Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria
Waheed Adeola Adedeji, AbdulKabir Babajide Adegoke, Fatai Adewale Fehintola
Received: 25 Feb 2021 - Accepted: 28 Jun 2021 - Published: 17 Nov 2021
Keywords: Attitude, community health workers, adverse drug reactions, health facilities, knowledge, Nigeria
©Waheed Adeola Adedeji et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Waheed Adeola Adedeji et al. Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria. Pan African Medical Journal. 2021;40:165. [doi: 10.11604/pamj.2021.40.165.28574]
Available online at: https://www.panafrican-med-journal.com/content/article/40/165/full
Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria
Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria
Waheed Adeola Adedeji1,2,&, AbdulKabir Babajide Adegoke3, Fatai Adewale Fehintola1,2
Introduction: timely adverse drug reactions (ADRs) reporting has contributed immensely towards public health safety. Community health extension workers (CHEWs) provides basic medical care in rural areas. This study assessed the knowledge, attitude, practice, and determinants of ADRs reporting among CHEWs in public health institutions, Southwest, Nigeria.
Methods: a cross-sectional survey of 333 CHEWs randomly selected from public health facilities using self-administered questionnaires. The questionnaire sought information on the knowledge, attitude and practice of CHEWs towards ADRs reporting. The knowledge and attitude questions were scored and categorized. The association between dependent and independent variables assessed with bivariate and multivariate logistic regressions, and p < 0.05 considered statistically significant.
Results: among 333 respondents, 205 (61.6%) had encountered patients with ADRs but only 26 (12.6%) had reported it with yellow forms. About half, 169 (50.8%), and 191 (57.4%) respondents had a positive attitude and inadequate knowledge of ADRs reporting respectively. Sex (aOR: 2.84, 95% CI: 2.10-7.10; p < 0.0001), working in Ogbomoso area (aOR:3.3, 95% CI: 1.34-8.21; p=0.01), and training (aOR:2.01, 95% CI: 1.20-3.42; p = 0.01) were factors associated with adequate knowledge. The determinant of ADRs reporting was training (aOR: 3.63, 95% CI: 1.13-11.63; p = 0.03).
Conclusion: though CHEWs had a slightly positive attitude, they had inadequate knowledge and poor ADRs reporting. The determinant of inadequate ADRs reporting knowledge and under reporting was lack of training. There is an urgent need for educational intervention programmes towards improving knowledge and practices of ADRs reporting among CHEWs.
Adverse Drug Reactions (ADRs) constitute an important cause of morbidity and mortality worldwide  and have been reported as the sixth leading cause of death in the U.S after heart disease, cancer, stroke, pulmonary disease, and accidents . In addition to potentially causing ill-health, ADRs impose a heavy economic loss on nations [3,4]. Despite the burden of ADRs, many times it is either not recognised as the cause of the patient´s problem, or when recognised, it may not be reported by health professionals [5-7]. The most common method of reporting ADRs worldwide is spontaneous reporting, which is done through pharmacovigilance [8-11]. However, the major problem of spontaneous ADR reporting worldwide is under reporting , but it is probably worse in developing countries. Inappropriate use of drugs is common in Africa . It is expected that the ADRs emanating from the continent would be high. Contrarily, ADR reports from Africa represent the least of the report to the VigiBase [13,14]. The decision on post-marketing withdrawal of medicines relies on the ADRs reported, and consequently, the continent continually has the least post-marketing withdrawal of unsafe medicines .
The Pharmacovigilance activities in Nigeria are coordinated by the National Pharmacovigilance Centre (NPC), at the National Agency for Food and Drug Administration and Control. All healthcare providers are to report any observed ADRS as part of their professional responsibility to NPC. NPC receive, collate and analyze submitted ADRs and transmit such to the WHO Uppsala Monitoring Centre [16,17]. Studies have shown that between 2.0 and 7.3% of Physicians practising in urban areas of Nigeria reported ADRs [18-21]. Similarly, low reporting rates have been reported among health care workers in urban areas in Nigeria. Also, there were inadequate knowledge and a negative to a moderately positive attitude of ADR reporting among health care professionals [22-27]. In Nigeria, the majority of health care professionals work in urban centres. The rural areas are devoid of health care workers and facilities. Most of the health facilities in the rural areas are manned by the Community Health Extension Workers (CHEWs). CHEWs provide support in the management of minor medical illnesses, antenatal care, routine and supplementary immunization services and referrals. NPC encourages all health workers to report suspected ADRs , but little is known about ADRs reporting among CHEWs. This study assessed the attitude, knowledge and practice, and determinants of ADR reporting among CHEWs in public health institutions in Oyo State, Southwest, Nigeria.
Study design: a cross-sectional study was conducted among CHEWs working in public health institutions, in Oyo State, Southwest Nigeria, between April and September 2014.
Setting: the capital of Oyo State is Ibadan. There are 33 Local Governments (LGs) in the state. The population of Oyo State according to the 2006 National census was 5,380, 894. The state was divided into five geopolitical zones: Zone I (Ibadan Area)-comprising 11 LGs, Zone II (Okeogun Area)-10 LGs, Zone III (Ogbomoso Area)-5 LGs, Zone IV (Oyo Area)-4 LGs and Zone V (Ibarapa Area)-3 LGs. There were 678 public health institutions in the state, comprising 517 primary health centres, 45 secondary health facilities, and 6 tertiary health centres.
Participants: they were CHEWs randomly selected from public primary and secondary health facilities in Oyo State. The PHC coordinators (for LGs) and hospital heads (secondary /general hospitals) were requested to randomly select one CHEW per health facility, as part of health care workers for the Malaria Action Program for States (MAPS) training. MAPS was case management training for acute uncomplicated malaria in Oyo State sponsored by FHI 360 and took place in all five zones. All CHEWs who provided verbal informed consent were asked to complete a self-administered study questionnaire on the first day, and submit the questionnaire the same day before leaving the venue of the training. A trained research assistant was employed for the research. And together with the principal investigator (PI) were available to clarify any question during the completion of the questionnaire.
Data sources/measurement: the study self-administered questionnaire included four sections and was adapted from previous studies [20,21,28]. Section A contains information on the socio-demographic characteristics of the participants, section B, knowledge of ADR reporting, section C, attitude of ADR reporting and section D, practices of ADR reporting and an open question on suggested ways of improving ADR reporting. Twenty questions were used to assess the knowledge of ADRs reporting. The knowledge questions were Yes/No with one mark allocated for one correct response giving a total score of 20 marks. The attitude questions comprising of 15 questions and using a 3-point Likert scale (agree, neutral and disagree) was used to measure the participants´ level of agreement with the survey questions. The reliability test (Cronbach alpha) on SPSS version 21 for the knowledge questions/scale and attitude questions/scale was 0.88 (0.86, 0.90) and 0.87 (0.84, 0.89) respectively. The normality plot test (Kolmogorov-Smirnov and Q-Q plot) of both the knowledge and attitude score were not normally distributed. For the knowledge score, a score of more than or equal to 12 was ranked as adequate knowledge while a score of less than 12 was ranked as inadequate knowledge. For the attitude, a score greater than or equal to 32 (median score) was considered a positive attitude while a score of less than 32 was ranked as a negative attitude.
Variables: dependent variables- overall knowledge and attitude of CHEWs about ADR reporting, and ADRs reporting with form. Independent variables- Age, sex, years of professional experience, marital status, attended training on ADRs reporting, level of practice, and geographical zones.
Study size: the sample size was calculated using the Leslie Kish formula, n = pqZ2 /d2 . Assuming 50% of the respondents will have adequate knowledge of ADRs reporting, the critical value for α at p < 0.05 of 1.96, precision (d)=5%. After adjustments for the population (number of CHEWs in the state=1,121) and 10% non-response, a minimum sample size of 317 was obtained.
Statistical methods: data was analysed using IBM-SPSS version 22. The continuous variables like age, years of professional experience, knowledge, and attitude score were summarized with mean (± standard deviation), or median (range) if not normally distributed. The categorical variables like sex, marital status, level of practice, geographical zones, ever received training, reporting ADRs with ADR form, knowledge, and attitude (categorized) were summarised using frequency and proportion. Association between knowledge (adequate and inadequate knowledge), attitude (positive and negative), reporting ADRs with forms and selected independent variables were assessed with odds ratios and Chi-square. Statistically significant variables in the bivariate analyses were included in multivariate analyses. Multivariate analyses were performed with binary logistic regression. The level of statistical significance was set at < 0.05.
Ethical consideration: the study was approved by the University of Ibadan/University College Hospital ethical review committee (UI/EC/12/0418). Verbal informed consent was obtained from the participants.
Participants: a total of 400-questionnaires were distributed to the CHEWs, of which 333 were completed and returned within the stipulated time, given a response rate of 83.3%. The majority of survey respondents were female (78.4%) and the mean age of the respondents was 43.5 (±8.3) years. The median (range) years of professional experience was 18 (1 to 40) years. One-third of the respondents have ever received training on ADRs reporting (Table 1).
Knowledge of community health extension workers on ADRs reporting: the majority of the respondents 246 (73.9%) knew that ADRs constitute an important problem in the medical practice. Awareness of the existence of the National Pharmacovigilance Centre (NPC) in Nigeria was low, 156 (46.8%) and only 63 (18.9%) respondents knew the location is in Abuja. The knowledge of ADRs to the agents (drugs, vaccines and medical devices etc.) to be reported was generally inadequate among the respondents. The median (range) proportion of the respondents who knew the ADRs to the agents to be reported was 41 (31.5 to 49.2). More than 70% of the respondents knew that suspected ADRs, confirmed ADRs, serious reactions and the reactions to the newly introduced drugs in the market should be reported. The mean knowledge score of the respondents was 10.2 (±5.3) while the median (range) score was 10 (0 to 20). One hundred and forty-two (42.6%) and 191 (57.4%) respondents had adequate and inadequate knowledge of ADRs reporting respectively.
Factors associated with community health extension workers knowledge of ADRs reporting: males had more knowledge of ADRs reporting than females, COR: 4.5, 95% CI 2.30-8.01; p<0.0001). Respondents who have ever had training on ADRs reporting were 1.83 times more likely to have adequate knowledge of ADRs reporting than those who have not had training. Those who are in secondary health facilities were about 47 times more likely to have adequate knowledge than those in the primary health care facilities. The determinant of adequate knowledge of ADRs reporting were male gender, respondents from Ogbomoso zone and ever received training on ADRs reporting (Table 2).
The attitude of community health extension workers on ADRs reporting: the majority had unfavourable attitudes to most of the questions tested except to those on the usefulness of ADRs reporting information, 205 (61.6%), reporting preventing respondents from publishing a case series of ADRs, 175 (52.6%) and professional obligation of ADRs reporting, 221 (66.4%). The mean attitude score was 32.1 (±7.4) while the median (range) was 32 (15 to 45). About half 169 (50.8) had a positive attitude to ADRs reporting.
Factors associated with community health extension Workers´ positive attitude on ADRs reporting: the factors that were significantly associated with positive attitudes towards ADRs reporting were male gender and working in Okeogun zone. The determinant of positive attitudes towards ADRs reporting was respondents from the Okeogun zone, aOR: 4.51, 95% CI 1.9-11.01; p=0.001 (Table 3).
Practices of community health extension workers regarding ADRs reporting: about two-third, 205 (61.6%) respondents have observed patients with ADRs, but only 26 (12.6%) of the respondents had reported with ADRs forms. When asked about which drugs were suspected or confirmed as the cause of the observed ADRs, 23 respondents identified chloroquine, 15 identified co-trimoxazole, 6 identified procaine penicillin, 5 identified ivermectin, and 2 identified multiple medications. One hundred and ninety-two respondents (57.7%) indicated that they always consider the possibility of ADRs before prescribing, dispensing or administration of drugs. Only about one-third of the respondents have ever received training on ADRs reporting (Table 4).
Factors influencing ADRs reporting by community health extension workers: males were 2.73 times more likely to report ADRs than females. Other factors that were significantly associated with reporting ADRs were age less than 40 years, less than or equal to 10 years of professional experience, and those who have had training on ADRs reporting. The only determinant of ADRs reporting was training, aOR: 3.63, 95% CI 1.13-11.63; p=0.01 (Table 5).
The main method of preventing ADRs worldwide is through spontaneous reporting [10,11,30], the limiting factor of which is underreporting. Under-reporting of ADRs is related to knowledge, attitude and practice of health workers towards ADRs reporting [20,28,31,32]. This study assessed the knowledge, attitude, practice and determinants of ADRs reporting by CHEWs in public health facilities. The respondents had a slightly positive attitude, inadequate knowledge and poor ADRs reporting. The determinant of ADRs reporting among the respondents was training. This study revealed inadequate knowledge of ADRs reporting by the respondents. Only one-third of the respondents have ever received training on ADRs reporting, and this may be an important contributory factor. Pharmacovigilance is not included in the curricula of many training schools in developing countries, and healthcare professionals only become aware during practice. Moreover, the majority of the respondents work in primary health care facilities where exposure to information on ADRs reporting are lacking. Studies among health care workers in Nigeria [20,21,24,28] and other developing countries[32-34] have reported inadequate knowledge of ADRs reporting by health care workers. However, a study in a tertiary centre in Ibadan, Nigeria, reported adequate knowledge of ADRs reporting by physicians . The centre has a functioning Pharmacovigilance Committee, which coordinates pharmacovigilance training for health care workers and hospital ADRs reporting. Though this may not account entirely, there is a difference in knowledge gap among different health professionals.
The determinants of adequate knowledge included male gender, respondents working in Ogbomoso zone and training on ADRs reporting. The reason for more respondents with adequate knowledge among males than females could not be immediately proffered. Males CHEWs are few and competition in a female-dominated profession may be an important reason. Contrarily, studies have reported female health workers as having adequate knowledge of ADRs and reporting than males [36-38]. Respondents who have received training on ADRs reporting were more likely to report an observed ADR than those who have not received any training. Studies in African countries have reported education and training as a means of improving knowledge and reporting of ADRs [20,31,32]. Also, studies have reported the impact of educational interventions on the improvement in the knowledge, attitude and practices of health professionals on ADRs reporting [27,39,40]. The reason for the findings of adequate knowledge of ADRs reporting among respondents from Ogbomoso zone could not immediately be ascertained, however, it may relate to the positive attitude of the heads of health facilities towards ADRs reporting.
The slightly positive attitudes of respondents towards ADRs reporting does not translate to increase ADRs reporting. Studies have reported a positive attitude with poor ADRs reporting [32,33,36]. A review study had reported attitudes towards ADRs reporting as a determinant of under-reporting of ADRs worldwide . Males were more likely to have a positive attitude than females, but the statistical significance was not sustained after multivariate analysis. The only determinant of a positive attitude toward ADRs reporting was working in Okeogun zone. This may be related to the attitude of the leadership of the various health facilities in the zone. However, this was not assessed in this study. Although majority have observed ADRs, only a few had reported it with the ADRs form. A major factor that may be implicated is the inadequate knowledge of ADRs reporting. Likewise, studies have reported low ADRs reporting in Nigeria [19-21, 23] and other developing countries [31-34, 38, 41] among health care professionals. Moreover, despite the National guidelines for the management of malaria, majority of the ADRs reported by the respondents were to antimalarial monotherapy-chloroquine or amodiaquine. This highlights the disparity between the guideline and practice especially at the primary health care level. In Nigeria, presumptive treatment of malaria for any case of fever is common, especially at the primary health care level. Our findings are in agreement with that of Sevene et al. in rural districts of Mozambique where the most implicated drugs were antimalarial and cotrimoxazole . Cotrimoxazole is commonly prescribed at the PHC level and a commonly self-medicated antibacterial agent due to its affordability and availability. It has been implicated as the most common cause of life-threatening/serious ADRs like Steven-Johnson´s syndrome (SJS) and toxic epidermal necrolysis (TEN) in sub-Saharan Africa .
The only determinant of ADRs reporting was the lack of training on ADRs reporting. Similarly, studies have reported a lack of training as a major deterrent to ADRs reporting [20,31,32,44]. Contrarily, studies have reported female gender [36-38] higher level of education , higher working experience [32,35,38,44] and the existence of ADRs reporting forms [23,32,38], as positively influencing ADRs reporting. However, our study found male respondents to be more likely to report ADRs than females. Males may have more aptitude to report ADRs than their females´ counterparts as against what was mostly reported by previous studies. Also, respondents aged less than 40 years and those with less than or equal to 10 years of professional experience were more likely to report ADRs. However, these factors were not sustained after multivariate analysis. The fact that studies used different cut-offs for years of professional working experiences may explain the dissimilar findings. Contrary to a study in Ethiopia , our study did not obtain the level of education of the respondents, rather they were treated as one professional cadre. The limitations of this study included the possibility of selection bias, reporting and recall biases among the respondents. There was a long delay in publishing these results. To the best of our knowledge, this is the first study on knowledge, attitude and practices of ADRs reporting among CHEWs. The importance cannot be overemphasized in developing countries considering the shortage of health care workers and the continuing need for new vaccines and hence adverse events following immunization (AEFI) and drugs (hence ADRs) in the midst of emerging and re-emerging infectious diseases, including COVID-19. This study provides baseline information for designing an educational intervention for improving ADRs and AEFIs reporting by CHEWs.
Community health extension workers (CHEWs) working in the public health facilities of Oyo State, Southwestern Nigeria had inadequate knowledge and poor ADRs reporting but a relatively favourable attitude. The determinants of adequate knowledge of ADRs reporting were male gender, working in Ogbomoso zone and training, while the determinant of positive attitude was working in Okeogun zone. Training was the determinant of ADRs reporting among CHEWs. There is an urgent need for educational intervention programmes aiming at increasing the knowledge and modifying the attitude and practices of CHEWs towards increasing ADRs reporting.
What is known about this topic
- Timely ADRs reporting has contributed immensely towards the prevention of serious ADRs and ensuring public safety;
- Community health extension workers provides basic medical care in rural areas.
What this study adds
- Majority of the community health extension workers in public health institutions had encountered patients with ADRs but only 26 (12.6%) had reported it with yellow forms;
- Community health extension workers had inadequate knowledge of ADRs reporting;
- The determinant of ADRs reporting among community health wxtension workers was training on ADRs reporting.
The authors declare no competing interest.
Waheed Adeola Adedeji conceived the study, wrote the research proposal, involved in the data collection, data analysis, interpretation and writing of the first draft; AbdulKabir Babajide Adegoke participated in the development and writing of the manuscript; Fatai Adewale Fehintola was involved in the development of the research, supervised the data analysis and interpretation and writing of the manuscript. All authors read and approved the final manuscript.
The entire staff and facilitators of the Malaria Action Program for States (MAPS) in Oyo State are appreciated for their support during the administration of the questionnaires for this research work. We thank Dr Kimberly M Shea of the Boston University Schools of Public Health, Boston, MA, USA, for the editing of the first draft of this manuscript
Table 1: sociodemographic characteristics of community health extension workers in public health facilities, South-West Nigeria
Table 2: factors associated with the knowledge of community health extension workers on adverse drug reactions reporting, South-West, Nigeria
Table 3: factors associated with positive attitude of community health extension workers on adverse drug reactions reporting, South-west Nigeria
Table 4: adverse drug reactions reporting practices of the community health extension workers in public health facilities, South-west Nigeria
Table 5: factors associated with adverse drug reactions reporting by the community health extension workers, South-west Nigeria
- Blockman M. Adverse drug reactions-an update. Continuing Medical Education. 2009;27(2):80. Google Scholar
- Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-5. PubMed | Google Scholar
- Oshikoya KA, Chukwura H, Njokanma OF, Senbanjo IO, Ojo I. Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria. Sao Paulo Med J. 2011 May;129(3):153-64. PubMed | Google Scholar
- Formica D, Sultana J, Cutroneo PM, Lucchesi S, Angelica R, Crisafulli S et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018 Jul;17(7):681-695. PubMed | Google Scholar
- Lopez-Gonzalez E, Herdeiro MT, Figueiras A. Determinants of under-reporting of adverse drug reactions. Drug Saf. 2009;32(1):19-31. PubMed | Google Scholar
- Inman W. Attitudes to adverse drug reaction reporting. Br J Clin Pharmacol. 1996 May;41(5):434-5. PubMed | Google Scholar
- Inman W. Under-reporting of adverse drug reactions. Br Med J (Clin Res Ed) . 1985 May 4;290(6478):1355. PubMed | Google Scholar
- World Health Organization. The importance of pharmacovigilance. 2002. Google Scholar
- Pal S. World Health Organization programme for international drug monitoring. Clinical Therapeutics. 2013;35(8):e123. Google Scholar
- Olsson S, Pal SN, Stergachis A, Couper M. Pharmacovigilance activities in 55 low-and middle-income countries. Drug Saf. 2010 Aug 1;33(8):689-703. PubMed | Google Scholar
- Wilbur K. Pharmacovigilance in the middle east. Drug Saf. 2013 Jan;36(1):25-30 PubMed | Google Scholar
- Sisay M, Mengistu G, Molla B, Amare F, Gabriel T. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross-sectional study. BMC Health Serv Res. 2017 Feb 23;17(1):161. PubMed | Google Scholar
- Ampadu HH, Hoekman J, de Bruin ML, Pal SN, Olsson S, Sartori D et al. Adverse drug reaction reporting in Africa and a comparison of individual case safety report characteristics between Africa and the rest of the World: analyses of spontaneous reports in VigiBaseŽ. Drug Saf. 2016 Apr;39(4):335-45. PubMed | Google Scholar
- Cliff-Eribo KO, Sammons H, Choonara I. Systematic review of paediatric studies of adverse drug reactions from pharmacovigilance databases. Expert Opin Drug Saf. 2016 Oct;15(10):1321-8. PubMed | Google Scholar
- Onakpoya IJ, Heneghan CJ, Aronson JK. Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature. BMC Med. 2016 Feb 4;14:10. PubMed | Google Scholar
- National Pharmacovigilance Centre, National agency for food and drug administration and control . Safety of medicines in Nigeria: a guide for detecting and reporting adverse drug reactions. 2004.
- Olowofela A, Fourrier-Réglat A, Isah AO. Pharmacovigilance in Nigeria: an overview. Pharmaceutical Medicine. 2016;30(2):87-94. Google Scholar
- Ohaju-Obodo J, Iribhogbe O. Extent of pharmacovigilance among resident doctors in Edo and Lagos states of Nigeria. Pharmacoepidemiol Drug Saf. 2010 Feb;19(2):191-5. PubMed | Google Scholar
- Bello SO. Knowledge and attitudes of physicians relating to reporting of adverse drug reactions in Sokoto, northwestern Nigeria. Ann Afr Med. Jan-Mar 2011;10(1):13-8. PubMed | Google Scholar
- Oshikoya KA, Awobusuyi JO. Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria. BMC Clin Pharmacol. 2009 Aug 11;9:14. PubMed | Google Scholar
- Adedeji W, Ibraheem W, Fehintola F. Attitude and practice of doctors toward adverse drug reactions (ADRs) reporting in a Nigerian tertiary health facility. Ann Ib Postgrad Med. 2013 Dec;11(2):77-80. PubMed | Google Scholar
- Oreagba IA, Ogunleye OJ, Olayemi SO. The knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria. Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):30-5. PubMed | Google Scholar
- Ogundele S, Dawodu C, Ogunleye O. Adverse drug reaction reporting among healthcare workers at a Nigerian Tertiary Hospital: a comparative cross-sectional survey of health care professionals. Glob Res J Med Sci. 2012;2:32-7. Google Scholar
- Adisa R, Omitogun TI. Awareness, knowledge, attitude and practice of adverse drug reaction reporting among health workers and patients in selected primary healthcare centres in Ibadan, southwestern Nigeria. BMC Health Serv Res. 2019 Dec 3;19(1):926. PubMed | Google Scholar
- Ezeuko AY, Ebenebe UE, Nnebue CC, Ndu OO. Adverse drug reaction reporting by different categories of healthcare workers in Nnewi, Nigeria: awareness, knowledge and attitudes. Journal of Advances in Medicine and Medical Research. 2015:932-41. Google Scholar
- Okechukwu RC, Odinduka SO, Ele GN, Okonta MJ. Awareness, attitude, and practice of pharmacovigilance among health care professionals in Nigeria: survey in a teaching hospital. International Journal of Hospital Research. 2013;2(3):99-108. Google Scholar
- Opadeyi AO, Fourrier-Réglat A, Isah AO. Educational intervention to improve the knowledge, attitude and practice of healthcare professionals regarding pharmacovigilance in south-South Nigeria. Ther Adv Drug Saf. 2019 Jan 25;10:2042098618816279. PubMed | Google Scholar
- Fadare JO, Enwere OO, Afolabi A, Chedi B, Musa A. Knowledge, attitude and practice of adverse drug reaction reporting among healthcare workers in a tertiary centre in Northern Nigeria. Tropical Journal of Pharmaceutical Research. 2011;10(3). Google Scholar
- Kish L. Sampling organizations and groups of unequal sizes. Am Sociol Rev. 1965 Aug;30:564-72. PubMed | Google Scholar
- Dodoo AN, Ampadu HH. Pharmacovigilance in Africa. Pharmacovigilance. 2014 Apr 1:299-301. Google Scholar
- Sabblah G, Akweongo P, Darko D, Dodoo A, Sulley A. Adverse drug reaction reporting by doctors in a developing country: a case study from Ghana. Ghana Med J. 2014 Dec;48(4):189-93. PubMed | Google Scholar
- Gidey K, Seifu M, Hailu BY, Asgedom SW, Niriayo YL. Healthcare professionals knowledge, attitude and practice of adverse drug reactions reporting in Ethiopia: a cross-sectional study. BMJ Open. 2020 Feb 25;10(2):e034553. PubMed | Google Scholar
- Kassa Alemu B, Biru TT. Health care professionals´ knowledge, attitude, and practice towards adverse drug reaction reporting and associated factors at selected public hospitals in Northeast Ethiopia: a cross-sectional study. Biomed Res Int. 2019 Nov 30;2019:8690546. PubMed | Google Scholar
- Nisa ZU, Zafar A, Sher F. Assessment of knowledge, attitude and practice of adverse drug reaction reporting among healthcare professionals in secondary and tertiary hospitals in the capital of Pakistan. Saudi Pharm J. 2018 May;26(4):453-461. PubMed | Google Scholar
- Okezie EO, Fawole O. Adverse drug reactions reporting by physicians in Ibadan, Nigeria. Pharmacoepidemiol Drug Saf . 2008 May;17(5):517-22. PubMed | Google Scholar
- Othman GQ, Ibrahim MIM, Alshakka M, Ansari M, Al-Qadasi F, Halboup AM. Knowledge and Perception about Pharmacovigilance among Pharmacy Students of Universities in Sana´a Yemen. J Clin Diagn Res. 2017 Jun;11(6):FC09-FC13. PubMed | Google Scholar
- Leone S. 5-year trend of reporting adverse drug reaction: An Italian general practice experience. EC Pharmacol Toxicol. 2017;5:29-37.
- Nadew SS, Beyene KGM, Beza SW. Adverse drug reaction reporting practice and associated factors among medical doctors in government hospitals in Addis Ababa, Ethiopia. PLoS One. 2020 Jan 21;15(1):e0227712. PubMed | Google Scholar
- Osakwe A, Oreagba I, Adewunmi AJ, Adekoya A, Fajolu I. Impact of training on Nigerian healthcare professionals' knowledge and practice of pharmacovigilance. Int J Risk Saf Med. 2013;25(4):219-27. PubMed | Google Scholar
- Farha RA, Hammour KA, Rizik M, Aljanabi R, Alsakran L. Effect of educational intervention on healthcare providers knowledge and perception towards pharmacovigilance: a tertiary teaching hospital experience. Saudi Pharm J. 2018 Jul;26(5):611-616. PubMed | Google Scholar
- Meher BR, Joshua N, Asha B, Mukherji D. A questionnaire based study to assess knowledge, attitude and practice of pharmacovigilance among undergraduate medical students in a Tertiary Care Teaching Hospital of South India. Perspect Clin Res. Oct-Dec 2015;6(4):217-21. PubMed | Google Scholar
- Sevene E, Mariano A, Mehta U, Machai M, Dodoo A, Vilardell D et al. Spontaneous adverse drug reaction reporting in rural districts of Mozambique. Drug Saf. 2008;31(10):867-76. PubMed | Google Scholar
- Saka B, Barro-Traore F, Atadokpede FA, Kobangue L, Niamba PA, Adegbidi H et al. Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries. Int J Dermatol. 2013 May;52(5):575-9. PubMed | Google Scholar
- Katusiime B, Semakula D, Lubinga SJ. Adverse drug reaction reporting among health care workers at Mulago National Referral and Teaching hospital in Uganda. Afr Health Sci. 2015 Dec;15(4):1308-17. PubMed | Google Scholar