational programs, channelled through the media and health workers in rural communities the existing gap in knowledge and treatment will be bridged.

Background The human immunodeficiency virus (HIV) is a neurotropic virus and one of its known eff... more Background The human immunodeficiency virus (HIV) is a neurotropic virus and one of its known effects on the nervous system is HIV Associated Neurocognitive Disorder (HAND). Method This was a cross-sectional prospective study carried out in a tertiary hospital in Southeastern Nigeria using a neuropsychological test battery drawn from the World Health Organization/University of California, Los Angeles test battery (WHO/UCLA). The performance of ninety-two HIV positive patients, divided into thirty-eight combined antiretroviral therapy (cART) experienced and fifty-four cART naïve patients, was compared with those of ninety-two HIV negative subjects. Sociodemographic data was collected from both arms and neuropsychological testing administered. The HIV positive patients also had blood samples collected for parked cell volume (PCV), CD4 count and HIV RNA viral load. The raw scores of the HIV positive patients were converted to standardized Z scores using the mean and standard deviation ...

Zenodo (CERN European Organization for Nuclear Research), May 1, 2023

Background: Medication nonadherence is a common problem, and the training of Clinicians to commun... more Background: Medication nonadherence is a common problem, and the training of Clinicians to communicate better enhances patients' adherence to medications. Objectives: This study aims to assess Clinicians' communication skills during the process of rational prescribing in the clinics. Methodology: This was a cross-sectional questionnaire-based descriptive study conducted among Clinicians in a Nigerian tertiary hospital. The questions were adapted from the section on communication skills outlined in "Guide to Good Prescribing". Responses were rated on a 5-point Likert scale from "all of the time" to "none of the time" and data analysed using SPSS version 22. Results: There were 100 Clinicians, 71 (71%) males and 29 (29%) females with mean years of practice of 8.2±5.8 years. Only 47% of the Clinicians informed their patients "all of the time" when medicine is prescribed in clinic on why the medicine is needed, 23% on which symptoms will disappear and which will not disappear with treatment. About 20% informed their patients "all of the time" on which side effects may occur and what action to take, while 18% and 11% respectively do same on how serious the expected side effects are and their expected duration. Conclusion: This study revealed poor communication of vital information, instructions and warning to patient during encounters in the clinics and this is a harbinger to medication nonadherence. Good training on therapeutic skills (how to select, prescribe and monitor treatment, and how to communicate effectively with their patients) if incorporated into medical training in developing nations will improve medication adherence.

SummaryBackgroundUnderstanding the genetic mechanisms underlying diseases in ancestrally diverse ... more SummaryBackgroundUnderstanding the genetic mechanisms underlying diseases in ancestrally diverse populations is a critical step towards the realization of the global application of precision medicine. The African and African admixed populations enable mapping of complex traits given their greater levels of genetic diversity, extensive population substructure, and distinct linkage disequilibrium patterns.MethodsHere we perform a comprehensive genome-wide assessment of Parkinson’s disease (PD) in 197,918 individuals (1,488 cases; 196,430 controls) of African and African admixed ancestry, characterizing population-specific risk, differential haplotype structure and admixture, coding and structural genetic variation and polygenic risk profiling.FindingsWe identified a novel common risk factor for PD and age at onset at theGBA1locus (risk, rs3115534-G; OR=1.58, 95% CI = 1.37 - 1.80, P=2.397E-14; age at onset, BETA =-2.004, SE =0.57, P = 0.0005), that was found to be rare in non-African/A...

BackgroundThe microtubule-associated protein tau (MAPT) gene is critical because of its putative ... more BackgroundThe microtubule-associated protein tau (MAPT) gene is critical because of its putative role in the causal pathway of neurodegenerative diseases including Parkinson’s disease (PD). However, there is a lack of clarity regarding the link between the main H1 haplotype and risk of PD. Inconsistencies in reported association may be driven by genetic variability in the populations studied to date. Data onMAPThaplotype frequencies in the general population and association studies exploring the role ofMAPThaplotypes in conferring PD risk in black Africans are lacking.ObjectivesTo determine the frequencies ofMAPThaplotypes and explore the role of the H1 haplotype as a risk factor for PD risk and age at onset in Nigerian Africans.MethodsThe haplotype and genotype frequencies ofMAPTrs1052553 were analysed using PCR-based KASP™ in 907 individuals with PD and 1,022 age-matched neurologically normal controls from the Nigeria Parkinson’s Disease Research (NPDR) network cohort. Clinical da...

NPJ Parkinson's disease, Nov 12, 2022

The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has no... more The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a twofold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD.

Annals of Clinical and Biomedical Research

Poor training of clinicians on the Rational Use of Medicines (RUMs) and the impact of pharmaceuti... more Poor training of clinicians on the Rational Use of Medicines (RUMs) and the impact of pharmaceutical promotional activities fuel irrational prescribing behavior, which is a major contributor to cost-related medication non-adherence. The aim of this study was to determine how training on the RUMs and related concepts and the influence of pharmaceutical promotional activities impact on clinicians prescribing behavior, a major cause of cost-related medication non-adherence. This was a cross-sectional descriptive study, conducted among medical practitioners in South-eastern Nigeria using a self-administered questionnaire. The questions were designed to determine the clinicians’ knowledge and practice of the basic concepts of the RUMs, as well as how much pharmaceutical promotional activities (information and incentives) impact on their prescribing behaviors. There were 100 clinicians, 71 (71%) males and 29 (29%) females, with mean years of practice of 8.2±5.8 years. About 66% of the res...

British Journal of Biomedical Science, 2015

Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid ac... more Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid acceptance of urbanisation and sedentary life styles pose an encumbrance to its prevention and management. Increased oxidative stress in diabetes mellitus has been implicated as a culprit in perpetuating antioxidant depletion and diabetic complications in diabetes mellitus individuals. This study aims to evaluate the level of antioxidant status in type 2 diabetes mellitus (DM) female participants visiting the out-patient diabetic clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. A total of 86 participants aged 51±10 years were recruited for this study. The test group consists of 43 already confirmed type 2 diabetes mellitus females, while the control group consists of 43 apparently healthy females. The test subjects were further subgrouped into good and poor glycaemic control groups, using a cut-off of <7% for HbA1c. Whole blood was collected from participants and aliquoted into specified sample containers for analysis of the following parameters: random blood glucose (RBG; mg/dL), glycosylated haemoglobin (HbA1c; %), glutathione reductase (GR; U/L) and total antioxidant status (TAS; mmol/L). Results from this study showed that the mean differences in RBG (197.74±49.29 mg/dL) and HbA1c (9.86±1.44%) were significantly higher in the test group compared to the control group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). The mean differences of GR (45.81±20.45 U/L) and TAS (1.81±1.04 mmol/L) were significantly lower in the test group compared to the control group GR (61.21±14.34 U/L) and TAS (2.73±2.08 mmol/L) (P<0.05). The poor glycaemic test group was observed to have the highest RBG (200.34±50.4 mg/dL) and HbA1c (10.23±1.33%) compared both to good glycaemic test group RBG (186.38±45.39 mg/dL), HbA1c (6.54±0.45%) and non-diabetic group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). Glutathione reductase (40.66±15.48 U/L) and TAS (1.80±1.08 mmol/L) were significantly more depleted in the poor glycaemic test group compared to the non-diabetic group GR (61.21±14.34 U/L), TAS (2.73±2.08 mmol/L) and good glycaemic test group GR (68.38±25.09 U/L), TAS (1.86±0.92 mmol/L) (P<0.05). Out of the 43 participants in the test group, only 18.6% had good glycaemic control and 81.4% had poor glycaemic control. There were significant negative correlations between RBG and TAS (r=-0.260; P=0.015); RBG and GR (r=-0.403; P=0.000) and HbA1c and GR (r=-0.471; P=0.000) (P<0.05). However, HbA1c and TAS showed no significant correlation (r=-0.170; P=0.119) (P>0.05). This study concludes that there is antioxidant depletion in females with type 2 diabetes.

Journal of AIDS and HIV Research

The relationship between APOE polymorphisms and Parkinson’s disease (PD) in black Africans has no... more The relationship between APOE polymorphisms and Parkinson’s disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and cognition in 1100 Nigerians with PD and 1097 matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95%CI: 1.13–3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95%CI 0.19–0.99, p = 0.02)). Altogether, our findings support previous studies in other ancestries, implying a role for APOE ε4 and ε2 as risk and protective factors respectively for cognitive decline in PD.

Nigerian Journal of Clinical Practice, 2015

Context: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 mill... more Context: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 million people the world over. Current community-based data on the prevalence of active epilepsy in Africa are sparse. Aims: This study was aimed at determining the prevalence and profile of active epilepsy in a suburban community in Southeast Nigeria. Methods: It was a two phase cross-sectional descriptive study. In the first phase, those with possible active epilepsy were identified in a door-to-door survey using a modification of the World Health Organization Neuroscience research protocol. In the second phase, cases of active epilepsy were identified and the clinical forms of epilepsy diagnosed based on the International League against Epilepsy guidelines 1993. Results: A total of 6,800 persons was screened in the first phase of the study. There were 29 cases (16 males and 13 females) of active epilepsy. The point prevalence of active epilepsy was 4.3/1,000 (95% confidence interval (95% CI): 2.7-5.9) for the total population, 4.9/1,000 (95% CI: 2.5-7.3) for males and 3.7/1,000 (95% CI: 1.7-5.7) for females. The age-adjusted prevalence for the total population was 4.1/1,000 (US Population 2000). Classified using clinical criteria only, generalized seizures occurred in 62.1% (n = 18) while partial seizures occurred in 37.9% (n = 11) of cases. Conclusions: The prevalence of active epilepsy in Southeast Nigeria is comparable to that found in developed and some developing countries but less than that reported in suburban Southwest Nigeria about three decades ago.

Acta Neurologica Scandinavica, 2013

The treatment gap of epilepsy in developing countries is high, and data on the magnitude and caus... more The treatment gap of epilepsy in developing countries is high, and data on the magnitude and causes of epilepsy treatment gap in Africa are sparse. We aimed to determine the prevalence and causes of epilepsy treatment gap among people with epilepsy in a Suburban community in Southeast Nigeria. The direct method was used to determine epilepsy treatment gap in a two-phase cross-sectional study. Those with probable epilepsy were identified in a door-to-door survey using a modification of World Health Organization (WHO) protocol in the first phase. In the second phase, an epilepsy-specific questionnaire that was further designed to determine the magnitude and causes of epilepsy treatment gap was used. The overall treatment gap of epilepsy was 76% (n = 22/29). The major contributors to the overall treatment gap were people who were never diagnosed accounting for a diagnostic gap of 38% (n = 11/29) and those who were diagnosed but discontinued antiepileptic drug (AED) treatment of their own volition accounting for a therapeutic gap of 38% (n = 11/29). Epilepsy treatment gap in Southeast Nigeria is comparable to that in many developing countries. Fifty percent of the overall treatment gap was caused by patients discontinuing AED treatment of their own volition despite continuing fits. This result may indicate that perhaps with appropriate education on the need to adhere to therapy, the treatment gap in the community may be narrowed.

West African journal of medicine, 2015

BACKGROUND Irrational prescription of medicine is a common problem in medical practice. This is m... more BACKGROUND Irrational prescription of medicine is a common problem in medical practice. This is more so in the immediate post admission period. The aim of this study was to characterize drug prescriptions patterns for elderly patients at hospital discharge and to detect areas of irrational and inappropriate prescription. STUDY DESIGN This was a longitudinal prospective study of drugs prescribed at hospital discharge for patients aged 65years and above. The World Health Organization (WHO) drug use indicators were used to characterize the drug prescription. The drugs prescribed were classified using the Anatomical Therapeutic Chemical (ATC) classification systemwhile potentially inappropriate medications were determined using the Beers criteria by the American Geriatric Society. RESULTS A total of 1,679 drugs were prescribed in 269 patient encounters surveyed. The average number of drugs prescribed per encounter was 6.2 ± 2.1. Vitamins and antihypertensive agents accounted for 23.2% (...

Orient Journal of Medicine, Jun 5, 2020

The American Journal of the Medical Sciences, 2011

National cholesterol treatment guidelines include a low level of high-density lipoprotein (HDL) c... more National cholesterol treatment guidelines include a low level of high-density lipoprotein (HDL) cholesterol (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40 mg/dL) as a major risk factor for coronary heart disease (CHD) that should be considered when making decisions on treatment of low-density lipoprotein (LDL) cholesterol. We investigated the association of HDL and LDL-cholesterol with incident CHD events (fatal or nonfatal CHD) over 14 years of follow-up among 13,615 adults aged 45 to 64 years in the Atherosclerosis Risk in Communities study. A total of 966 (7.1%) participants had a CHD event during follow-up. After adjustment for age, race, sex, diabetes, smoking, alcohol consumption, systolic blood pressure, waist circumference, chronic kidney disease and physical activity, a graded association was present between progressively lower levels of HDL-cholesterol and higher CHD risk, overall (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and within each level of LDL-cholesterol (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;100, 100-129, 130-159, 160-189 and ≥190 mg/dL) investigated (all P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In addition, after multivariable adjustment including LDL-cholesterol, each standard deviation higher HDL-cholesterol (18 mg/dL) was associated with a hazard ratio of incident CHD of 0.70 (95% CI: 0.63-0.77). These data suggest a graded association exists between lower levels of HDL-cholesterol and CHD across the full range of LDL-cholesterol levels. As interventions targeting HDL levels are developed, the combinatorial effects of lower HDL levels with various levels of LDL-cholesterol should be examined.

West African College of Physicians and the West African College of Surgeons, 2013

Journal of basic and clinical pharmacy, 2017

Background: Adverse drug reactions (ADRs) are common and important causes of morbidity and death ... more Background: Adverse drug reactions (ADRs) are common and important causes of morbidity and death in the elderly. Though the world elderly population is on a rise, data on the profile of adverse drug reactions (ADR) in Sub-Saharan Africa is still sparse. This study was aimed at determining the frequency of occurrence and patterns of ADR among admitted older Nigerians. Methods: This was a prospective study of patients aged 65 years and above admitted in a Nigerian tertiary health institute. ADR was defined using the World Health Organization (WHO) definition of ADR, while intensive event recording was used to detect ADR. Patients were grouped into those admitted with an adverse drug reaction (ADRad) and those that developed an adverse drug reaction during hospitalization (ADRin). Results: A total of 345 patients were surveyed. There were 23 cases (males: 14[60.9%], females: 9 [39.1%]) of ADRs giving an overall frequency of 6.7% (n=23/345) (95% CI: 4.0-9.3) [ADRin: 2.6% (n=9/345) (95% ...

African Journal of Neurological Sciences, 2012

Background Epilepsy is characterized by episodic and unpredictable seizure recurrences which are ... more Background Epilepsy is characterized by episodic and unpredictable seizure recurrences which are often amenable to medical treatment. Simple and readily available medications can be used to control seizures in epilepsy. However, in many communities in developing countries seizure control among people living with epilepsy is still poor. Method We assessed the patterns of antiepileptic drug use and seizure control among persons living with epilepsy in a suburban community in Southeast Nigeria found in a two phase cross-sectional study. Detailed information on epilepsy treatment, seizure control and patterns of antiepileptic drug use (AED) by those diagnosed with epilepsy was determined by use of a semi-structured interviewer administered questionnaire. Further verification of the type of antiepileptic drugs (AEDs) was done by drug inspection. Result The total of 29 cases of active epilepsy comprising 16 (55.2%) males and 13 (44.8%) females were found. Those receiving AEDs at the time ...