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Kiguba R, Olsson S, Waitt C. Pharmacovigilance in low- and middle-income countries: A review with particular focus on Africa. Br J Clin Pharmacol 2023; 89:491-509. [PMID: 34937122 DOI: 10.1111/bcp.15193] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023] Open
Abstract
Low- and middle-income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliability of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities. There are particular challenges relating to the need to translate reporting tools into numerous local languages and the low numbers of healthcare providers relative to number of patients, with very short consultation times. Additional factors frequent in LMIC include high uptake of herbal and traditional medication, mostly by self-medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data, which makes it difficult to reliably estimate the true risks of medicines use. Pharmacovigilance activities are hindered by the scarcity of well-trained personnel with little or no budgetary support from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; and little awareness of pharmacovigilance among healthcare workers, decision makers and consumers. Furthermore, little collaboration between public health programmes and national medicines regulatory authorities coupled with limited investment in pharmacovigilance activities, especially during mass drug administration for neglected tropical diseases and mass vaccinations, produces major challenges in establishing a culture where pharmacovigilance is systematically embedded. Very low spontaneous reporting rates with poor quality reports hinders robust signal detection analyses. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Sten Olsson
- Pharmacovigilance Consulting, Uppsala, Sweden
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, UK.,Infectious Diseases Institute, Makerere University College of Health Sciences, Uganda
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Khalili M, Sharifi H, Mesgarpour B, Kheirandish M, Olsson S, Javidnikou N, Haghdoost AA. Evaluation of Pharmacovigilance System in Iran. Int J Health Policy Manag 2022; 11:990-1000. [PMID: 33590736 PMCID: PMC9808195 DOI: 10.34172/ijhpm.2020.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evaluating a pharmacovigilance system helps identify its deficiencies and could facilitate measures to remedy and improve the quantity and quality of adverse drug reaction (ADR) reports and other opportunities for pharmacovigilance systems strengthening. This study aimed to evaluate the status of pharmacovigilance in Iran using the World Health Organization (WHO) pharmacovigilance indicators with the prospect of identifying the gaps and areas for improvement. METHODS This study was conducted in 2 parts. The first part included a secondary analysis of the national data obtained from the Iranian National Pharmacovigilance Center (PVC) using a structured data collection form based on WHO core pharmacovigilance indicators. In the second part, a 3-month prospective study was carried out to investigate 2 outcome indicators, ie, length of stay and costs of medicine-related hospitalization in all patients of 2 main referral hospitals in the southeast and north of Iran. RESULTS Iran has a PVC with national policy, trained staff, and a statutory budget. In 2017, the number of ADR reports was 15.0 per 100 000 population, and 262 signals were detected during the preceding 5 years. The average length of stay and costs of medicine-related hospitalization were 5 days and US$817.2 in Afzalipour hospital and 6.6 days and US$306.7 in Razi hospital, respectively. The status of pharmacovigilance in the Iranian public health programs (PHPs) is unknown, and most of the indicators could not be assessed. CONCLUSION A robust pharmacovigilance system is a pivotal part of the overall medicines regulatory system. The Iranian pharmacovigilance system has relatively the proper structural condition. Though the underreporting of ADRs, especially medicine-related deaths, is an important issue, and some indicators' status was unclear. The Iranian pharmacovigilance program requires a higher prioritization, particularly in the PHPs, a greater allocation of resources, and cross-sectoral cooperation to bolster and achieve the pharmacovigilance objectives.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development, Tehran, Iran
| | - Mehrnaz Kheirandish
- Department for Assessment and Control of Prescribing and Use of Medicines and Health Products, Food and Drug Administration, Tehran, Iran
| | - Sten Olsson
- International Society of Pharmacovigilance, London, UK
- Pharmacovigilance Consulting, Uppsala, Sweden
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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A Systematic Review of Pharmacovigilance Systems in Developing Countries Using the WHO Pharmacovigilance Indicators. Ther Innov Regul Sci 2022; 56:717-743. [PMID: 35657484 PMCID: PMC9356965 DOI: 10.1007/s43441-022-00415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022]
Abstract
Background In the context of the growth of pharmacovigilance (PV) among developing countries, this systematic review aims to synthesise current research evaluating developing countries’ PV systems’ performance. Methods EMBASE, MEDLINE, CINAHL Plus and Web of Science were searched for peer-reviewed studies published in English between 2012 and 2021. Reference lists of included studies were screened. Included studies were quality assessed using Hawker et al.'s nine-item checklist; data were extracted using the WHO PV indicators checklist. Scores were assigned to each group of indicators and used to compare countries’ PV performance. Results Twenty-one unique studies from 51 countries were included. Of a total possible quality score of 36, most studies were rated medium (n = 7 studies) or high (n = 14 studies). Studies obtained an average score of 17.2 out of a possible 63 of the WHO PV indicators. PV system performance in all 51 countries was low (14.86/63; range: 0–26). Higher average scores were obtained in the ‘Core’ (9.27/27) compared to ‘Complementary’ (5.59/36) indicators. Overall performance for ‘Process’ and ‘Outcome’ indicators was lower than that of ‘Structural’. Conclusion This first systematic review of studies evaluating PV performance in developing countries provides an in-depth understanding of factors affecting PV system performance.
Supplementary Information The online version contains supplementary material available at 10.1007/s43441-022-00415-y.
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Le TT, Nguyen TTH, Nguyen C, Tran NH, Tran LA, Nguyen TB, Nguyen N, Nguyen HA. Factors associated with spontaneous adverse drug reaction reporting among healthcare professionals in Vietnam. J Clin Pharm Ther 2019; 45:122-127. [PMID: 31486525 DOI: 10.1111/jcpt.13037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Under-reporting is a major drawback of a voluntary adverse drug reaction reporting system in pharmacovigilance. However, little is known about facilitators and barriers to ADR reporting by healthcare professionals (HCPs) in developing countries. To investigate factors associated with adverse drug reaction (ADR) reporting among HCPs in Vietnam. METHODS A cross-sectional survey of 2091 HCPs was conducted in 2015 at 10 hospitals throughout Vietnam. The binary outcome was ever reporting ADRs. Healthcare professionals knowledge, attitude and practice about ADR reporting were measured. Multiple logistic regression analyses examined factors significantly associated with ever ADR reporting. RESULTS Overall, 29.3%, 2.2% and 68.4% of the sample were doctors, pharmacists and nurses, respectively. More than half (59.3%) had ever reported any ADR. Facilitators for ADR reporting were educational training (OR = 1.77, 95%CI = 1.42-2.22) and having better knowledge, such as awareness of ADR reporting regulation (OR = 1.63, 95%CI = 1.19-2.21), of reporting time (OR = 1.76, 95%CI = 1.35-2.29) and of necessary information in reporting form (OR = 1.94, 95%CI = 1.53-2.45).Conversely, barriers to non-reporting were unknown of reporting procedure (OR = 0.27, 95%CI = 0.22-0.35), unavailability of reporting form (OR = 0.54, 95%CI = 0.42-0.68) and lack of time (OR = 0.59, 95%CI = 0.46-0.74). WHAT IS NEW AND CONCLUSION Given the low ADR reporting rate among HCPs, educational interventions to improve their knowledge and attitude should be prioritized in Vietnam. Additional interventions addressing obstacles (i.e. availability and complexity of reporting form, lack of time) should be considered to improve both the quantity and quality of ADR reporting.
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Affiliation(s)
- Thu Thuy Le
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Thi Thanh Huong Nguyen
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Chi Nguyen
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Ngan Ha Tran
- The National Centre for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Lan Anh Tran
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Thanh Binh Nguyen
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Hoang Anh Nguyen
- The National Centre for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
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Vuong QH, Ho MT, Vuong TT, La VP, Ho MT, Nghiem KCP, Tran BX, Giang HH, Giang TV, Latkin C, Nguyen HKT, Ho CSH, Ho RCM. Artificial Intelligence vs. Natural Stupidity: Evaluating AI readiness for the Vietnamese Medical Information System. J Clin Med 2019; 8:E168. [PMID: 30717268 PMCID: PMC6406313 DOI: 10.3390/jcm8020168] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 01/02/2023] Open
Abstract
This review paper presents a framework to evaluate the artificial intelligence (AI) readiness for the healthcare sector in developing countries: a combination of adequate technical or technological expertise, financial sustainability, and socio-political commitment embedded in a healthy psycho-cultural context could bring about the smooth transitioning toward an AI-powered healthcare sector. Taking the Vietnamese healthcare sector as a case study, this paper attempts to clarify the negative and positive influencers. With only about 1500 publications about AI from 1998 to 2017 according to the latest Elsevier AI report, Vietnamese physicians are still capable of applying the state-of-the-art AI techniques in their research. However, a deeper look at the funding sources suggests a lack of socio-political commitment, hence the financial sustainability, to advance the field. The AI readiness in Vietnam's healthcare also suffers from the unprepared information infrastructure-using text mining for the official annual reports from 2012 to 2016 of the Ministry of Health, the paper found that the frequency of the word "database" actually decreases from 2012 to 2016, and the word has a high probability to accompany words such as "lacking", "standardizing", "inefficient", and "inaccurate." Finally, manifestations of psycho-cultural elements such as the public's mistaken views on AI or the non-transparent, inflexible and redundant of Vietnamese organizational structures can impede the transition to an AI-powered healthcare sector.
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Affiliation(s)
- Quan-Hoang Vuong
- Center for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
| | - Manh-Tung Ho
- Center for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
| | | | - Viet-Phuong La
- Center for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
| | - Manh-Toan Ho
- Center for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
- Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong district, Hanoi 100803, Vietnam.
| | | | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Hai-Ha Giang
- Institute for Global Health Innovations, Duy Tan University, Da Nang 100000, Vietnam.
| | - Thu-Vu Giang
- Center of Excellence in Artificial Intelligence in Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 100000, Vietnam.
| | - Carl Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Hong-Kong T Nguyen
- A.I. for Social Data Lab (AISDL), Vuong & Associates, Dong Da district, Hanoi 100000, Vietnam.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore.
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
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Shin JY, Shin E, Jeong HE, Kim JH, Lee EK. Current status of pharmacovigilance regulatory structures, processes, and outcomes in the Asia-Pacific region: Survey results from 15 countries. Pharmacoepidemiol Drug Saf 2019; 28:362-369. [DOI: 10.1002/pds.4717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/23/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ju-Young Shin
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Eungyeong Shin
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Han Eol Jeong
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Ju Hwan Kim
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Eui-Kyung Lee
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
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Singh J, Singh H, Rohilla R, Kumar R, Gautam CS. Lack of Awareness of Pharmacovigilance among Young Health-care Professionals in India: An Issue Requiring Urgent Intervention. Int J Appl Basic Med Res 2018; 8:158-163. [PMID: 30123745 PMCID: PMC6082015 DOI: 10.4103/ijabmr.ijabmr_423_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/21/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Young healthcare professionals (HCPs) are the pillar of healthcare system. The objective of the present study was to assess the knowledge, attitude, and practices of young HCPs regarding adverse drug reactions (ADRs) reporting. METHODS This cross-sectional questionnaire-based study was conducted on young HCPs in a tertiary care teaching hospital of North India. The study instrument was semi-structured, prevalidated questionnaire. The responses obtained were compared among doctors and nursing professionals. RESULTS We obtained response from 84 HCPs (61 doctors and 23 nurses). The mean age of the doctors and nurses was 25.0 ± 2.4 versus 26.3 ± 3.4 years, respectively. No significant difference was observed in questions related to definition of ADR, components of pharmacovigilance (PV), who can report ADRs and medications for which ADRs are to be reported. Only 9.8% doctors and 26.1% nurses were aware of ADR reporting system in India, of which 6 (26%) nurses and none of the doctors were aware of its name. About 16.4% doctors as compared to 61% nurses admitted to have reported an ADR (P < 0.001). The main discouraging factor in ADR reporting was time constraint while lack of knowledge was also highlighted by the HCPs. More nurses as compared to doctors (78.3% vs. 49.2%, P = 0.01) were of the opinion that holding continuing medical education/workshop could encourage reporting. CONCLUSION There is an urgent need to increase awareness about PV among young HCPs, and adequate interventions should be instituted to encourage PV practices.
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Affiliation(s)
- Jagjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Harmanjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Ravi Rohilla
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Rajiv Kumar
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - C S Gautam
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
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