OBJECTIVE: There is paucity of data on paediatric medicine administration error (MAE) in developing countries. This study aimed to investigate the experience of MAEs among paediatric nurses working in public hospitals in Lagos, Nigeria. DESIGN: A confidential, self-reporting questionnaire was the instrument for the study SETTING: Public hospitals in Lagos, Nigeria with established paediatric services and departments. PARTICIPANTS: Paediatric nurses. METHODS: The questionnaire was administered to 75 nurses working in public hospitals in Lagos to obtain information on the experience of medication errors during their entire career, as well as to know their views on the nature of MAEs and the contributing factors. RESULTS: Fifty nurses responded to give a response rate of 66.7%. All the participants were females with a mean ± s.d age of 35.3 ± 10.7 years. Thirty two (64%) had committed at least one medication error over the course of their career. Wrong dose error (24; 48%) and wrong timing of medicine administration (20; 40%) were the MAEs frequently committed by the participants. The consequences of the errors included shock (23; 46%), restlessness (21; 42%), disorientation (11; 22%), and respiratory depression (10; 20%). Increased workload (26; 52%) and not double checking medicine doses (12; 24%) were the major factors the nurses perceived to be contributing to MAEs. Only 15(30%) nurses had reported MAEs to their superiors. Fear of intimidation, retribution or being punished (11; 22%) and lack of policies in place to report errors (13; 26%) were the two major barriers to reporting MAEs. Half (50%) of the nurses indicated that policies were available in their work places to prevent medication errors. CONCLUSIONS: Medication administration errors were frequently committed by the participants and resulted in some inconsequential effects, morbidity and deaths. Appropriate measures should be implemented to prevent future occurrences of MAEs.

Sickle cell anaemia (SCA) is an incurable genetic disorder widespread in sub-Saharan Africa and among African descendants worldwide. It is an inherited disorder that is characterised by genetic abnormalities affecting β-haemoglobin, resulting in polymerisation and sickling of the red blood cells. [1] According to the World Health Organization (WHO), over 300 000 babies with severe haemoglobin disorders are born each year, with Nigeria accounting for about three-quarters of these births. [2] Sixty percent of these children die as infants. Most SCA children are ambulatory and often enter the acute inpatient system for debilitating events such as crises or acute pain. Crippling pain is the most frequent symptom associated with SCA. [3] It can be unrelenting, unpredictable and vary from acute to chronic or mixed. Acute pain is the leading cause of emergency department visits and hospitalisations among children with SCA in the USA. [4] It is an episodic pain that is primarily due to tissue ischaemia and vaso-occlusion of the microcirculation by sickled cells. [5] Frequently, it acts as a protective agent in response to tissue injury, thereby warning the body of the presence of potentially harmful agents. [6] Just as the injury heals, the pain disappears. The resolution of acute pain usually occurs in a few days to several weeks. [7] The arms, legs, abdomen, chest and back are the most common locations of pain episodes. Acute pain associated with SCA children is often described as aching, tiring and uncomfortable. This may be experienced as early as 6-12 months of age. One of the most debilitating aspects of vaso-occlusive episodes is their unpredictable nature in terms of frequency, intensity, affected sites and duration of pain. [5] It is thought that vaso-occlusive episodes are triggered by various environmental and psychological states, such as high altitudes, extreme temperatures, infection, dehydration, stress and fatigue. [8] Painful episodes experienced by children with SCA often interfere with intellectual activities, such as attending school and completing homework, social activities such as participating in activities with family members and peers, and the quality and quantity of sleep. Currently, there are many means of managing pain in children with SCA, which include pharmacological and nonpharmacological approaches. [4] However, the effectiveness of the approaches has not been extensively reported in the literature. The WHO has developed guidelines for pain management in children. [9] Pain management may, however, vary from one country to another [10,11] as well as from one institution to another. [12] The Standard Treatment Guidelines in Nigeria contain a step-by-step approach to managing acute pain in SCA, which is helpful for clinicians who care for children with pain crises. [13] Generally, the guidelines deal specifically with the pharmacological and nonpharmacological management of persisting (long-term) pain in children with medical illnesses, as well as those with SCA. Optimal pain management beg...

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those of EU and IDF criteria were 91.8% and 86.9% respectively. Similarly the NPV was highest for the NCEP criteria followed by the EU (99.3%) and IDF (98.3%) criteria. The kappa-statistics showed highest agreement with the NCEP criteria (kappa= 0.90) while the IDF (kappa= 0.46) and EU criteria (kappa= 0.33) displayed moderate and fair levels of agreement respectively with the WHO criteria. CONCLUSIONS: Our findings demonstrate that NCEP criteria displayed best performance parameters relative to WHO criteria and may serve as alternative to the WHO criteria when comparing other definitions used in older studies to current studies.

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