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Kilonzi M, Mutagonda RF, Mwakawanga DL, Mlyuka HJ, Mikomangwa WP, Kibanga WA, Marealle AI, Mallya B, Katabalo D, Sanga S, Kalokola F, Rwegasha J, Magambo R, Mmassy J, Kabissi S, Balati JA, Maduki P, Minzi OM, Kamuhabwa AAR. Establishment of clinical pharmacy services: evidence-based information from stakeholders. Hum Resour Health 2024; 22:6. [PMID: 38200603 PMCID: PMC10782669 DOI: 10.1186/s12960-023-00887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
High morbidity and mortality related to the use of drugs resulted in demand for clinical pharmacy services (CPS) globally. In developed countries, the evolution of pharmacists' role in direct patient care started in the 1960s. The participation of pharmacists in CPS has resulted in positive clinical, economic, and humanistic outcomes. In developing countries, efforts have started to ensure pharmacists are engaged in the provision of CPS. However, the efforts are hampered by poorly defined pharmacist career paths, financial constraints, and a lack of political willingness. In Tanzania, efforts started in 2008, in which CPS was introduced into the Bachelor of Pharmacy curriculum, followed by the initiation of a postgraduate program on hospital and clinical pharmacy in 2013. A regulation was released by the Tanzania Ministry of Health in 2020 to enforce pharmacists' engagement in providing CPS. In 2021, a project was launched in the country, aiming to strengthen the provision of CPS in public and faith-based hospitals by training on-job pharmacists. The project was implemented in phases, including stakeholders' engagement, baseline survey, training, and supportive supervision of the trained pharmacists. Therefore, this commentary aims to share what we experienced during project implementation, the achievements, challenges, and key lessons learned.
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Affiliation(s)
- Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania.
| | - Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. BOX 65001, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Wema A Kibanga
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Bertha Mallya
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Deogratias Katabalo
- School of Pharmacy, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - Sofia Sanga
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar es Salaam, Tanzania
| | - Fredrick Kalokola
- School of Medicine, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - John Rwegasha
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar es Salaam, Tanzania
| | - Rose Magambo
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - John Mmassy
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Sungwa Kabissi
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Josephine A Balati
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Peter Maduki
- Christian Social Services Commission, P.O. BOX 9433, Dar es Salaam, Tanzania
| | - Omary Mashiku Minzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar es Salaam, Tanzania
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Kilonzi M, Mutagonda RF, Mlyuka HJ, Mwakawanga DL, Mikomangwa WP, Kibanga WA, Marealle AI, Mallya B, Katabalo D, Sanga S, Kalokola F, Rwegasha J, Magambo R, Mmassy J, Kabissi S, Balati JA, Maduki P, OmaryMashikuMinzi, Kamuhabwa AAR. Barriers and facilitators of integration of pharmacists in the provision of clinical pharmacy services in Tanzania. BMC Prim Care 2023; 24:72. [PMID: 36932338 PMCID: PMC10021921 DOI: 10.1186/s12875-023-02026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Collaboration between medical doctors and nurses in the provision of healthcare services has been there for decades. The concept of clinical pharmacy services as a main goal for pharmacy practice is relatively new and is yielding more positive results for healthcare providers (HCPs), patients, and the health system. This study assessed barriers and facilitators toward the integration of pharmacists in the provision of CPS in Tanzania. METHODS A qualitative study was conducted in five tertiary hospitals representing Tanzania mainland. Ten (10) focus group discussions (FGDs) with 83 HCPs and 14 in-depth interviews (IDIs) with hospital administrators in referral hospitals were conducted between August and September 2021. The experienced qualitative researchers moderated the IDIs and FGDs, and all discussions were audio-recorded. Finally, the audios were transcribed verbatim, and analysis was done using a thematic approach. RESULTS Limited skills, lack of confidence, poor communication, inferiority, and superiority behaviors among HCPs were among the mentioned barriers. Shortage of pharmacists, lack of in-job training, standard operating procedures (SOPs), and guidelines were also mentioned. The study noted the high acceptability of CPS by other HCPs, the positive perception of pharmacists, and the recognition of CPS by the Tanzania Pharmacy Act and regulation. CONCLUSION The facilitators and barriers to the integration of pharmacists in the provision of CPS lie at the individual, health facility, and health system levels. Therefore, the study recommends in-job pharmacists training, fostering teamwork among HCPs, and development of CPS SoPs, and guidelines.
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Affiliation(s)
- Manase Kilonzi
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania.
| | - Ritah F Mutagonda
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65001, Dar Es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Wema A Kibanga
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Bertha Mallya
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Deogratias Katabalo
- School of Pharmacy, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - Sofia Sanga
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar Es Salaam, Tanzania
| | - Fredrick Kalokola
- School of Medicine, the Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania
| | - John Rwegasha
- Department of Internal Medicine, Muhimbili National Hospital, P. O. BOX 65000, Dar Es Salaam, Tanzania
| | - Rose Magambo
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - John Mmassy
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Sungwa Kabissi
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Josephine A Balati
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - Peter Maduki
- Christian Social Services Commission (CSSC), P.O BOX 9433, Dar Es Salaam, Tanzania
| | - OmaryMashikuMinzi
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P. O. BOX 65013, Dar Es Salaam, Tanzania
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Kibanga W, Mutagonda RF, Moshiro R, Mareale A, Kilonzi M, Mlyuka HJ, Mikomangwa WP, Kunambi PP, Kamuhabwa A, Minzi OM. Effectiveness of antenatal dexamethasone in reducing respiratory distress syndrome and mortality in preterm neonates: a nested case control study. BMC Pediatr 2023; 23:94. [PMID: 36859189 PMCID: PMC9976379 DOI: 10.1186/s12887-023-03887-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is a significant cause of preterm neonatal morbidity and mortality globally. Measures like the use of antenatal corticosteroids (ACS) and immediate resuscitation of the newborn after birth are taken to abate preterm related complications. Most studies that evidenced the benefit of ACS were done in high resource settings. Therefore, this study was conducted to assess the effectiveness of ACS in reducing RDS and neonatal mortality in preterm neonates in resource-limited settings. METHODS A three months prospective nested case-control study (1:2 unmatched) was conducted at Muhimbili National Hospital and Amana regional referral hospital in Dar es salaam, Tanzania. Neonates delivered at 28 to 34 gestational weeks were enrolled and followed up until discharge. Data analysis was done using the statistical package of social sciences version 23. Logistic regression analysis was used to determine the effect of ACS on the RDS and mortality in the cohort, controlling for important maternal and neonatal variables. All tests were considered statistically significant at p < 0.05. RESULTS Out of 330 preterm neonates enrolled, 110 were cases and 220 were controls. The median gestational age at delivery was 30 weeks and 6 days (IQR 4.68) among cases and 33 weeks (IQR 3) among controls. One-minute APGAR score of < 7 (AOR: 3.11; 95% CI 1.54-6.30), and neonatal birth weight (AOR: 0.998; 95% CI 0.997-0.999) were significantly associated with RDS. No significant association was observed between ACS exposure and RDS occurrence (AOR: 1.65; 95% CI 0.86 - 3.15). The overall mortality rate was 9 per 1000 neonates. Neonatal mortality occurred only among cases whereby, a unit increase in gestational age was associated with a 30% reduction in neonatal mortality (Adjusted hazard ratio, AHR: 0.70, 95% CI: 0.5-0.92, p = 0.011). CONCLUSION Decrease in gestational age, one minute APGAR score of < 7 and decreasing birth weight were associated with RDS among preterm neonates. ACS was not associated with reduced RDS occurrence and neonatal mortality rates. Moreover, increase in gestation age was the only factor found to be protective against preterm neonatal mortality.
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Affiliation(s)
- Wema Kibanga
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania.
| | - Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Robert Moshiro
- Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Alphonce Mareale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Peter P Kunambi
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Omary Mashiku Minzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
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Ngunyali DA, Mpomele SS, Kilonzi M, Mutagonda RF, Mikomangwa WP, Mlyuka HJ, Kibanga W, Marealle AI. Knowledge and participation in mass drug administration against lymphatic filariasis and soil-transmitted helminth infections among the community members in Dar es Salaam, Tanzania. Trans R Soc Trop Med Hyg 2022; 117:358-364. [PMID: 36563099 PMCID: PMC10153728 DOI: 10.1093/trstmh/trac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although the WHO has made an effort to ensure optimal participation of the community in mass drug administration (MDA) against lymphatic filariasis (LF) and soil-transmitted helminth infections (STHIs), studies are still reporting suboptimal coverage. This study assessed the knowledge and participation of the community in MDA against LF and SHTIs in Tanzania to provide updates on its acceptability. METHODS A cross-sectional study was conducted in Dar es Salaam from December 2021 to February 2022 among market vendors. The information regarding demographic characteristics, knowledge and participation in MDA was collected using a questionnaire. Statistical Package for Social science version 26 was used for data analysis. RESULTS More than half of the participants demonstrated an adequate level of knowledge of LF and STHI, 212 (50.8%) and 267 (64%), respectively. Only 286 (68.5%) reported having heard about MDA against LF and STHIs, out of which 119 (42%) had taken the medication. Of those who disagreed to participate in MDA, 20 (50%) claimed to fear the side effects of the medication. CONCLUSIONS This study found that the community has average knowledge and poor participation in MDA against LF and STHIs. Community sensitization is recommended to increase the participation of the community.
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Affiliation(s)
- Diana A Ngunyali
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Stella S Mpomele
- School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Wema Kibanga
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, the Muhimbili University of Health and Allied Sciences, P O Box 65013, Dar es Salaam, Tanzania
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Myemba DT, Maganda BA, Kibwana UO, Nkinda L, Ndayishimiye P, Kilonzi M, Mikomangwa WP, Njiro BJ, Ndumwa HP, Mlyuka HJ, Felix FF, Mwakawanga DL, Kunambi PP, Sambayi G, Costantine JK, Marealle AI, Mutagonda R, Makuka GJ, Kubigwa SW, Sirili N, Mwakalukwa R, Mfaume R, Nshau AB, Bwire GM, Nyankesha E, Scherpbier RW. Profiling of antimicrobial dispensing practices in accredited drug dispensing outlets in Tanzania: a mixed-method cross-sectional study focusing on pediatric patients. BMC Health Serv Res 2022; 22:1575. [PMID: 36564772 PMCID: PMC9783391 DOI: 10.1186/s12913-022-08980-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The emergency of antimicrobial resistance due to irrational antimicrobial use has put public health under threat. Accredited Drug Dispensing Outlets (ADDOs) play an important role in enhancing availability and accessibility of antimicrobials, however, there is a scarcity of studies assessing antimicrobial dispensing practices in these outlets, focusing on children in Tanzania. OBJECTIVE This study was conducted to assess the antimicrobial dispensing practices among ADDO dispensers and explore the factors influencing the use of antimicrobials for children in Tanzania. METHODS A community-based cross-sectional study utilizing both qualitative (interviews) and quantitative (simulated clients) methods was conducted between June and September 2020 in seven zones and 14 regions in Tanzania. RESULTS The study found inappropriate dispensing and use of antimicrobials for children, influenced by multiple factors such as patient's and dispenser's knowledge and attitude, financial constraints, and product-related factors. Only 8% (62/773) of dispensers asked for prescriptions, while the majority (90%) were willing to dispense without prescriptions. Most dispensers, 83% (426/513), supplied incomplete doses of antimicrobials and only 60.5% (345/570) of the dispensers gave proper instructions for antimicrobial use to clients. Over 75% of ADDO dispensers displayed poor practice in taking patient history. CONCLUSION ADDO dispensers demonstrated poor practices in dispensing and promoting rational antimicrobial use for children. Training, support, and regulatory interventions are required to improve antimicrobial dispensing practices in community drug outlets.
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Affiliation(s)
- David T. Myemba
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Betty A. Maganda
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Upendo O. Kibwana
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Lilian Nkinda
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Pacifique Ndayishimiye
- grid.10818.300000 0004 0620 2260School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 4285, Kigali, Rwanda
| | - Manase Kilonzi
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Wigilya P. Mikomangwa
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Belinda J. Njiro
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Harrieth P. Ndumwa
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Hamu J. Mlyuka
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Fatuma F. Felix
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Dorkasi L. Mwakawanga
- grid.25867.3e0000 0001 1481 7466School of Nursing, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Peter P. Kunambi
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Godfrey Sambayi
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Judith K. Costantine
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Alphonce I. Marealle
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Ritah Mutagonda
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Gerald J. Makuka
- grid.25867.3e0000 0001 1481 7466School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | | | - Nathanael Sirili
- grid.25867.3e0000 0001 1481 7466School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Rogers Mwakalukwa
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Rashid Mfaume
- Regional Administrative Secretary, P.O. Box 5429, Dar Es Salaam, Tanzania
| | | | - George M. Bwire
- grid.25867.3e0000 0001 1481 7466School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Elevanie Nyankesha
- grid.420318.c0000 0004 0402 478XUnited Nations Children’s Fund, 3 United Nations Plaza, New York, NY 10017 USA
| | - Robert W. Scherpbier
- United Nations Children’s Fund, Bâtiment BIT, Route Des Morillons 4, CH-1211 Geneva, Switzerland
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Nkinda L, Mwakawanga DL, Kibwana UO, Mikomangwa WP, Myemba DT, Sirili N, Mwakalukwa R, Kilonzi M, Sambayi G, Maganda BA, Njiro BJ, Ndumwa HP, Mutagonda R, Marealle AI, Felix FF, Mlyuka HJ, Makuka G, Kubigwa SW, Kunambi PP, Mfaume R, Nshau AB, Bwire GM, Scherpbier R, Nyankesha E. Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers. JAC Antimicrob Resist 2022; 4:dlac118. [PMID: 36439992 PMCID: PMC9683393 DOI: 10.1093/jacamr/dlac118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In 2017, Tanzania launched the National Action Plan for Antimicrobial Resistance (NAPAR), 2017-2022 and implementation of antibiotic stewardship programmes (ASPs) was one of the agendas. Since the launch of the National Action Plan, no study has been done to assess its implementation. OBJECTIVES To explore the experiences of prescribers and dispensers on implementing ASPs among paediatric patients attending Regional Referral Hospitals (RRHs) in Tanzania. METHODS An exploratory qualitative study was conducted among key informants, in 14 RRHs in Tanzania between July and August 2020. A total of 28 key informants, 14 dispensers in charge of pharmacies and 14 medical doctors in charge of paediatric departments (prescribers), were interviewed. A hybrid thematic analysis was conducted on the gathered information. RESULTS Most of the study participants were not conversant with the term 'antibiotic stewardship'. Some had heard about the programmes but were not aware of the activities involved in the programme. Those who were knowledgeable on ASPs mentioned the lack of existence of such programmes in their settings. They further added that absence or limited knowledge of the stewardship concepts may have influenced the current poor practices. Barriers to the implementation of ASPs mentioned were lack of laboratory facilities to support culture and susceptibility tests, lack of materials and reagents, management pressure to prevent loss or to generate income, patients' influence and limited training opportunities. CONCLUSIONS Despite launching the NAPAR in 2017, we found limited implementation of ASPs in the management of paediatric patients. This study highlighted some barriers and identified possible intervention points.
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Affiliation(s)
- Lilian Nkinda
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Upendo O Kibwana
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - David T Myemba
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Rodgers Mwakalukwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Godfrey Sambayi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Betty A Maganda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Harrieth P Ndumwa
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Alphonce I Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Fatuma F Felix
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Gerald Makuka
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | | | - Peter P Kunambi
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Rashid Mfaume
- Regional Administrative Secretary, Dar es Salaam Region, PO Box 5429, Dar es Salaam, Tanzania
| | - Arapha Bashir Nshau
- Pharmacy Council, Ministry of Health, Community Development, Gender, Elderly and Children, PO Box 31818, Dar es Salaam, Tanzania
| | - George M Bwire
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Robert Scherpbier
- United Nations Children’s Fund, Bâtiment BIT, 4 Route des Morillons, CH-1211 Geneva 22, Switzerland
| | - Elevanie Nyankesha
- United Nations Children’s Fund, 3 United Nations Plaza, New York, NY 10017, USA
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Mlyuka HJ, Kilonzi M, Mutagonda RF, Chirande L, Mikomangwa WP, Myemba DT, Sambayi G, Mwakawanga DL, Ndunguru J, Jonathan A, Makani J, Ruggajo P, Minja IK, Balandya E, Kamuhabwa AAR. Barriers and Facilitators of Availability of Hydroxyurea for Sickle Cell Disease in Tanzania; A Qualitative Study of Pharmaceutical Manufacturers, Importers, and Regulators. Healthcare (Basel) 2022; 10:healthcare10112223. [PMID: 36360565 PMCID: PMC9690851 DOI: 10.3390/healthcare10112223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Despite three decades of proven safety and effectiveness of hydroxyurea in modifying sickle cell disease (SCD), its accessibility is limited in Sub-Saharan Africa, which shares 75% of the world's SCD burden. Therefore, it is time to explore the barriers and facilitators for manufacturing and importation of hydroxyurea for SCD in Tanzania. This was qualitative research that employed a case study approach. Purposive sampling followed by an in-depth interview (IDI) using a semi-structured questionnaire aspired by data saturation enabled us to gather data from 10 participants. The study participants were people with more than three years of experience in pharmaceuticals importation, manufacturing, and regulation. The audio-recorded data were verbatim transcribed and analyzed using thematic analysis. Two themes were generated. The first comprised barriers for importation and manufacturing of hydroxyurea with sub-themes such as inadequate awareness of SCD and hydroxyurea, limited market, and investment viability. The second comprised opportunities for importation and manufacturing of hydroxyurea with sub-themes such as awareness of activities performed by medicines regulatory authority and basic knowledge on SCD and hydroxyurea. Inadequate understanding of SCD, hydroxyurea, and orphan drug regulation are major issues that aggravate the concern for limited market and investment viability. Existing opportunities are a starting point towards increasing the availability of hydroxyurea.
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Affiliation(s)
- Hamu J. Mlyuka
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
- Correspondence:
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
| | - Ritah F. Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
| | - Lulu Chirande
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Wigilya P. Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
| | - David T. Myemba
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
| | - Godfrey Sambayi
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
| | - Dorkasi L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Joyce Ndunguru
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Sickle Cell Program, Department of Hematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Agnes Jonathan
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Sickle Cell Program, Department of Hematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Julie Makani
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Sickle Cell Program, Department of Hematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Paschal Ruggajo
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Nephrology Unit, Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Irene K. Minja
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Department of Restorative Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Emmanuel Balandya
- Sickle Pan African Research Consortium (SPARCO), Dar es Salaam P.O. Box 65001, Tanzania
- Department of Physiology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Appolinary A. R. Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65013, Tanzania
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Kizindo J, Marealle AI, Mutagonda R, Mlyuka HJ, Mikomangwa WP, Kilonzi M, Sangeda RZ. Adherence to Antiretroviral Therapy Among HIV-Infected Clients Attending Opioid Treatment Program Clinics in Dar es Salaam, Tanzania. Cureus 2022; 14:e25522. [PMID: 35800807 PMCID: PMC9245442 DOI: 10.7759/cureus.25522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Adherence to antiretroviral therapy (ART) among key populations like human immunodeficiency virus (HIV)-positive People Who Inject Drugs (PWID) could be challenging, especially in low and middle-income countries (LMICs). Therefore we conducted this study to assess the adherence to ART among HIV-positive PWID attending three methadone clinics in Dar es Salaam, Tanzania. Methods A cross-sectional study was conducted at three methadone clinics in Dar es Salaam, Tanzania. Adherence to ART was measured by using pharmacy refill and patient self-report methods. Bivariate and multivariable logistic regression was performed to determine the association between dependent and independent variables. A p-value of less than 0.05 was considered to be statistically significant. Results Of the 180 participants, 97.2% recorded good adherence to ART as per the pharmacy refill method. However, only 66.1% of the PWID were found to adhere to ART based on the patient self-report method. Upon associating the self-report method with a viral load of >1000 copies/mL, participants were 3.37 times more likely to have missed their ART dose at least once in the last three days before their refill visit compared to those with a viral load of <1000 copies/mL [Adjusted Odds ratio; 3.37, 95% Confidence Interval (95% CI); 1.35 - 8.45, p = 0.009]. Conclusion The adherence to ART among HIV-infected PWID attending methadone clinics was high based on the pharmacy refill method but relatively much lower based on the patient self-report method. There was a strong correlation between viral load and the level of adherence measured by the patient self-report method.
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9
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Mutagonda RF, Marealle AI, Nkinda L, Kibwana U, Maganda BA, Njiro BJ, Ndumwa HP, Kilonzi M, Mikomangwa WP, Mlyuka HJ, Felix FF, Myemba DT, Mwakawanga DL, Sambayi G, Kunambi PP, Ndayishimiye P, Sirili N, Mfaume R, Nshau A, Nyankesha E, Scherpbier R, Bwire GM. Determinants of misuse of antibiotics among parents of children attending clinics in regional referral hospitals in Tanzania. Sci Rep 2022; 12:4836. [PMID: 35318386 PMCID: PMC8941073 DOI: 10.1038/s41598-022-08895-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/14/2022] [Indexed: 01/10/2023] Open
Abstract
Parents are the important implementers on appropriate/inappropriate use of antibiotics, especially in the pediatric population. Limited studies have associated poor knowledge, attitude, and practice (KAP) among parents with antibiotics misuse. Therefore, this study was conducted to determine the parents' KAP and factors associated with inappropriate use of antibiotics among Tanzanian children. A hospital-based cross-sectional study was conducted in 14 regional referral hospitals (RRHs) in Tanzania between June and September 2020. KAP was estimated using a Likert scale, whereas KAP factors were determined using logistic regression models. A total of 2802 parents were enrolled in the study. The median age (interquartile range) of parents was 30.0 (25-36) years where 82.4% (n = 2305) were female parents. The majority of the parents had primary education, 56.1% (n = 1567). Of 2802 parents, only 10.9% (n = 298) had good knowledge about antibiotics, 16.4% (n = 455) had positive attitude whereas 82.0% (n = 2275) had poor practice on the appropriate use of antibiotics. Parents' education level, i.e., having a university degree (aOR: 3.27 95% CI 1.62-6.63, p = 0.001), good knowledge (aOR: 1.70, 95% CI 1.19-2.23, p = 0.003) and positive attitudes (aOR: 5.56, 95% CI 4.09-7.56, p < 0.001) were significantly associated with the appropriate use of antibiotics in children. Most parents had poor knowledge, negative attitude, and poor practice towards antibiotics use in children. Parents' education level, employment status, knowledge on antibiotic use, and good attitude contributed to the appropriate use of antibiotics in children attending clinics at RRHs.
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Affiliation(s)
- Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Alphonce I Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Lilian Nkinda
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Upendo Kibwana
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Betty A Maganda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Harrieth P Ndumwa
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Fatuma F Felix
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - David T Myemba
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Godfrey Sambayi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Peter P Kunambi
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | | | - Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Rashid Mfaume
- Regional Administrative Secretary, Dar Es Salaam Region, P.O. Box 5429, Dar es Salaam, Tanzania
| | - Arapha Nshau
- Pharmacy Council, Ministry of Health, Community Development, Gender, Elderly and Children, P.O. Box 31818, Dar es Salaam, Tanzania
| | - Elevanie Nyankesha
- United Nations Children's Fund, New York Head Quarter, 3 United Nations Plaza, New York, NY, 10017, USA
| | - Robert Scherpbier
- United Nations Children's Fund, Bâtiment BIT, Route des Morillons 4, 1211, Geneva 22, Switzerland
| | - George M Bwire
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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10
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Mutagonda RF, Mlyuka HJ, Maganda BA, Kamuhabwa AAR. Adherence, Effectiveness and Safety of Dolutegravir Based Antiretroviral Regimens among HIV Infected Children and Adolescents in Tanzania. J Int Assoc Provid AIDS Care 2022; 21:23259582221109613. [PMID: 35776522 PMCID: PMC9257168 DOI: 10.1177/23259582221109613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives:This study aimed at assessing adherence, effectiveness,
and safety of DTG-based HAART regimens among HIV-infected children and
adolescents in Tanzania. Methods: This was a single-center
prospective cohort study, conducted at the pediatric HIV Clinic in Mbeya,
Tanzania. A binary logistic regression model was used to determine predictors of
undetectable viral load at week 24. The results were significant when P-value
was <0.05. Results: A total of 200 patients were enrolled with
the majority (85.5%) being treatment experienced. High adherence levels (71%)
were observed using the pharmacy refill method. At week 24, the overall
proportion of patients with undetectable viral load was 70.2%. The predictors of
undetectable viral load were age, World Health Organization (WHO) clinical
stage, baseline VL and adherence to pharmacy refill. Conclusion:
The majority of patients attained undetectable viral load 6 months after using
DTG based regimen. DTG-based regimens were generally safe with few ADEs
reported.
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Affiliation(s)
- Ritah F Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, 92976Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, 92976Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Betty A Maganda
- Department of Pharmaceutics and Pharmacy practice, School of Pharmacy, 92976Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, 92976Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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11
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Gabriel S, Manumbu L, Mkusa O, Kilonzi M, Marealle AI, Mutagonda RF, Mlyuka HJ, Mikomangwa WP, Minzi O. Knowledge of use of antibiotics among consumers in Tanzania. JAC Antimicrob Resist 2021; 3:dlab183. [PMID: 34859224 PMCID: PMC8634462 DOI: 10.1093/jacamr/dlab183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background Studies assessing consumers' knowledge of the rational use of antibiotics are essential to understand the knowledge gap before intervention strategies are instituted. Objectives To assess the knowledge of rational use of antibiotics among consumers in Dar es Salaam, Tanzania. Methods A cross-sectional study assessing knowledge of rational use of antibiotics among 960 consumers was conducted in Dar es salaam in March 2021. Participants were consecutively enrolled from outpatient pharmacies in selected public and private hospitals and marketplaces in Ilala Municipality. Data were collected using the WHO-validated questions on knowledge of consumers of antibiotic uses. Results Overall, 196 (20.4%) and 503 (52.4%) participants demonstrated good knowledge of rational antibiotic use and conditions that can be treated with antibiotics, respectively. However, 678 (70.6%) responded that they stopped using antibiotics after dose completion, 515 (53.6%) would request the same antibiotic if it had helped to treat a similar condition in the past and 406 (42.3%) are willing to use the same antibiotic if a friend or family member used the medication previously to treat similar signs and symptoms. Besides, the following conditions were mentioned as being treatable with antibiotics: influenza (50.7%), sore throat (61.4%) and urinary tract infection (60.5%). Conclusions The majority of the consumers had poor knowledge of the rational uses of antibiotics and a moderate proportion had good knowledge of the conditions that are treatable with antibiotics. Those with a high level of education and with health insurance had good knowledge of rational uses of antibiotics.
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Affiliation(s)
- Salvador Gabriel
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Loyce Manumbu
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Omary Mkusa
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Omary Minzi
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
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Minzi OM, Kilonzi M, Mikomangwa WP, Bwire GM, Myemba DT, Marealle AI, Mlyuka HJ, Kibanga W, Mutagonda RF, Mwambete K. Update on bacterial and antibiotic susceptibility profiles among patients attending a tertiary referral hospital in Tanzania. J Glob Antimicrob Resist 2021; 25:87-88. [PMID: 33727206 DOI: 10.1016/j.jgar.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Omary Mashiku Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania.
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - David T Myemba
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Wema Kibanga
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Ritah Francis Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Kennedy Mwambete
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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Kisamo O, Kilonzi M, Mikomangwa WP, Bwire GM, Mlyuka HJ, Marealle AI, Mutagonda RF. The magnitude of prescribing medicines by brand names at Muhimbili National Hospital, Tanzania. Medicine Access @ Point of Care 2020; 4:2399202619900148. [PMID: 36204086 PMCID: PMC9413603 DOI: 10.1177/2399202619900148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/12/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Tanzania National Treatment Guidelines and National Therapeutic Committee circular of 2012 requires prescribers to prescribe medicines using their generic names as recommended by the World Health Organization. The implementation of the aforementioned recommendations by prescribers is not well documented in our settings. Therefore, this study aimed to explore the compliance on the use of generic names by prescribers at Muhimbili National Hospital. Methods: A descriptive cross-sectional study was conducted at Muhimbili National Hospital from January to May 2019 in both inpatient and outpatient pharmacy units. Data were analyzed using SPSS, version 23. Chi-square test was used to analyze proportions between the different variables of the study. A p-value for significance was <0.05. Results: Of 1001 prescriptions analyzed, 71.6% contained medicines prescribed using brand names. The mean (±standard deviation (SD)) number of medicines per prescription was 2.98 (±1.5). The most frequently prescribed medicines by brand names were a combination of vitamin and mineral supplements (34.4%) followed by antibiotics (26.7%). Medical doctors (25.6%) and medical specialists (21.6%) prescribed ⩾2 medicines using brand names per prescription compared to interns (15.0%) and residents (6.9%) ( p < 0.001). Conclusion: Prescribing medicines using brand names was highly observed in this study. Supplements and antibiotics were among the products that were highly prescribed using their brand names. Qualitative studies to explore reasons for brand name prescribing practices are recommended.
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Affiliation(s)
- Ombeni Kisamo
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alphonce I Marealle
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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14
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Marealle AI, Mbwambo DP, Mikomangwa WP, Kilonzi M, Mlyuka HJ, Mutagonda RF. A decade since sulfonamide-based anti-malarial medicines were limited for intermittent preventive treatment of malaria among pregnant women in Tanzania. Malar J 2018; 17:409. [PMID: 30400908 PMCID: PMC6219183 DOI: 10.1186/s12936-018-2565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite the development of resistance to Plasmodium falciparum malaria, sulfadoxine–pyrimethamine is still effective for intermittent preventive treatment of malaria in pregnancy (IPTp). In Tanzania, more than 10 years have passed since sulfadoxine–pyrimethamine and sulfamethopyrazine–pyrimethamine (SPs) were reserved for IPTp only. However, the retail pharmaceutical outlet dispensers’ knowledge and their compliance with the policies have not been recently explored. Therefore, this study was designed to investigate dispensers’ knowledge about these medications together with their actual dispensing practices, a decade since they were limited for IPTp use only. Methods This descriptive cross-sectional study was conducted between February and July 2017 in all municipalities of Dar-es-Salaam city. Data were collected by direct interviews using a structured questionnaire to assess knowledge and a simulated client approach was used to assess the actual practice of medicine dispensers. Data analysis was done by using SPSS version 20 and Chi square test was used to test significant differences in proportions between different categorical variables. A p-value of less than 0.05 was considered to be statistically significant. Results A random sample of 422 medicine dispensers participated in this study whereby 185 (43.8%) were from community pharmacies and 237 (56.2%) from accredited drug dispensing outlets. The study revealed that SPs were available in 76% of the community pharmaceutical outlets in Dar es Salaam. In general majority of the dispensers (64%) had moderate to high knowledge about SPs and their indication. About 80% of the dispensers were aware that SP is reserved for IPTp. However, irrespective of the level of knowledge, almost all dispensers (92%) were willing to dispense the medicines for the purpose of treating malaria, contrary to the current Tanzania malaria treatment guideline. Conclusion Majority of the medicine dispensers in the community pharmaceutical outlets were knowledgeable about SPs and their indications. Disappointingly, almost all dispensers irrespective of their levels of knowledge were willing to dispense SPs for treatment of malaria contrary to the available treatment guidelines.
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Affiliation(s)
- Alphonce I Marealle
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania.
| | - Dennis P Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
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