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Baral P, Hann K, Pokhrel B, Koirala T, Thapa R, Bijukchhe SM, Khogali M. Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study. Public Health Action 2021; 11:52-57. [PMID: 34778016 PMCID: PMC8575388 DOI: 10.5588/pha.21.0043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
SETTING Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal. OBJECTIVES To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019. DESIGN This was a cross-sectional study. RESULTS Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories. CONCLUSION We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.
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Affiliation(s)
- P Baral
- Department of Pharmacy, Modern Technical College, Sanepa, Lalitpur, Nepal
| | - K Hann
- Sustainable Health System, Freetown, Sierra Leone
| | - B Pokhrel
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - T Koirala
- Dasharathpur Primary Health Centre, Department of Health Services, Ministry of Health and Population, Surkhet, Nepal
| | - R Thapa
- Department of Pharmacy, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - S M Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Shrestha S, Hann K, Kyaw KWY, Koju P, Khogali M. Surgical antibiotic prophylaxis administration practices. Public Health Action 2021; 11:18-23. [PMID: 34778011 PMCID: PMC8575384 DOI: 10.5588/pha.21.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 01/05/2023] Open
Abstract
SETTING A referral hospital in Kavre, Nepal. OBJECTIVES To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019). DESIGN This was a retrospective cohort analysis. RESULTS The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG. CONCLUSION A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.
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Affiliation(s)
- S Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - K W Y Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- Centre for Operational Research, The Union, Paris, France
| | - P Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Moses FL, Tamang D, Denisiuk O, Dumbuya U, Hann K, Zachariah R. Management of malaria in children with fever in rural Sierra Leone in relation to the 2014-2015 Ebola outbreak. Public Health Action 2017; 7:S22-S26. [PMID: 28744435 DOI: 10.5588/pha.16.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/29/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Sixty-eight primary health facilities, Koinadugu District, rural Sierra Leone. Objectives: Sierra Leone, a country with one of the highest burdens of malaria, was severely affected by the 2014-2015 Ebola virus disease outbreak. In under-five children, we compared trends in the completeness of malaria reports sent to the district office during the pre-Ebola, Ebola and post-Ebola periods, including the number of children with reported fever, malaria diagnostic testing performed and treatment for malaria initiated with artemisinin-based combination therapy (ACT). Design: A cross-sectional study. Results: Of 1904 expected malaria reports, 1289 (68%) were received. Completeness of reporting was 61% pre-Ebola, increased to 88% during the outbreak and dropped to 44% post-Ebola (P = 0.003). Total malaria testing (n = 105 558) exceeded the number of fever cases (n = 105 320). Pre-Ebola, 75% (n = 43 245) of all reported fever cases received malaria treatment, dropping to 34% (n = 50 453) during the Ebola outbreak. Of 36 804 confirmed malaria cases during Ebola, 17 438 (47%) were treated, significantly fewer than in the pre-Ebola period (96%, P < 0.001). Of the fever cases, 95% in both the pre- and post-Ebola periods received ACT, a rate that increased to 99% during the Ebola outbreak. Conclusion: Pre-existing gaps in malaria reporting worsened after the Ebola outbreak. Reassuringly, malaria testing matched fever cases, although only half of all confirmed cases received treatment during the outbreak, possibly explained by outbreak-related operational difficulties. These findings could be useful to guide health systems strengthening and recovery.
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Affiliation(s)
- F L Moses
- Koinadugu District Health Management Team, Ministry of Health and Sanitation, Koinadugu, Sierra Leone
| | - D Tamang
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - O Denisiuk
- Alliance for Public Health, Kiev, Ukraine
| | - U Dumbuya
- Koinadugu District Health Management Team, Ministry of Health and Sanitation, Koinadugu, Sierra Leone
| | - K Hann
- Partners in Health, Freetown, Sierra Leone
| | - R Zachariah
- Médecins Sans Frontières, Medical Department, Operational Centre Brussels, Luxembourg
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Sylvester Squire J, Hann K, Denisiuk O, Kamara M, Tamang D, Zachariah R. The Ebola outbreak and staffing in public health facilities in rural Sierra Leone: who is left to do the job? Public Health Action 2017; 7:S47-S54. [PMID: 28744439 DOI: 10.5588/pha.16.0089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/24/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: The 82 public health facilities of rural Kailahun District, Sierra Leone. Objective: The 2014-2015 Ebola virus disease outbreak in Sierra Leone led the Ministry of Health and Sanitation and stakeholders to set minimum standards of staffing (medical/non-medical) for a basic package of essential health services (BPEHS). No district-level information exists on staffing levels in relation to the Ebola outbreak. We examined the staffing levels before the Ebola outbreak, during the last month of the outbreak and 4 months after the outbreak, as well as Ebola-related deaths among health care workers (HCWs). Design: This was a retrospective cross-sectional study. Results: Of 805 recommended medical staff (the minimum requirement for 82 health facilities), there were deficits of 539 (67%) pre-Ebola, 528 (65%) during the Ebola outbreak and 501 (62%) post-Ebola, hovering at staff shortages of >50% at all levels of health facilities. Of the 569 requisite non-medical staff, the gap remained consistent, at 92%, in the three time periods. Of the 1374 overall HCWs recommended by the BPEHS, the current staff shortage is 1026 (75%). Of 321 facility-based HCWs present during Ebola, there were 15 (14 medical and one non-medical staff) Ebola-related and three non-Ebola related deaths among HCWs. Conclusion: The post-Ebola health-related human resource deficit is alarmingly high, with very few staff available to work. We call for urgent political will, resources and international collaboration to address this situation.
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Affiliation(s)
- J Sylvester Squire
- District Health Management Team, Ministry of Health and Sanitation, Kailahun District, Sierra Leone
| | - K Hann
- Partners in Health, Freetown, Sierra Leone
| | - O Denisiuk
- Alliance for Public Health, Kiev, Ukraine
| | - M Kamara
- District Health Management Team, Ministry of Health and Sanitation, Kailahun District, Sierra Leone
| | - D Tamang
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - R Zachariah
- Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre (LuxOR), Luxembourg
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Garland J, Warren G, Drasher M, Dierberg K, Gottesfeld J, Hann K, Stewart A, Kanu A, Bangura J, Bangura S. Employing survivors of Ebola virus disease (EVD) as a novel system to support community-based surveillance in an Ebola hotspot within Sierra Leone. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Leighl NB, Paz-Ares L, Douillard JY, Peschel C, Arnold A, Depierre A, Santoro A, Betticher DC, Gatzemeier U, Jassem J, Crawford J, Tu D, Bezjak A, Humphrey JS, Voi M, Galbraith S, Hann K, Seymour L, Shepherd FA. Randomized phase III study of matrix metalloproteinase inhibitor BMS-275291 in combination with paclitaxel and carboplatin in advanced non-small-cell lung cancer: National Cancer Institute of Canada-Clinical Trials Group Study BR.18. J Clin Oncol 2005; 23:2831-9. [PMID: 15837997 DOI: 10.1200/jco.2005.04.044] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether BMS-275291, a broad-spectrum matrix metalloproteinase inhibitor (MMPI), added to systemic chemotherapy improved survival in advanced non-small-cell lung cancer (NSCLC). In early phase studies, BMS- 275291 was not associated with dose-limiting joint toxicity seen with other MMPIs. PATIENTS AND METHODS Chemotherapy-naive patients with stage IIIB/IV NSCLC, performance status (PS) 0 to 2, and adequate organ function were eligible. All patients received paclitaxel 200 mg/m2 plus carboplatin (area under the curve, 6 mg/mL-min) intravenously every 21 days for up to 8 cycles, and were randomly assigned to receive BMS-275291, 1,200 mg orally daily, or placebo until disease progression. The primary study end point was survival (OS); secondary end points included progression-free survival (PFS), response rates (RR), toxicity, and quality of life. RESULTS From 2000 to 2002, 774 patients were randomly assigned. Pretreatment characteristics were well balanced between arms: median age, 61 years; male sex, 73%; stage IV, 79%; PS 0 to 1, 88%. Interim safety analysis revealed no survival advantage and increased toxicity in the experimental arm, and study treatment was stopped. Median OS, PFS and RR in the final analysis in the BMS-275291 arm were 8.6 months, 4.9 months, and 25.8% respectively, and in the control arm 9.2 months, 5.3 months, 33.7%. Toxicity was significantly higher in the BMS-275291 arm, including flu-like symptoms, rash, hypersensitivity reactions (8.6% v 2.4%), and febrile neutropenia (9.7% v 5.5%). CONCLUSION BMS-275291 added to chemotherapy increases toxicity and does not improve survival in advanced NSCLC.
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Affiliation(s)
- Natasha B Leighl
- National Cancer Institute of Canada--Clinical Trials Group, Kingston, Canada.
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Leighl NB, Shepherd F, Paz-Ares L, Douillard JY, Peschel C, Arnold A, Tu D, Galbraith S, Hann K, Seymour L. Randomized phase II-III study of matrix metalloproteinase inhibitor (MMPI) BMS-275291 in combination with paclitaxel (P) and carboplatin (C) in advanced non-small cell lung cancer (NSCLC): NCIC-CTG BR.18. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. B. Leighl
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - F. Shepherd
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - L. Paz-Ares
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - J.-Y. Douillard
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - C. Peschel
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - A. Arnold
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - D. Tu
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - S. Galbraith
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - K. Hann
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
| | - L. Seymour
- National Cancer Institute of Canada, Kingston, ON, Canada; Bristol Myers Squibb, Wallingford, CT
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Ioanitziu D, Dragomirescu M, Mitrache L, Hann K. [The clinical metaboli developmental stages of diabetes mellitus in acromegaly]. Z Gesamte Inn Med 1968; 23:Suppl:241-3. [PMID: 5727621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Gligore V, Lucaciu O, Hann K, Sopon E, Scheau M, Papp E. [Research on the disorders of carbohydrate metabolism in chronic diffuse hepatopathy]. Med Interna (Bucur) 1965; 17:1077-84. [PMID: 5843758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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