BackgroundSnakebite envenoming (SBE) is a major problem in rural areas of West Africa (WA). Compared to other Neglected Tropical Diseases (NTD), the public health burden of SBE has not been well characterized. We estimated the impact of snakebite mortality and morbidity using the Disability Adjusted Life Years (DALYs) metrics for 16 countries in WA.MethodsWe used the reported annual number of SB deaths and mean age at time of SB and converted these into years of life lost (YLL). Similarly, the years of life lived with disability (YLD) were estimated by multiplying the number of amputations by the respective disability weight of 0.13.ResultsIn WA, the annual cases of SB mortality and amputations ranged from 24 (95% Confidence Interval: 19–29) and 28 (17–48) respectively in Guinea-Bissau with the highest estimates of 1927 (1529–2333) and 2368 (1506–4043) respectively in Nigeria. We calculated that the annual DALYs associated with a SB death ranged from 1550 DALYs (95%CI: 1227–1873 DALYs) in Guinea Bissau to 124,484 DALYs (95%CI: 98,773–150,712 DALYs) in Nigeria. The annual DALYs associated with amputation for the two countries were 149 DALYs (95%CI: 91–256 DALYs) and 12,621 DALYs (95%CI: 8027–21,549 DALYs) respectively. The total burden of SBE was estimated at 319,874 DALYs (95% CI: 248,357–402,654 DALYs) in the 16 countries in WA. These estimates are similar, and in some instances even higher, than for other NTDs encountered in WA (e.g., Buruli ulcer, Echinococcosis, Intestinal Nematode Infections, Leishmaniasis, Onchocerchiasis, Trachoma and Trypanosomiasis) as reported in the Global Burden of Diseases 2010 (GBD).ConclusionsThe public health burden of SBE in WA is very substantial and similar to other more widely recognized NTDs. Efforts and funding commensurate with its burden should be made available for the control of snakebite in the sub-region.

Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events.

The best way to analyze drug utilization and evaluate impact of an intervention in health care institutions is to study the universal indicators, which are not dependent either on investigator or time of measurement. The aim of this study was to characterize the prescription pattern of public health institutions in Kano, Nigeria and evaluate the rational use of anti-malarial drugs with a view to intervening where necessary. Values of drug utilization indicators were measured prospectively and areas that required intervention identified. Intervention; consisting of free pictorial handbills given to patients, discussions held with health care personnel and pieces of advice were given to health administrators. The impact of the intervention was assessed using pre and post comparison of appropriate indicators. The study revealed a significant decline (P < 0.01) in percentage of encounters with injections and increase utilization of oral chloroquine (P < 0.05). Significant increase (P < 0.05) in dispensing time was also observed in the study group. The results of this study suggest the need for further intervention.

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Children are more vulnerable to adverse events related to use of drugs. It is therefore important to study drug use in children in order to optimize pharmacotherapy. The aim of this study was to compare drug utilization in paediatric outpatient departments of primary and secondary health care facilities. The patient and drug information of 600 patients was analyzed for World Health Organization (WHO) recommended prescribing indicators. The average number of drugs per prescription was significantly (p < 0.0005) lower in secondary (2.97) compared to primary (3.62) facilities, while average consultation time was shorter (p < 0.0005) in primary than secondary facilities. Percentages of drugs prescribed from Nigerian Essential Drug List (EDL, primary {89.78%}; secondary {91.79%}) and by generic name (primary {55.04%}; secondary {57.88%}) were insignificantly different between the facilities. The use of injectables was low (8.32% in primary versus 3.74% in secondary facilities) while antibiotic use was high (54.14% in primary to 60.28% in secondary facilities). Analysis of the dispensing indicators showed that the secondary facilities were significantly (p < 0.05) better than the primary facilities, even though not a single drug was adequately labeled in both the primary and secondary facilities. Prescription from EDL was found to be fair in the study area while use of injections was low. There is a need for improvement in case of medicines prescribed by generic name.