Perceptions of Doctors to Adverse Drug Reaction Reporting in a Teaching Hospital in Lagos, Nigeria

Kazeem A Oshikoya; Jacob O Awobusuyi

BMC Clin Pharmacol. 2009;9:15

Conclusion

There are gaps between knowledge and ADRs reporting among doctors working in a teaching hospital in Lagos, Nigeria. These gaps need to be filled by improved training in pharmacovigilance and risk perceptions of drugs. It may take the doctors some time to fully accept ADR reporting as a role if continuous medical education, reminders and awareness on the Yellow Card reporting scheme are not instituted in the hospital. Attitudinal and cultural changes, whereby ADR reporting is seen as an integral part of the clinical activities of the doctors, are very necessary for a long term improvement of ADR reporting.

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Abbreviations
ADR: Adverse drug reaction; WHO: World Health Organisation; LASUTH: Lagos State University Teaching Hospital; NPC: National Pharmacovigilance Centre; NAFDAC: National Agency for Food and Drug Administration; IQR: Interquartile Range and Control; OTC: Over The Counter.

Competing interests
The authors are members of adverse drug reaction motoring committee of the Lagos State University Teaching Hospital, Ikeja, where the study was conducted.

Authors' contributions
KAO and JOA conceived the study, designed the study and questionnaire, and participated in distributing the questionnaires. KAO performed the statistical analysis and was reviewed by JOA. Both authors drafted the manuscript and approved the final version.

Acknowledgements
The authors are grateful to Mrs Johnson, the secretary, Department of Medicine, LASUTH, for performing the data entry.

Cite this: Perceptions of Doctors to Adverse Drug Reaction Reporting in a Teaching Hospital in Lagos, Nigeria - Medscape - Aug 11, 2009.

Table 1. The demographics and characteristic features of the respondents
Characteristics	Values
Median age (years)	36 (IQR 32–40)
Median year of first degree qualification (years)	10 (IQR 4–15)
Median year of practice in a teaching hospital (years)	3 (IQR 1.5–7.0)
Male: female ratio	59: 40
Cadre
Interns	30 (30.3%)
Junior residents	29 (29.3%)
Consultants	22 (22.2%)
Senior residents	18 (18.2%)
Country of undergraduate education
Nigeria	84 (84.8%)
Abroad	15 (15.2%)
Additional qualifications	37 (37.4%)

Table 2. Factors that may discourage doctors from reporting adverse drug reaction
Factor^a	Agree	Disagree
Concern that the report may be wrong	47 (47.5%)	52 (52.5%)
Lack of time to fill in a report and a single unreported case may not affect ADR database	37 (37.4%)	62 (62.6%)
Level of clinical knowledge makes it difficult to decide whether or not an ADR has occurred	36 (36.4%)	63 (63.6%)
Lack of time to actively look for an ADR while at work	33 (33.3%)	66 (66.7%)
Don't feel the need to report well recognised actions	27 (27.2%)	72 (72.2%)
The absence of fee for reporting	18 (18.2%)	81 (81.8%)
Concern that a report will generate an extra work	15 (15.2%)	84 (84.8%)
Fear of the negative impact the report may have on the company that produced or marketed the drug	15 (15.2%)	84 (84.8%)
Lack of confidence in discussing the ADR with other colleagues	12 (12.1%)	87 (87.9%)

^a Number of doctors responding (n = 99).

Table 3. Proportion of respondents that would report hypothetical cases of ADRs in line with the National Pharmacovigilance Centre reporting criteria
Reaction^a	Yes	No	Don't know
Palpitation with Coartem® (Yes)^b	58 (59.2%)	20 (20.4%)	20 (20.4%)
Skin rashes with roxithromycin (Yes)^b	54 (55.1%)	26 (26.5%)	18 (18.4%)
Jaundice with frusemide (Yes)^b	53 (54.1%)	21 (21.4%)	24 (24.5%)
Thrombocytopenia with heparin (Yes)^b	39 (39.8%)	36 (36.7%)	23 (23.5%)
Hiccup with enalapril (No)^b	36 (36.7%)	29 (29.6%)	33 (33.7%)
Gastrointestinal bleed with diclofenac (Yes)^b	35 (35.7%)	41 (41.8%)	22 (22.4%)
Headache with isordil dinitrate (No)^b	33 (33.7%)	41 (41.8%)	22 (22.4%)

^a Number of doctors responding (n = 98), ^b Response refer to standard NPC reporting in Nigeria.

Table 4. Suggested methods of improving ADRs reporting
Methods	Frequency (n = 98)	Percentage (%)
Continuous medical education, training and refresher study	94	95.9
Instituting and encouraging feedback between patients prescribers and dispensers of drugs	69	70.4
Reminders and increased awareness from the ADR Monitoring Committee	67	68.4
Increasing awareness among other professionals that they could report ADRs	62	63.3
Increased collaboration with other healthcare professionals	58	59.2
More publicity about reporting scheme in local journals	56	57.1
Encouragement from the ADR Monitoring Committee and various head of departments	49	50.0
Having an ADR specialist in every department	46	46.9
Encouraging on-line or telephone reporting	45	45.9
Alerting all outpatients to watch out for possible ADR when prescribing new drugs	44	44.4
Remuneration for every reported case of ADR	28	28.6
Spending more time on the wards with patients	26	26.5
Making reporting a professional obligation	25	25.5
Incentives to every outpatient that report ADR	21	21.4
Leaving Yellow Cards on the ward for easy accessibility	6	6.1