Objectives:We systematically reviewed the rational use of medicines using the World Health Organiza-tion/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.Mann-Whitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P＜0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0 to 4.0)],percentage of medicines prescribed by generic[50.4％(IQR:47.4％to 65.0％)],percentage of en-counters with antibiotic prescribed[40.2％(IQR:30.5％to 52.7％)],percentage of encounters with injection prescribed[18％(IQR:3.2％to 30.0％)]and the percentage of medicines prescribed from essential medicines list[82.0％(IQR:66.4％to 89.3％)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pan-demic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.

Objectives:We systematically reviewed the rational use of medicines using the World Health Organiza-tion/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.Mann-Whitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P＜0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0 to 4.0)],percentage of medicines prescribed by generic[50.4％(IQR:47.4％to 65.0％)],percentage of en-counters with antibiotic prescribed[40.2％(IQR:30.5％to 52.7％)],percentage of encounters with injection prescribed[18％(IQR:3.2％to 30.0％)]and the percentage of medicines prescribed from essential medicines list[82.0％(IQR:66.4％to 89.3％)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pan-demic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.

Background: Petrol is known to be hazardous to human health and is associated with various health effects, such as haematotoxicity and oxidative stress. Although Malaysia has adopted the European fuel quality standards in recent years in order to reduce petroleum pollutants and to improve air quality, gasoline with research octane number 95 (RON95), believed to contain benzene and other toxic substances, is still widely used all over the country. This study assessed the effect of RON95 gasoline on haemtological parameters of rats after 11 weeks of exposure. Methods: A total of 16 male Sprague-Dawley rats were randomly divided into two groups: control (exposed to ambient air daily) and gasoline exposed (exposed to petrol fumes at 11.13 ± 1.1cm3/h for 6h daily, 6 days/week) groups. Body weight was monitored daily. At the end of 11 weeks, the rats were sacrificed, bone marrow was extracted for cytological examination, and blood samples were collected for a full blood picture examination, full blood counts and oxidative markers. Results: The results show that gasoline inhalation was associated with a significant (P < 0.05) reduction in the rate of weight gain and a reduction in mean corpuscular haemoglobin concentration and red cell distribution width. It was also observed that the inhalation of gasoline was associated with changes in the nuclei of megakaryocytes, hence causing an increase in the percentage of abnormal megakaryocytes with detached nuclei, hypo-lobulation and/or disintegration. However, the inhalation of gasoline did not cause significant changes in oxidative markers in the erythrocytes. Conclusion: This study shows that 11 weeks of inhaling RON95 petrol vapours caused adverse effects on weight gain, blood cell indices and bone marrow megakaryocytes, but did not cause significant changes in oxidative markers in erythrocytes. The definitive effects of these changes on health require further confirmation.