Availability of Essential Antidotes and the Role of Community Pharmacists in the Management of Acute Poisoning: A Cross-Sectional Study in Ethiopia

Background

Morbidity and mortality related to acute poisoning is a major public health issue in both developing and developed countries. Community pharmacists have a crucial role in ensuring drug availability, increasing drug safety, counseling patients, overdose risk reduction and management, and provision of appropriate drug information. This study aimed to assess the availability of necessary antidotes in community pharmacies in Gondar and Bahir-Dar cities, Ethiopia, and the role of community pharmacists in the management of acute poisoning.

Methods

A cross-sectional survey was conducted in Gondar and Bahir-Dar cities. A self-administered, structured questionnaire was used for data collection and Statistical Package for Social Sciences (SPSS) version 24.0 was used for data analysis. Chi-square analysis was computed to identify the associated factors with a confidence interval of 95% and a P value less than .05 was used as a cut-point for statistical significance.

Results

Out of 101 community pharmacies invited to participate in the study, 80 of them completed the survey with a response rate of 79.2%. The overall mean antidote availability score was .59 (SD = .837), which falls within the definition of Poor availability. None of the pharmacies had kept all of the antidotes, and the maximum number of an antidote kept by a single pharmacy was 7 out of nineteen essential antidotes surveyed. The most commonly reported reason for the unavailability of essential antidotes was stock was not ordered (56.3%) followed by stock ordered but not delivered from suppliers (wholesalers) (20.0%). More than 3 fourth of the respondents (83.8%) had poor knowledge about the antidotes for the common poisonings.

Conclusion

There was a significantly very low availability of essential antidotes in the community pharmacies. Strategies should be implemented to improve pharmacist’s knowledge about antidotes, and management of poisoning emergencies through on-job training and provision of reference materials.

Effect of Crude Leaves Extract of Bersama Abyssinica on Blood Glucose Level and Serum Lipid Level of Streptozotocin-Induced Diabetic Mice: Evidence for In vivo Antidiabetic Activity

BACKGROUND

Diabetes mellitus is one of the major and common metabolic, and chronic disorders in the world. Several medicinal plants have been used globally for the management of diabetes mellitus. The current study aimed to study the anti-hyperglycemic and anti-hyperlipidemic effects of Bersama abyssinica.

METHODS

Antidiabetic effect of 80% methanolic crude extract of Bersama abyssinica was studied in repeated dose-treated STZ-induced diabetic mice model. The activities of Bersama abyssinica on serum lipid level and body weight were investigated on STZ-induced diabetic mice. Data were analyzed using one-way ANOVA and significant when the p-value was less than 0.05.

RESULTS

All doses of the crude 80% methanolic extract of Bersama abyssinica (100 mg/kg, 200 mg/kg, and 400 mg/kg) exhibited a noticeable BGL reduction when compared with baseline blood glucose level and diabetic control on the 7th and 14th days of administration. Moreover, the higher dose of the extract (at 400 mg/kg) significantly (p < 0.001, 54.3%) decreased the BGL in STZ-induced diabetic mice. The maximum decrement in fasting BGL was achieved at the 14th days: 34.92%, 41.10%, 54.30%, and 59.66%, respectively for BAC 100 mg/kg, BAC 200 mg/kg, BAC 400 mg/kg, and GLC 5 mg/kg treated groups. Bersama abyssinica also displayed a significant (p < 0.05) improvement of serum lipid levels and body weight.

CONCLUSION

Bersama abyssinica crude extract exhibited a significant antidiabetic effect and prevented body weight loss in streptozotocin-induced diabetic mice. The finding also confirmed the valuable biochemical activity of Bersama abyssinica by improving serum lipid levels.

Impact of COVID-19 on Pharmaceutical Care Services and the Role of Community Pharmacists: A Multi-Center Cross-Sectional Study in Ethiopia

Objectives

The current study aimed at assessing the impact of COVID-19 on pharmaceutical care services and the role of community pharmacists.

Methods

A cross-sectional study was conducted from May 1st to June 7, 2020, on community pharmacies in Bahir Dar and Gondar cities, Ethiopia. Descriptive statistics and Chi-square test were conducted. A P-value of less than 0.05 was considered to declare statistical significance at a 95% Confidence interval (CI).

Results

A total of 101 community pharmacies were approached (one pharmacist per pharmacy), and 80 of them had completed the survey. From the total pharmacies, 78.8% of them had encountered a shortage of pharmaceutical products. Chi-square test revealed that there was a significant difference (P = 0.036) in the shortage of personal protection equipment between Gondar and Bahir Dar cities. Face mask 55 (77.4%) followed by hand glove 15 (21.1%) were the most commonly reported personal protective equipment's in short supply.

Conclusion

Strategies should be in place to improve the availability and affordability of various essential pharmaceuticals to mitigate the spread of the disease and prevent other complications.

Health professional's exposure, attitude, and acceptance of drug promotion by industry representatives: A cross-sectional study in Ethiopia

Interactions between pharmaceutical companies and health care providers have long been an area of interest from ethical as well as scientific grounds. The information provided by those companies must be scientifically accurate and fair. The current study aimed to investigate the exposure, attitude, and training background of medical doctors and pharmacy professionals regarding drug promotional activities, and assess their acceptance of promotional gifts provided by pharmaceutical sales representatives. A cross-sectional study was conducted on medical doctors and pharmacy professionals working at Bahir Dar and Gondar cities, Amhara regional state, Ethiopia. Data were collected using a self-administered structured questionnaire and Statistical Package for Social Science (SPSS) version 26 was used for analysis. A Chi-square test was computed to investigate the presence of an association between the dependent and independent variables. A p-value of less than 0.05 was considered to declare significance at a 95% Confidence Interval (CI). A total of 105 health professionals, 81 pharmacy professionals, and 24 medical doctors have participated in the study. Above two-thirds of the respondents (69.5%) agreed that most talks sponsored by drug companies were helpful and educational. On the other hand, 39% of the respondents agreed and 47.6% disagreed that receiving gifts from pharmaceutical representatives will increase the chance that they will eventually sell or recommend the drug company's products. The majority of the study participants (81%) preferred drug samples and stationery as appropriate gifts by pharmaceutical sales representatives. Significant gaps were found regarding the training of health professionals about the ethics of drug marketing and how to deal with pharmaceutical representatives. Policies aiming at restricting health care provider's contacts with pharmaceutical companies during residency training along with incorporating gift restriction policies could bring significant improvements.

A Recent Achievement in the Discovery and Development of Vaccines and Therapeutic Agents in the Race for COVID-19 Protection and Treatment

Currently, the coronavirus disease 2019 (COVID-19) is a big challenge to the healthcare systems in the world. Several researchers in the world have immediately carried out clinical investigations for the discovery of vaccines and drugs. Different studies have shown that antiviral measures including small bioactive compounds targeting multifaceted molecular communications take in COVID-19 infection. The drug development archived in this review emphasizes mainly on drugs that are effective for the Management of MERS-CoV, SARS-CoV, and other RNA viruses. The investigation of therapeutic agents for COVID-19 includes anti-inflammatory agents, antibodies, and nucleic acid-based treatments targeting virus gene expression as well as different sorts of vaccines. Numerous patents revealed techniques of these biologics with the potential for treating and preventing coronavirus infections, which may apply to COVID-19. Phase 3 clinical trials such as Sputnik V, AZD1222, mRNA-1273, BNT162b2, Ad5-nCoV, Anti-COVID antibodies, Kevzara; Actemra, Jakafi; Baricitinib, and some others were undergoing in the race for Covid-19 treatment. However, there's still a lack of a review on vaccines and drugs for COVID-19 management. Therefore, this review summarizes different studies that are ongoing in the race for Covid-19 protection and treatment.

Self-medication Practice and Associated Factors among Private Health Sciences Students in Gondar Town, North West Ethiopia. A Cross-sectional Study

Self-medication is the most common practice worldwide and it may lead to irrational use of drugs. Therefore, this study aimed to assess the prevalence of self-medication practice and its associated factors among health science students. A cross-sectional study was conducted on 600 health science students in Gondar town. The data regarding self-medication practice and its associated factors were collected using a face-to-face interview on a structured questionnaire. SPSS −24 was used for data analysis and explained with univariate, and multivariate logistic regression analysis to determine the factors associated with self-medication practice (sex, age, religion, marital status, residence, department, year of study, monthly income, access to pharmacy, and peer/family pressure). A total of 554 students responded to the questionnaire with a response rate of 92.3%. Out of 554 respondents, 78.2% were practiced self-medication. Headache/fever 37.88% (n = 164) was reported as the most common complaint to practice self-medication. Among the reasons for self-medication practice, similarity of symptoms with past illness 33.49% (n = 145) was the most frequently reported. In current study, Females (AOR = 3.11, 95% CI = 1.55, 6.25), Muslim followers (AOR = 2.78, 95% CI = 1.30, 5.91), Protestant followers (AOR = 4.25, 95% CI = 1.38, 13.07), pharmacy students (AOR = 3.72, 95% CI = 1.97, 9.30), clinical nursing students (AOR = 2.88, 95% CI = 1.87, 14.48), monthly income (>500ETB) (AOR = 2.49, 95% CI = 1.12, 5.56), distance of health institution (<30 min) (AOR = 2.79, 95% CI = 1.39, 5.61), and accessibility of pharmacy (AOR = 4.85, 95% CI = 2.08, 11.29) were the independent predictors of self-medication practice. Self-medication is common in health science students in Gondar town. Health professionals should educate students on the risks and benefits of self-medication to encourage responsible self-medication. National guidelines on medicine access should be developed and strong measures should be implemented to halt the selling of medications without a proper prescription.

Antimalarial Activity of Seed Extracts of Schinus molle Against Plasmodium berghei in Mice

Background.

Malaria is a major public health problem in developing countries. In Ethiopian, the seeds of Schinus molle are used for the management of malaria. Therefore, the current study aimed to evaluate in vivo antimalarial activity of hydro-alcoholic crude extract and solvent fractions of Schinus molle seeds in Plasmodium berghei infected mice.

Methods.

An 80 percent of methanolic crude extract and solvent fractions of Schinus molle seeds were tested for antimalarial activity at 100, 200 and 400 mg/kg doses. The parasitemia level, packed cell volume, body weight, survival of date and rectal temperature were used to evaluate the anti-malarial activity of the extracts. One-way ANOVA followed by post hoc Tukey’s HSD multiple comparison test was employed and the result was expressed in mean ± SEM (standard error of the mean).

Results.

The curative activity of the highest dose of crude extract and aqueous fraction of Schinus molle seeds was 69.86% and 73.82% (p < 0.001), respectively. In the prophylactic test, aqueous fraction had 72.39% (p < 0.001) suppression antimalarial activity. Among solvent fractions, only chloroform fraction was significantly attenuated packed cell volume reduction. The mice treated with crude extract and aqueous fraction had longer survival date than vehicle-treated mice (p < 0.001).

Conclusion.

The experiment finding showed that the crude extract and solvent fractions of Schinus molle seeds had significant curative and prophylaxis anti-plasmodial activity. This result revealed that the Schinus molle seeds extract has promising antimalarial activity against Plasmodium berghei. However, further confirmatory studies, isolation and characterization of the active constituents are recommended.

Prevalence and Predictors of Self-Medication Practice Among Teachers' Education Training College Students in Amhara Region, Ethiopia: A Cross-Sectional Study

Background: Self-medication practice is the use of medications without healthcare professional requests. It can lead to inappropriate medication usage, wastage of resources, increased chance of microbial resistance, and adverse drug reactions. Therefore, this study aimed at assessing the prevalence and associated factors of self-medication practice among teachers' education training college students in the Amhara region, Ethiopia. Methods: A multicentre cross-sectional study was conducted on 344 teachers' education training college students in the Amhara region, Ethiopia, from January 1 to February 28, 2020. Data on sociodemography, the practice of self-medication, and factors associated with self-medication practice were collected through a self-administered structured questionnaire. Systematic random sampling was used to select participants. Descriptive statistics and univariate and multivariate logistic regression analyses were done to determine various variables and factors associated with self-medication practice. Results: Out of the 344 respondents, 234 (68.0%) practiced self-medication. The most commonly cited indication for self-medication practice was headache (75, 32.05%), followed by abdominal discomfort (53, 22.6%). The respondents who were older than 26 years of age (AOR: 2.47, 95% CI: 1.18-3.94), were in the third year of study (AOR: 3.14, 95% CI: 1.94-5.79), lived in urban residence (AOR: 2.97, 95% CI: 1.06-3.64), had accessibility to a nearby pharmacy (AOR: 2.12, 95% CI: 1.43-4.46), and had peer/family pressure (AOR: 2.34, 95% Cl: 1.53-3.56) were significantly associated with self-medication practice. Conclusion: More than two-thirds of the study participants practiced self-medication. Being from an urban area, having access to a private pharmacy, and higher year of study positively affect self-medication practice.

COVID-19: What should health professionals know? Assessment of Knowledge, attitude, and practice of community pharmacists in a developing country

BACKGROUND

Healthcare professionals are the primary frontiers of the fight against every public health threat. These had made them vulnerable to various infectious agents, with many reports of morbidity and mortality also being evident.

OBJECTIVES

The current study aimed to assess the knowledge, attitude, and practice toward COVID-19 among community pharmacists in Gondar town, Ethiopia.

METHODS

A cross-sectional study was conducted. A structured, self-administered questionnaire was used for data collection, and the collected data were coded, validated, and analyzed using SPSS version 26. Quantitative data were summarized using means and standard deviations, while frequencies and proportions were used to summarize categorical data. A chi-square test was used to assess an association between the different variables, and a P-value of less than 0.05 was considered to declare statistical significance at a 95% confidence interval.

RESULTS

A total of 46 community pharmacy professionals had participated in the study. The main sources of information about COVID-19 were news media 29 (63%), followed by social media 24 (52.2%). The mean knowledge score was 8.15 (standard deviation: 1.86), and among the total study participants, 29 (63%) were found to have good knowledge about COVID-19. The mean attitude score was 31.52 (standard deviation: 4.288). Only 30.4% of the study participants were found to have a good practice toward the prevention of COVID-19. Chi-square results showed that having a good knowledge of COVID-19 was significantly associated with practice (P = 0.035).

CONCLUSION

Significant gaps were identified concerning community pharmacy professional's knowledge of COVID-19 and their practice toward prevention of the disease. Strategies should be implemented to equip community pharmacy professionals with all necessary information about COVID-19 through continuous training programs and other virtual platforms.

Utilization of Provider-Initiated HIV Testing and Counseling as an Intervention for PMTCT Services Among Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Ethiopia

Purpose: Little is known about acceptance of provider-initiated HIV testing and counseling (PICT) as an intervention for prevention of mother to child transmission of HIV (PMTCT) in many parts of sub-Saharan Africa including Ethiopia. This study aimed at assessing the utilization and acceptance rate of PICT as an intervention for PMTCT among pregnant women attending University of Gondar referral and teaching hospital (UoGRTH), Ethiopia.

Methods: A hospital-based cross-sectional study was conducted on 364 pregnant women attending antenatal care clinic at UoGRTH through an interviewer-administered questionnaire. Frequencies, means, and percentages were used to report different variables. Univariate analysis and multivariate logistic regression analysis were used to come up with factors associated with acceptance of PICT services.

Results: Out of 364 respondents, 298 330 (81.7%) of them accepted provider-initiated HIV testing and counseling. Rural residency (AOR: 364, 95% CI: 2.17–6.34), higher educational status (AOR: 3.15, 95% CI: 1.86–6.82), planning of HIV test disclosure to male partners (AOR: 7.81, 95% CI: 3.17–13.14), and a higher average monthly income (AOR: 4.01, 95% CI: 2.32–7.61) were found to be strong predictors of acceptance of provider-initiated HIV testing and counseling.

Conclusions: The present study revealed a higher rate of acceptance of PICT among pregnant women. Enhancing access to and consistent use of antenatal care service among pregnant women and encouraging the active involvement of male partners are recommended to further increase the uptake of provider-initiated HIV testing and counseling.

Evaluating patients', physicians' and pharmacy professionals' perception and concern regarding generic medicines in Gondar town, northwest Ethiopia: A multi-stakeholder, cross-sectional survey

BACKGROUND

Generic medicine prescribing has become common practice in many countries. However, data regarding the perceptions of stakeholders (patients, prescribers and dispensers) regarding generic medicines in Ethiopia is scarce. The present survey aimed to investigate the perception of patients, physicians and pharmacy professionals regarding generic medicines in Ethiopia.

METHODS

A quantitative cross-sectional survey was conducted in Gondar town, Northwest Ethiopia between January 1 and February 1, 2017. The questionnaire, comprised of 5-point Likert scale items on perception and concerns regarding generic medicine, was administered to patients, physicians and pharmacy professionals working in the community drug retail outlets. Frequencies, percentages, and median were calculated using Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows to describe different variables.

RESULTS

The survey was completed by 612 participants. More than half of patients, 56% (n = 219) knew about the term brand and generic medicines and 38.7% (n = 151) of patients agreed/strongly agreed that brand medicines are more effective. Nearly half, 47% (n = 184) of patients agreed that they should have the option of choosing between generic and brand medicines and 61.4% (n = 240) of patients believed that cost should be considered before a medicineis prescribed. The majority of physicians 70.6% (n = 101) indicated a very low generic medicine prescription rate. 56% (n = 130) of physicians and 87.2% (n = 68) of pharmacy professionals agreed that they need a standard guideline to both prescribers and pharmacists on brand substitution process. Furthermore, 39.9% (n = 57) of the physicians and 87.2% (n = 68) of pharmacy professionals agreed that drug advertisements by the manufacturers would influence their prescribing/dispensing practice.

CONCLUSIONS

Overall, our findings demonstrate a knowledge gap among patients towards the perception of generics, perceiving generics are less effective and inferior in quality compared to their branded equivalents. The majority of physicians reported a very low generic medicine prescribing rate and the majority pharmacy professionals' dispensing practice was influenced by drug advertisements. Hence, a customized educational program should be developed and implemented to patients, prescribers and dispensers so as to boost the acceptability of generic medicines and increase generic prescribing and/or substitution.

Prevalence and correlates of herbal medicine use among type 2 diabetic patients in Teaching Hospital in Ethiopia: a cross-sectional study

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) patients are increasingly using herbal remedies due to the fact that sticking to the therapeutic regimens is becoming awkward. However, studies towards herbal medicine use by diabetic patients is scarce in Ethiopia. Therefore, the aim of the current study was to explore the prevalence and correlates of herbal medicine use with different sociodemographic variables among type 2 diabetes patients visiting the diabetic follow-up clinic of University of Gondar comprehensive specialized hospital (UOGCSH), Ethiopia.

METHODS

A hospital-based cross sectional study was employed on 387 T2DM patients visiting the diabetes illness follow-up care clinic of UOGCSH from October 1 to November 30, 2016. An interviewer-administered questionnaire regarding the demographic and disease characteristics as well as herbal medicine use was completed by the study subjects. Descriptive, univariate and multivariate logistic regression statistics were performed to determine prevalence and come up with correlates of herbal medicine use.

RESULTS

From 387 participants, 62% were reported to be herbal medicine users. The most prevalent herbal preparations used were Garlic (Allium sativum L.) (41.7%), Giesilla (Caylusea abyssinica (fresen.) (39.6%), Tinjute (Otostegia integrifolia Benth) (27.2%), and Kosso (Hagenia abyssinicaa) (26.9%). Most of herbal medicine users (87.1%) didn't consult their physicians about their herbal medicine use. Families and friends (51.9%) were the frontline sources of information about herbal medicine followed by other DM patients who used herbal medicines (28.9%).

CONCLUSIONS

The present study revealed a high rate of herbal medicine use along with a very low rate use disclosure to the health care professionals. Higher educational status, a family history of DM, duration of T2DM and presence of DM complications were identified to be strong predictors of herbal medicine use. From the stand point of high prevalence and low disclosure rate, it is imperative for health care providers to strongly consult patients regarding herbal medicine use.

Pattern of Chemotherapy-Related Adverse Effects Among Adult Patients With Cancer Treated at Gondar University Referral Hospital, Ethiopia: A Cross-Sectional Study

Abstract 32

Purpose

Adverse drug reactions (ADRs) are a global problem and constitute a major clinical problem in terms of human suffering. The high toxicity and narrow therapeutic index of chemotherapeutic agents makes oncology pharmacovigilance essential. The objective of the current study was to assess the pattern of ADRs that occur in patients with cancer who were treated with chemotherapy in a tertiary care teaching hospital in Ethiopia.

Methods

A cross-sectional study over a 2-year period from September 2013 to August 2015 was conducted in patients with cancer who underwent chemotherapy at Gondar University Referral Hospital Oncology Center. Data were collected directly from patients and their medical case files. Reported ADRs were assessed for causality using the WHO causality assessment scale and Naranjo’s algorithm. Severities of the reported reactions were also assessed using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). Pearson’s χ2 test was used to examine the association between two categorical variables.

Results

A total of 815 ADRs were identified from 203 patients who were included in the study. The most commonly occurring ADRs were nausea and vomiting (18.9%), infections (16.7%), neutropenia (14.7%), fever and/or chills (11.3%), and anemia (9.3%). Platinum compounds (31.4%) were the most common group of drugs that caused ADRs. Of reported ADRs, 65.8% were grades 3 to 4 (severe level), 29.9% were grades 1 to 2 (mild level), and 4.3% were grade 5 (toxic level). Significant association was found between age, number of chemotherapeutic agents, and dose of chemotherapy with the occurrence of grades 3 to 5 toxicity.

Conclusion

The high incidence of chemotherapy-related ADRs among patients with cancer is of concern. Establishing an effective ADR monitoring and reporting system—oncopharmacovigilance—and creating awareness among health care professionals of the importance of ADR reporting may help prevent the problem.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.

Comprehensive Knowledge and Uptake of Cervical Cancer Screening Is Low Among Women Living With HIV/AIDS: The Case of Northwestern Ethiopia

Abstract 1

Purpose

In Ethiopia, cervical cancer is the second most common type of cancer in women, and is approximately 8 times more common in HIV-infected women; however, data on the knowledge of HIV-infected women of cervical cancer and the acceptability of screening is scarce in Ethiopia. The current study aimed to assess the level of knowledge of cervical cancer and the uptake of screening among HIV-infected women in Gondar in northwestern Ethiopia.

Methods

A cross-sectional, questionnaire-based survey was conducted in 302 HIV-infected women who attended the outpatient clinic of the University of Gondar referral and teaching hospital from March 1, 2017, to March 30, 2017. Descriptive statistics and univariable and multivariable logistic regression analyses were also performed to examine factors that are associated with the uptake of cervical cancer screening service.

Results

Overall, only 64 respondents (21.2%) were knowledgeable about cervical cancer and screening, and only 71 respondents (23.5%) underwent screening in their lifetimes. Age between 21 years and 29 years (adjusted odds ratio [AOR], 2.78; 95% CI, 1.71 to 7.29), perceived susceptibility to the development of cervical cancer (AOR, 2.85; 95% CI, 1.89 to 6.16), and comprehensive knowledge of cervical cancer (AOR, 3.02; 95% CI, 2.31 to 7.15) were found to be strong predictors of cervical cancer screening service uptake.

Conclusion

Knowledge and uptake of cervical cancer screening among HIV-infected women was found to be poor. Taking into consideration the heightened importance of comprehensive knowledge for increasing the number of participants in cervical cancer screening services, different stakeholders working on cancer and HIV/AIDS should provide a customized health promotion intervention for, and create awareness among, HIV-infected women, as well as improve the accessibility of cervical cancer screening services in rural areas.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.

Management of minor ailments in a community pharmacy setting: Findings from simulated visits and qualitative study in Gondar town, Ethiopia

Community pharmacy professionals are being widely accepted as sources of treatment and advice for managing minor ailments, largely owing to their location at the heart of the community. The aim of the present study was, therefore, to document the involvement of community pharmacy professionals in the management of minor ailments and perceived barriers that limit their provision of such services. Simulated patient (SP) visits combined with a qualitative study using in-depth interviews was conducted among community pharmacy professionals in Gondar town, Northwest Ethiopia. Scenarios of three different minor ailments (uncomplicated upper respiratory tract infection, back pain and acute diarrhea) were selected and results were reported as percentages. Pharmacy professionals were also interviewed about the barriers in the management of minor ailments. Out of 66 simulated visits, 61 cases (92.4%) provided one or more medications to the SPs. Pharmacy professionals in 16 visits asked SPs information on details of symptoms and past medical and medication history. Ibuprofen alone or in combination with paracetamol was the most commonly dispensed analgesics for back pain. Oral rehydration fluid (ORS) with zinc was the most frequently dispensed medication (33.3%) for the management of acute diarrhea followed by mebendazole (23.9%). Moreover, amoxicillin-clavulanic acid capsule (35%) followed by Amoxicillin (25%) were the most commonly dispensed antibiotics for uncomplicated upper respiratory tract infection. Lack of clinical training and poor community awareness towards the role of community pharmacists in the management of minor ailments were the main barriers for the provision of minor ailment management by community pharmacy professionals. Overall, community pharmacists provided inadequate therapy for the simulated minor ailments. Lack of access to clinical training and poor community awareness were the most commonly cited barriers for providing such services. So as to improve community pharmacists' involvement in managing minor ailments and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

Comprehensive knowledge and uptake of cervical cancer screening is low among women living with HIV/AIDS in Northwest Ethiopia

Background

In Ethiopia, cervical cancer is ranked as the second most common type of cancer in women and it is about 8 times more common in HIV infected women. However, data on knowledge of HIV infected women regarding cervical cancer and acceptability of screening is scarce in Ethiopia. Hence, the present study was aimed at assessing the level of knowledge of about cervical cancer and uptake of screening among HIV infected women in Gondar, northwest Ethiopia.

Methods

A cross sectional, questionnaire based survey was conducted on 302 HIV infected women attending the outpatient clinic of University of Gondar referral and teaching hospital from March 1 to 30, 2017. Descriptive statistics, univariate and multivariate logistic regression analysis were also performed to examine factors associated with uptake of cervical cancer screening service.

Results

Overall, only 64 (21.2%) of respondent were knowledgeable about cervical cancer and screening and only 71 (23.5%) of respondents were ever screened in their life time. Age between 21 and 29 years old (AOR = 2.78, 95% CI = 1.71–7.29), perceived susceptibility to develop cervical cancer (AOR =2.85, 95% CI = 1.89–6.16) and comprehensive knowledge of cervical cancer (AOR = 3.02, 95% CI = 2.31–7.15) were found to be strong predictors of cervical cancer screening service uptake.

Conclusion

The knowledge and uptake of cervical cancer screening among HIV infected women was found to be very poor. Taking into consideration the heightened importance of comprehensive knowledge in boosting up the number of participants towards cervical cancer screening services, different stakeholders working on cancer and HIV/AIDS should provide a customized health promotion intervention and awareness creation to HIV-infected women, along with improving accessibility of cervical cancer screening services in rural areas.

Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance

Background

The emergence of antimicrobial resistance, the main cause of morbidity and mortality from otherwise treatable infections, is largely attributed to the inappropriate use of antimicrobials. However, data on the extent of inappropriate use of antibiotics in the community is scarce in Ethiopia. The aim of present study is to document the extent of inappropriate use of antibiotics and its associated factors among the communities of Gondar, Northwest Ethiopia.

Methods

A community based cross-sectional survey was conducted on a total of 650 participants in Gondar town, northwest Ethiopia from December 1, 2016 to January 30, 2017. Descriptive statistics, univariate and multivariate logistic regression analysis were also performed to express different variables and to examine factors associated with inappropriate use of antibiotics.

Results

According to the finding of our study, 315 (48.5%) of the participants took antibiotics in the past 1 year, of which 115 (35.9%) of them used inappropriately. Amoxicillin (72%) was the most commonly utilized antibiotics and respiratory tract infection (40.9%) was the most common disease condition to which antibiotics had been sought. About 36.8% of the respondents got antibiotics from community drug retail outlets without a prescription and 67.9% of respondents had discontinued the use of antibiotics once their symptoms subside. Low educational status (AOR = 5.01, 95% CI = 2.62–9.34), being employed (AOR = 2.12, 95% CI = 1.81–7.29) and unsatisfied with health care services provided (AOR = 5.41, 95% CI = 2.71-14.21) were found to be strong predictors of inappropriate use of antibiotics use among the community.

Conclusion

Inappropriate use of antibiotics was found to be considerably high in the communities of Gondar, northwest Ethiopia. Taking into consideration the heightened importance of comprehensive knowledge in the rational use of antibiotics, different stakeholders working in the public health sectors should provide a comprehensive and customized education to the public so as to improve their knowledge about antibiotics. It is also essential to adopt a strong and explicit line of actions towards the accessibility of antibiotics without a valid prescription in community medicine retail outlets.

The role of community pharmacists in patient counseling and health education: a survey of their knowledge and level of involvement in relation to type 2 diabetes mellitus

PURPOSE

The present study aimed at evaluating the knowledge and level of involvement of community pharmacists in the provision of patient counseling and health education services for patients with DM and perceived barriers that limit the delivery of such services.

MATERIALS AND METHODS

A self-administered questionnaire based-survey was undertaken from January to March, 2017 with 412 pharmacists working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya, and Debre Birhan. Descriptive statistics, ANOVA, and Student's t-test were employed to examine different variables.

RESULTS

Community pharmacists were found to have poor knowledge and low level of involvement, with an overall mean score of 11.54 and 2.06, respectively. A significant number of community pharmacists never practiced promoting smoking cessation (45.2%), counseling on good foot care techniques (33.7%), and counseling on the potential impact of over-the-counter and herbal drugs on DM management (34%). On the other hand, describing the right time to administer antidiabetic medications (46%) and counseling on suitable administration, handling, and storage of insulin (33.7%) were done more frequently. The main reported barriers to the delivery of these services were lack of knowledge or clinical skills, lack of access to additional training programs, and lack of personnel or resources.

CONCLUSION

The present study revealed a poor knowledge and low level of involvement in counseling and health education services for patients with DM. Lack of knowledge or clinical skills was the most commonly reported barrier for providing such services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

The changing trend of cardiovascular disease and its clinical characteristics in Ethiopia: hospital-based observational study

Objective

The aim of this study was to assess the pattern of cardiovascular diseases (CVDs), their clinical characteristics, and associated factors in the outpatient department of the chronic illness clinic of Gondar University Referral Hospital.

Method

A retrospective cross-sectional study was conducted among patients on follow-up at the outpatient chronic illness clinic of the hospital from October 2010 to October 2015. The source population for the study included patients with a diagnosis of CVD whose medical records have the required socio-demographic information during the study period. The data were collected from August 2015 to December 2015. Chi-square and binary logistic regression tests were performed to test the significance of difference among predictive variables and CVDs.

Results

Of 1105 patient medical records, 862 fulfilled the inclusion criteria. The majority of the patients were females (65%) and living in urban areas (62.7%). Hypertension accounted for the majority (62.3%) of CVDs followed by heart failure (HF) (23.9%). Headache was the leading chief complaint among the patients (37.7%) upon diagnosis and was the prominent clinical feature in more than half of the patients during their course of follow-up. Higher proportions of dyslipidemia (85.7%), hypertension (72.8%), and ischemic heart disease (IHD) (73.2%) were associated with urban residency (P<0.01). Patients from rural areas (crude odds ratio [COR] =1.306 [95% confidence interval 1.026–2.166], adjusted odds ratio [AOR] =1.272 [95% confidence interval 1.017–2.030]) and those with comorbidity illnesses (COR= 1.813 [1.279–2.782], AOR =1.551 [95% confidence interval 1.177–2.705]) were more likely to have poor CVD outcome (P<0.05).

Conclusion

Hypertension was found to be the most frequent CVD followed by HF, and hypertensive heart disease was the leading cause of cardiac diseases. Most of the patients had improved assessment in the last follow-up, but patients from rural regions and those with comorbidty had higher likelihood of poor cardiovascular outcome.

Preferred Information Sources and Needs of Patients With Cancer on Disease Symptoms and Management: A Cross-Sectional Study

Abstract 3

Background:

The provision of appropriate information to patients with cancer has a weighty impact on heightening the quality of cancer care across the whole community of patients with cancer. Diagnosis and management of cancer require patients to be aware of their disease. This study aimed at identifying the information needs of patients with cancer, their preferences for the means of receiving health information, and the perceived level of satisfaction of existing possibilities for acquiring cancer-related information in Ethiopia.

Methods:

An institutional-based cross-sectional survey was administered to 556 patients with cancer who were undergoing chemotherapy in the oncology wards of Gondar University Referral Hospital and Tikur Anbesa Specialized Hospital. Data were collected through an interviewer-administered questionnaire.

Results:

Information regarded as most important by the majority of patients (67.26%) concerned that of the specific type of cancer (name and stage of cancer), followed by information on the adverse effects of chemotherapy and their management (63.29%) and prognosis (survival; 51.8%). Doctors, overwhelmingly, were the source of information about cancer (88.8%), followed by nurses (34%). The majority of respondents (70.3%) were not satisfied at all or only a little satisfied, whereas 15.6% of respondents reported that they were “quite” or “very” satisfied with the existing possibilities for acquiring information regarding cancer.

Conclusion:

Medical practitioners other than doctors and nurses, such as clinical pharmacists, should support and identify measures that can enhance patient satisfaction regarding existing possibilities for acquiring information about cancer. Periodic assessment of the information requirements of a patient with cancer is also crucial, considering the ever-changing dynamics of priorities of such information desires.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.

Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: a cross-sectional study

BACKGROUND

Improving maternal and child health is one of the public health priorities in several African countries including Ethiopia. However, research on herbal medicine use during pregnancy is scarce in Ethiopia. The present study aimed at assessing the prevalence and correlates of herbal medicine use among pregnant women on antenatal care (ANC) follow-up at Gondar university referral hospital, Ethiopia METHODS: An institutional-based cross sectional study was conducted on 364 pregnant women attending ANC clinic from March to May 2016 at University of Gondar referral and teaching hospital, northwest Ethiopia. Data on socio-demography, pregnancy related information as well as herbal medicine use was collected through an interviewer-administered questionnaire. Descriptive statistics, univariate and multivariate logistic regression analysis were performed to determine prevalence and associated factors of herbal medicine use.

RESULTS

From 364 respondents, 48.6% used herbal medicine during current pregnancy. ginger (40.7%) and garlic (19%) were the two most commonly used herbs in pregnancy. Common cold (66%) and inflammation (31.6%) were the most common reasons for herbal use. Majority of herbal medicine users (89.8%) had not consulted their doctors about their herbal medicine use. Rural residency (Adjusted odds ratio (AOR): 3.15, Confidence interval (CI): 1.17-6.14), illiteracy (AOR: 4.05, CI: 2.47-6.62) and average monthly income less than 100 USD (AOR: 3.08CI: 1.221-7.77) were found to be strong predictors of herbal medicine use.

CONCLUSIONS

The use of herbal medicine during pregnancy is a common practice and associated with residency, level of education and average monthly income. From the stand point of high prevalence and low disclosure rate, the health care providers should often consult pregnant women regarding herbal medicine use.

Pattern of chemotherapy-related adverse effects among adult cancer patients treated at Gondar University Referral Hospital, Ethiopia: a cross-sectional study

BACKGROUND

Adverse drug reactions (ADRs) are a global problem and constitute a major clinical problem in terms of human suffering. The high toxicity and narrow therapeutic index of chemotherapeutic agents makes oncology pharmacovigilance essential. The objective of the present study was to assess the pattern of ADRs occurring in cancer patients treated with chemotherapy in a tertiary care teaching hospital in Ethiopia.

METHODS

A cross-sectional study over a 2-year period from September 2013 to August 2015 was conducted on cancer patients undergoing chemotherapy at Gondar University Referral Hospital Oncology Center. Data were collected directly from patients and their medical case files. The reported ADRs were assessed for causality using the World Health Organization's causality assessment scale and Naranjo's algorithm. The severities of the reported reactions were also assessed using National Cancer Institute Common Terminology CTCAE version 4.0. The Pear-son's chi-square test was employed to examine the association between two categorical variables.

RESULTS

A total of 815 ADRs were identified per 203 patients included in the study. The most commonly occurring ADRs were nausea and vomiting (18.9%), infections (16.7%), neutropenia (14.7%), fever and/or chills (11.3%), and anemia (9.3%). Platinum compounds (31.4%) were the most common group of drugs causing ADRs. Of the reported ADRs, 65.8% were grades 3-4 (severe level), 29.9% were grades 1-2 (mild level), and 4.3% were grade 5 (toxic level). Significant association was found between age, number of chemotherapeutic agents, as well as dose of chemotherapy with the occurrence of grades 3-5 toxicity.

CONCLUSION

The high incidence of chemotherapy-related ADRs among cancer patients is of concern. Setting up an effective ADR monitoring and reporting system (onco-pharmacovigilance) and creating awareness among health care professionals regarding the importance of ADR reporting may help prevent the problem.

Extent of dispensing prescription-only medications without a prescription in community drug retail outlets in Addis Ababa, Ethiopia: a simulated-patient study

PURPOSE

This study was aimed at assessing the extent of dispensing prescription-only medications without a prescription in community drug retail outlets (CDROs) of Addis Ababa, Ethiopia.

METHODS

A descriptive cross-sectional observational study design was used to sample 31 pharmacies, 25 drug stores, and two rural drug vendors from August 11, 2015, to October 21, 2015, through a simple random sampling method. A simulated-patient method of visit was implemented to collect data. Requests of six tracer prescription-only medicines (amoxicillin + clavulanic acid capsule, amitriptyline, captopril, glibenclamide [also known as glyburide], omeprazole capsule, and sildenafil citrate) and upper respiratory tract infection were selected as the simulated clinical scenario.

RESULTS

Amoxicillin-clavulanic acid capsule was dispensed when requested in 87.93% of the dispensaries. All of the CDROs dispensed omeprazole upon request. Sildenafil citrate (Viagra) was in stock in 96.55% of the CDROs, all of which issued the requested number of tablets without asking why or for whom the drug was needed. Amitriptyline, captopril, and glibenclamide (glyburide) were dispensed in 84.48%, 89.65%, and 87.93% of CDROs upon the provision of an empty container. Antibiotics were obtained from 75.86% of CDROs for presentation of upper respiratory tract infection symptoms. Among the dispensed antibiotics, the most common was amoxicillin (93.18%), followed by amoxicillin-clavulanic acid capsule (72.72%), and azithromycin (50%). Only 4.5% of the dispensaries asked about drug allergies, and 15.9% of the CDROs informed the simulated patient about the possible side effects of the drugs.

CONCLUSION

This study revealed a very high rate of dispensing of prescription-only medicines without a prescription. Antimicrobials and drugs for chronic diseases were obtained with ease from almost all of the randomly sampled CDROs. Putting good dispensing practice into effect and adhering to the existing national laws and regulations regarding the same are necessary. It is also necessary to adopt a strong and explicit line of action, especially toward the irrational use of antibiotics.

Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV/AIDS in Gondar University Referral Hospital, northwestern Ethiopia: a retrospective cross-sectional study

PURPOSE

Cotrimoxazole preventive therapy (CPT) is a feasible, inexpensive, and well-tolerated way of using cotrimoxazole intervention for patients living with HIV/AIDS to reduce HIV/AIDS-related morbidities and mortalities caused by various bacteria, fungi, and protozoa. The aim of this study was to evaluate the use of cotrimoxazole as a prophylaxis therapy among patients living with HIV/AIDS at Gondar University Referral Hospital (GURH), northwestern Ethiopia.

MATERIALS AND METHODS

A retrospective cross-sectional study was used to evaluate the use of cotrimoxazole as a prophylaxis therapy among people living with HIV/AIDS at GURH, northwestern Ethiopia from September 2013 to October 2015. Medical records of 264 patients were selected by using systematic random sampling technique from the sampling frame list of all patients' medical records. Data were collected from patients' medical records using the structured checklist and evaluated against World Health Organization (WHO) guidelines on the use of cotrimoxazole prophylaxis. The quantitative data were analyzed using the statistical packages for social sciences Version 20. Descriptive and binary logistic regression analyses were used to describe and assess the association between different variables.

RESULTS

Approximately 95 (36.0%) patients were at WHO clinical stage III at the start of CPT. The use of CPT was consistent with the guidelines in the rationale for indication 200 (75.75%) and dose 263 (99.62%), despite the presence of contraindications in 24 (9.90%) patients. The occurrence of cotrimoxazole-associated side effects was higher in the first month of therapy. Problems regarding drug-drug interactions were identified in 63 (23.86%) patients, and 92 (34.84%) patients discontinued CPT due to different reasons.

CONCLUSION

Although the practice of discontinuation of CPT and follow-up for adverse drug effects were not consistent with WHO guidelines on the rational use of cotrimoxazole prophylaxis, the use of CPT among people living with HIV/AIDS at GURH was appropriate. Health professionals who were working in the antiretroviral therapy units should update themselves and adhere to the available updated guidelines to reduce the occurrence of adverse effects and prophylaxis failure.

Preferred information sources and needs of cancer patients on disease symptoms and management: a cross-sectional study

PURPOSE

This study aimed at identifying the information needs of cancer patients, their preferences for the means of receiving health information, and the perceived level of satisfaction of existing possibilities for acquiring cancer-related information in Ethiopia.

MATERIALS AND METHODS

An institutional-based cross-sectional survey was employed on 556 cancer patients undergoing chemotherapy in the oncology wards of Gondar University Referral Hospital and Tikur Anbesa Specialized Hospital. Data were collected through interviewer-administered questionnaire.

RESULTS

The principal information regarded as the most important by the majority of them (67.26%) concerned information on the specific type of cancer (name and stage of cancer), followed by the side effects of chemotherapy and their management (63.29%) and "prognosis (survival)" (51.8%). Doctors were the overwhelming information source about cancer (88.8%), followed by nurses (34%). The majority of respondents (70.3%) were not satisfied at all or satisfied a little, while 15.6% of respondents reported that they were "quite" or "very" satisfied with the existing possibilities for acquiring information regarding cancer.

CONCLUSION

Medical practitioners other than doctors and nurses such as clinical pharmacists should support and identify measures that can enhance patients' satisfaction level regarding the existing possibilities for acquiring information regarding cancer. Periodic assessment of cancer patient's information requirements is also crucial, considering the ever-changing dynamics of priorities of such information desires.

Knowledge and Self-Reported Practice of Insulin Injection Device Disposal among Diabetes Patients in Gondar Town, Ethiopia: A Cross-Sectional Study

Background. Incorrect sharp disposal practices may expose the public to needle-stick injuries. The present study aimed at assessing the knowledge and practice of diabetic patients towards insulin injection device disposal in Gondar town, Ethiopia. Methods. A cross-sectional study was employed on insulin requiring diabetes patients who visited the diabetes clinic at Gondar University Referral Hospital (GURH) from February 1 to March 28, 2016. Frequencies, percentages, and ANOVA (analysis of variance) and Student's t-test were used to analyze variables. Results. About half of the participants (49.5%) had poor knowledge towards safe insulin injection waste disposal. More than two-thirds (80.7%) of respondents had poor practice and 64.3% of respondents did not put insulin needle and lancets into the household garbage. 31% of respondents threw sharps on street when they travel outside. Respondents living in urban areas had a higher mean of knowledge and practice score than those who live in rural area. Conclusions. This study revealed that knowledge and practice of diabetic patients were low towards safe insulin injection waste disposal in study area. Healthcare providers should also be aware of safe disposing system and counsel patients on appropriate disposal of used syringes.

Expectation and satisfaction of HIV/AIDS patients toward the pharmaceutical care provided at Gondar University Referral Hospital, Northwestern Ethiopia: a cross-sectional study

PURPOSE

Measurements of patient satisfaction help to assess the performance of health service provision and predict treatment adherence and outcomes. This study aimed to assess human HIV/AIDS patients' expectation of and satisfaction with the pharmaceutical service delivered at Gondar University Referral Hospital, Ethiopia.

PATIENTS AND METHODS

An institution-based cross-sectional study was performed from May 11 to 25, 2015. A total of 291 patients living with HIV/AIDS were included using a simple random sampling method. Data were collected using structured questionnaires measuring expectation and satisfaction of respondents using a Likert scale of 1-5 through face-to-face interviews. The data collected were entered into and analyzed using Statistical Packages for Social Sciences. Comparison was made between those respondents who lived in and outside the town.

RESULTS

The overall mean expectation and satisfaction of respondents toward pharmacy setting and services were 3.62 and 3.13, respectively. More than half (56.1%) of the participants were dissatisfied with the comfort and convenience of waiting area and private counseling room. Similarly, 69.3% of the respondents claimed that pharmacy professionals did not give information about side effects and drug-drug and drug-food interactions of antiretroviral medications. There was a statistically significant difference between respondents who live in and outside Gondar town in overall expectation (t=3.415, P=0.001) with the pharmacy setting and services.

CONCLUSION

In this study, the overall satisfaction level of respondents with pharmaceutical service (pharmacy setting and services) provided at Gondar University Referral Hospital was found to be low, while the overall respondents' expectation from the pharmaceutical services were exceedingly high. The hospital should implement good dispensing practice systems in relation to the services and continuing professional development to professionals in order to improve the satisfaction of patients.