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Asmamaw G, Ejigu N, Tewihubo D, Ayenew W. Assessment of private health sector prescribing patterns and adherence to prescription format using World Health Organization core drug use indicators in Addis Ababa, Ethiopia. J Pharm Policy Pract 2022; 15:11. [PMID: 35232489 PMCID: PMC8886342 DOI: 10.1186/s40545-022-00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Currently, the private healthcare sector's role in healthcare delivery is growing in Ethiopia. However, there are limited studies on private healthcare sector drug use patterns. This study aimed to evaluate the private healthcare sector prescribing practices and adherence to prescription format, using some of the World Health Organization (WHO) core drug use indicators in Addis Ababa, Ethiopia. Methods A retrospective cross-sectional study design was used to collect quantitative data from prescriptions prescribed and dispensed by private healthcare sectors in the Lemi-Kura sub-city, Addis Ababa. The study was conducted from June to July 2021. The WHO criteria were used to evaluate prescribing and prescription completeness indicators. Prescriptions, kept for the last 1 year that were prescribed between January 1, 2020, to January 1, 2021, by private drug outlets, were analyzed. Simple random and systematic sampling procedures were employed in selecting drug outlets and prescriptions, respectively. Results Of a total of 1,200 prescriptions, 2,192 drugs were prescribed and the average number of drugs per prescription was 1.83. Generic names, antibiotics, injections, and drugs on the Ethiopian essential medicines list accounted for 77.4, 63.8, 11.5, and 80.6% of all prescriptions, respectively. Among the patient identifiers, the patient card number (54.3%), weight (2.3%), and diagnoses (31.7%) were less likely to be completed. In terms of the drug-related information, the dosage form (35.5%) was the least likely to be completed. Only 36.6 and 25.8% of prescriptions contained the names and qualifications of the prescribers, respectively. It was difficult to obtain prescription papers with the dispenser identifier. Conclusion The study findings indicated prescribing and prescription completeness indicators all considerably deviated from WHO standards and hence unsuitable. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing irrational medicine use in Ethiopia. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00408-0.
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Tusubira AK, Nalwadda CK, Akiteng AR, Hsieh E, Ngaruiya C, Rabin TL, Katahoire A, Hawley NL, Kalyesubula R, Ssinabulya I, Schwartz JI, Armstrong-Hough M. Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda. Ann Glob Health 2021; 87:86. [PMID: 34458110 PMCID: PMC8378074 DOI: 10.5334/aogh.3308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. Objective We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Methods Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Results Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Conclusion Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY USA
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Tusubira AK, Akiteng AR, Nakirya BD, Nalwoga R, Ssinabulya I, Nalwadda CK, Schwartz JI. Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda. PLoS One 2020; 15:e0235696. [PMID: 32634164 PMCID: PMC7340292 DOI: 10.1371/journal.pone.0235696] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. Methods We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Results Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients’ confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Conclusion Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- * E-mail:
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Brenda D. Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Ritah Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine K. Nalwadda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences Makerere University, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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Smith C, van Velthoven MH, Truong ND, Nam NH, Anh VP, AL-Ahdal TMA, Hassan OG, Kouz B, Huy NT, Brewster M, Pakenham-Walsh N. How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review. BMJ Glob Health 2020; 5:e002094. [PMID: 32337085 PMCID: PMC7170426 DOI: 10.1136/bmjgh-2019-002094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries. Methods We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools. Results Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low. Discussion Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers. PROSPERO registration number CRD42018091088.
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Affiliation(s)
- Chris Smith
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Michelle Helena van Velthoven
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
- Department of Paediatrics, Oxford University, Oxford, Oxfordshire, UK
| | - Nguyen Duc Truong
- Nagasaki University, Nagasaki, Japan
- Obstetrics and Gynecologic Department, FV Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Hai Nam
- Nagasaki University, Nagasaki, Japan
- Department of General Surgery, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Vũ Phan Anh
- Nagasaki University, Nagasaki, Japan
- Department of Neonatology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Tareq Mohammed Ali AL-Ahdal
- Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Gamal Hassan
- Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Basel Kouz
- Nagasaki University, Nagasaki, Japan
- Faculty of Medicine, Damascus University, Damascus, Damascus Governorate, Syria
| | | | - Malcolm Brewster
- Healthcare Information For All (HIFA) network, Global Healthcare Information Network, Charlbury, UK
| | - Neil Pakenham-Walsh
- Healthcare Information For All (HIFA) network, Global Healthcare Information Network, Charlbury, UK
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Schwartz JI, Ssinabulya I. Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans. N Engl J Med 2019; 381:1390-1391. [PMID: 31577886 DOI: 10.1056/nejmc1909844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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