Assessment of the extent and monetary loss in the selected public hospitals in Jimma Zone, Ethiopia: expired medicine perspectives

Introduction

Medicine plays a crucial role in the field of healthcare as a therapeutically significant pharmaceutical product. By effectively preventing diseases, medicine has the power to save countless lives and improve the quality of life for people worldwide. However, despite hospitals' efforts to provide medical care to patients, a significant issue arises from the substantial amount of drugs that go unused due to expiration dates. This problem is particularly prevalent in resource-limited countries like Ethiopia, where the pharmaceutical supply system fails to adequately address the issue of expired drugs in public hospitals, leading to an unsatisfactory situation. Hence, the objective of this study was to assess the economic impact and volume of expired medicines in the selected public hospitals in Jimma Zone, Southwestern Ethiopia.

Methods

A hospital-based cross-sectional study design was conducted to assess the economic impact and volume of expired medicines available in the public hospitals in Jimma Zone. All available hospitals that fulfilled the EFDA guidelines were included. The medication expiration rate was calculated by dividing the total monetary value of expired medicines in a year by the total value of medicines received in the same year multiplied by 100. Then, the collected data was cleared, filtered, coded, and quantitatively analyzed using the Microsoft Excel 2010 version.

Results

The average medicine waste rate was 4.87% in the fiscal year of 2019/2020 and 2020/2021 in Jimma Zone public hospitals worth 32,453.3 US$. Additionally, the facility wasted an estimated of 2711.44 US$ on the disposal of expired medicines. The expiration of medicines has been linked to several issues, including near-expiry, irrational prescribing practices, and weak participation of clinicians in medicine selection and quantification of the facility. Additionally, only two hospitals had relatively good storage and handling practices.

Conclusion

Overall, the expiration rate of medicines in the public hospitals in Jimma Zone was greater than the allowed level of 2%. In order to optimize the allocation of healthcare funds and ensure the appropriate use of pharmacologically significant medications it is vital to conduct a comprehensive examination at the national level within a regional hospitals.

Study on identification, assay and organoleptic quality of veterinary medicines in Ethiopia

BACKGROUND

Medicines of poor quality are currently prevailing problems undermining the quality of health care services in veterinary and human medicine. In this study, physico-chemical quality of veterinary medicines was evaluated.

METHODS

A total of 959 veterinary medicines samples were collected during routine regulatory activities, i.e. pre-registration, re-registration, consignment checking and post-marketing surveillance, in Ethiopia. The samples were transported to Animal Products, Veterinary Drug and Feed Quality Assessment Centre (APVD-FQAC), which is the quality control laboratory of the Veterinary Drug and Feed Administration and Control Authority (VDFACA) and stored until analysis. The samples were subjected to visual inspection and chemical analysis following the United States, European or British Pharmacopoeias, or manufacturer's methods.

RESULTS

The findings revealed that 12 (1.3%) of tested products showed defects in physical characteristics, packaging, or labelling information, while a total of 66 (6.9%) samples of the investigated products failed to comply with the Pharmacopoeias and supplier's specification limit set for assay. Of these, 60 samples did not comply with the minimum assay specification limit.

CONCLUSION

Overall, 8.2% of the investigated veterinary medicine samples did not comply with the specification set for the investigated quality attributes and thus were categorized as of poor quality. This indicates the need for continued strengthening of regulatory functions.

Environmental risk assessment of the anthelmintic albendazole in Eastern Africa, based on a systematic review

This study performs an environmental risk assessment (ERA) of the anthelmintic medicine albendazole (ABZ) in the eastern African region. A systematic literature search strategy was applied to obtain quantitative information on the physicochemical characteristics, the metabolization-fate, the ecotoxicity and the environmental occurrence in different countries worldwide serving as model regions. In addition, insilico tools were employed to obtain data on physicochemical characteristics and toxic hazards of ABZ and its metabolites. Moreover, ERA models were used to predict environmental concentrations in different compartments and compare them with the measured environmental concentrations. Finally, the environmental risk of ABZ in the eastern Africa was estimated by calculating the risk quotient (RQ), and its uncertainty estimated by Monte Carlo simulation. The predicted environmental concentrations of ABZ in surface water in the model region based on consumption (1.6-267 ng/L) were within the range of values obtained from the measured environmental concentrations of the same region (0.05-101,000 ng/L). Using these models with adapted input variables for eastern Africa, the predicted surface water concentration in that region was 19,600 ± 150 ng/L (95% CI). The calculated soil concentrations of ABZ in the model regions and the eastern Africa were found to be 0.057 ± 0.0 μg/kg and 0.022 ± 0.0 μg/kg, respectively. The environmental risk expressed as risk quotient of ABZ in eastern Africa estimated for the aquatic compartment (146 ± 1) indicated a significant environmental risk calling on appropriate actions from the competent authorities to reduce this risk in this region.

Ethnobotanical Assessment and Physicochemical Properties of Commonly Used Medicinal Plants in Jimma Zone, Southwest Ethiopia: Traditional Healers Based Cross-Sectional Study

Background

The demand for traditional herbal medicine is increasing and about 85% of the world population use herbal medicines for the prevention and treatment of diseases. More than 62.5% of the forest areas in Ethiopia are found in the southwest region, which have been used as a source of traditional medicine to treat different human and livestock ailments. The aim of this study was the investigation of the ethnobotanical and physicochemical properties of commonly used medicinal plants in Jimma zone, southwest Ethiopia.

Materials and Methods

A cross-sectional study was conducted in the district of Jimma zone from June 1 to 30, 2017. The ethnobotanical data were collected from traditional healers through semi-structured questionnaires. Specimens collected from various habitats were taken into Jimma University, Herbarium laboratory, dried, and prepared using standard herbarium specimen techniques for identification. Physicochemical analysis was done for selected medicinal plants.

Results

A total of 72 medicinal plants categorized under 61 genera and 39 families were stated by the respondents for the treatment of different human and livestock ailments. Herbs constitute the largest category (28 species, 38.89%) followed by shrubs (21 species, 29.17%), trees (20 species, 27.78%) and climbers (3 species, 4.17%). Leaves (39.19%) were the most commonly used plant parts followed by roots (27%) and seeds (10.81%). Traditional healers reported processing remedies mainly through crushing (46.91%), powdering (18.52%), pounding (11.11%), and pressing (9.88%). The water-soluble extractive value of the selected medicinal plants were between 1.825 to 18.507%w/w and the alcohol-soluble extractive value were between 0.143 to 1.107%w/w. The moisture content (%LOD) of Barleria argentea Balf. f. was higher than the recommended standard which consisted of 21.063%w/w and followed by high %LOD of Crateva adansonii D.C. Prodr (8.143%w/w) and Euphorbia abbyssinica J.F. Gmel. (16.347%w/w). The highest total ash value was registered in Dioscorea quartiniana A.Rich. species which consisted of 18.563%w/w and followed by Crateva adansonii D.C. Prodr (16.033%w/w) and Barleria argentea Balf. f. (15.648%w/w). High acid-insoluble ash value (7.227%w/w) and water-soluble ash (6.731%w/w) was recorded in Euphorbia abbyssinica J.F. Gmel.

Conclusion

The study revealed that the water-soluble extractive value of the selected medicinal plants indicates the presence of water-soluble components such as sugar, acids, and inorganic compounds. In the future, these characters can be used to check the genuine nature of the crude drug; thus, it plays an important role in preventing the possible steps of adulteration.

Development of a dissolution method for lumefantrine and artemether in immediate release fixed dose artemether/lumefantrine tablets

Background

Dissolution of artemether (ART) and lumefantrine (LUM) active pharmaceutical ingredients (APIs) in fixed dose combination (FDC) ART/LUM tablets is one of the critical quality attributes. Thus, the verification of the release profile of ART and LUM from FDC ART/LUM tablets using a robust and discriminatory dissolution method is crucial. Therefore, the aim of this study was to develop and validate an appropriate dissolution method for quality control of FDC ART/LUM tablets.

Methods

The dissolution medium was selected based on saturation solubility data and sink conditions. The effect of agitation speed, pH and surfactant concentration on the release of ART and LUM was evaluated by employing a two-level factorial experiment. The resulting final method was validated for linearity, precision, robustness and API stability. In addition, the discriminatory power of the method was evaluated using expired and unexpired FDC ART/LUM products.

Results

A suitable dissolution profile of FDC ART/LUM tablets was obtained in 900 ml HCl (0.025 N, pH 1.6) with 1%Myrj 52 using paddle method at 100 rpm and 37 °C. ART and LUM were analysed using a HPLC method with UV detection at wavelengths of 210 and 335 nm, respectively. The results from the stability study showed that ART and LUM were sufficiently stable in HCl (0.025 N, pH 1.6) with 1%Myrj 52 at 37 °C. The method was linear (r² = 0.999) over the concentration range of 6.25–100 μg/ml. The results for precision were within the acceptance limit (%RSD < 2). The percent relative standard deviation (< 2%) and statistically non-significant (p > 0.05) difference in release of ART and LUM observed between deliberately changed dissolution method settings (pH = 1.6 ± 0.2 or agitation speed = 100 ± 2) and optimized dissolution conditions revealed the robustness of the dissolution method. The method was capable to discriminate among different FDC ART/LUM products with different quality.

Conclusions

The developed dissolution method is robust and discriminatory. It can be used in the quality evaluation of FDC ART/LUM tablets.

In vitro comparative quality assessment of different brands of norfloxacin tablets available in Jimma, Southwest Ethiopia

Background

Pharmaceuticals play a pivotal role in maintaining human health and promoting well-being. However, safety, efficacy, and quality of the drugs should be ascertained to provide a desired pharmacological effect.

Aim

The aim of the present study was to determine the quality as well as the physicochemical equivalence of nine brands of norfloxacin tablets marketed in Jimma, Ethiopia.

Methods

Nine norfloxacin brands were subjected to in vitro tests associated with quality of tablet dosage form, and the tests were conducted according to procedures described in the United States Pharmacopeia (USP).

Results

This study indicated that all brands of norfloxacin complied with the USP for uniformity of weight, friability, hardness, and assay of active ingredient. However, two of the nine brands evaluated failed to release 80% of their drug contents within 30 minutes as outlined in the USP. Correspondingly, all of the brands studied were within the specification for hardness test. Furthermore, different dissolution profile comparison methods have proven the similarity in dissolution profile of Negaflox and Norcin with the comparator product (Trizolin). Mathematical models-dependent approaches have shown that the drug release data fit well to the Weibull release model.

Conclusion

The physicochemical evaluation showed that all the norfloxacin brands met the quality specification with respect to uniformity of weight, hardness, friability, and assay. With regard to dissolution test, two brands of norfloxacin were found to be out of the specified pharmacopeial requirement. The study also revealed the similarity in the dissolution profile of two brands of norfloxacin with the comparator product.

Treatment of malaria and related symptoms using traditional herbal medicine in Ethiopia

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plants have always been an integral part of different cultures in Ethiopia in the treatment of different illnesses including malaria and related symptoms. However, due to lack of proper documentation, urbanization, drought, acculturation and deforestation, there is an increased risk of losing this traditional knowledge. Hence, the use of the indigenous knowledge should be well documented and validated for potential future use.

AIM OF THE STUDY

To gather and document information on medicinal plants which are used in the traditional treatment of malaria and related symptoms in Ethiopia.

MATERIALS AND METHODS

First, an ethnomedicinal survey of plants was conducted in 17 districts of Jimma zone, the Oromia national regional state of Ethiopia. Jimma zone is malarious and rich in natural flora. A total of 115 traditional healers were interviewed using a semi-structured questionnaire containing personal data of the respondents, and information on medicinal plants used to treat malaria and related symptoms. In addition, a literature search using Medline/PubMed, Google Scholar, ScienceDirect and HINARI was conducted on the indigenous use, in-vitro/in-vivo anti-malarial activity reports, and the chemical characterization of medicinal plants of Ethiopia used against malaria.

RESULTS

From ethnomedicinal survey, a total of 28 species of plants used in the traditional treatment of malaria and related symptoms in Jimma Zone were collected, identified and documented. In addition, the literature search revealed that 124 medicinal plant species were reported to be traditionally used in the treatment of malaria in Ethiopia. From both ethnomedicinal survey and the literature search, Asteraceae and Fabaceae were the most represented families and Allium sativum L., Carica papaya L., Vernonia amygdalina Del., Lepidium sativum L. and Croton macrostachyus Del. were the most frequently reported plant species for their anti-malarial use. The dominant plant parts used in the preparation of remedies were leaves. About 54% of the medicinal plants documented in the survey have been reported as an anti-malarial plant in the literature search. Furthermore, the in-vitro and in-vivo anti-plasmodial activity reports of extracts from some of plant species were found to support the traditional claim of the documented plants. Moreover, literatures indicate that several secondary metabolites isolated from certain plant species that are traditionally used for the treatment of malaria and related symptoms in Ethiopia demonstrate strong anti-plasmodial activity.

CONCLUSIONS

The result of the current study showed that traditional knowledge is still playing an important role in the management of malaria and related symptoms in Ethiopia. Allium sativum L., Carica papaya L., Vernonia amygdalina Del., and Lepidium sativum L. are the most commonly reported species as anti-malarial plants and the traditional claim of some species was supported by known anti-plasmodial activity and bioactivity reports. The finding of this study is important in the rational prioritization of plant species which are potentially used for investigating new compounds, which could be efficacious for malaria treatment.

Quality of anthelminthic medicines available in Jimma Ethiopia

Soil-transmitted helminthiasis and schistosomiasis are major public health problems in Ethiopia. Mass deworming of at-risk population using a single dose administration of 400mg albendazole (ABZ) or 500mg mebendazole (MBZ) for treatment of common intestinal worms and 40mg of praziquantel (PZQ) per kg body weight for treatment of schistosomiasis is one of the strategies recommended by World Health Organization (WHO) in order to control the morbidity of soil-transmitted helminthiasis and schistosomiasis. Since storage condition, climate, way of transportation and distribution route could all affect the quality of medicines, regular assessment by surveys is very critical to ensure the therapeutic outcome, to minimize risk of toxicity to the patient and resistance of parasites. Therefore, this study was conducted to assess the pharmaceutical quality of ABZ, MBZ and PZQ tablet brands commonly available in Jimma town (south west Ethiopia). Retail pharmacies (n=10) operating in Jimma town were selected using simple random sampling method. Samples of anthelminthic medicines available in the selected pharmacies were collected. Sample information was recorded and encompassed trade name, active ingredient name, manufacturer's name and full address, labeled medicine strength, dosage form, number of units per container, dosage statement, batch/lot number, manufacturing and expiry dates, storage information and presence of leaflets/package insert. Moreover, a first visual inspection was performed encompassing uniformity of color, uniformity of size, breaks, cracks, splits, embedded surface spots or visual contaminations. Finally, physico-chemical quality attributes investigated encompassed mass uniformity, quantity of active pharmaceutical ingredient (API), disintegration and dissolution, all following Pharmacopoeial test methods The physical characteristics of dosage form, packaging and labeling information of all samples complied with criteria given in the WHO checklists. The mass uniformity of tablets of each brand of ABZ, MBZ and PZQ complied with the pharmacopoeial specification limits, i.e no more than 2 individual masses >5% of average tablet weight, and none deviate by more than 10%. The quantity of APIs in all investigated tablet brands were within the 90-110% label claim (l.c.) limits, ranging between 95.05 and 110.09% l.c. Disintegration times were in line with the pharmacopoeial specification limit for immediate release (IR) tablets, ranging between 0.5 and 13min. However, the dissolution results (mean±SD, n=6) of one ABZ brand (i.e. Wormin^®, Q=59.21±0.99% at 30min) and two PZQ brands (i.e. Bermoxel^®, Q=63.43%±0.7 and Distocide^®, Q=62.43%±1.67, at 75min) showed poor dissolution, failing the United States Pharmacopoeia (USP) dissolution specification limit.

Assessment of Efficacy and Quality of Two Albendazole Brands Commonly Used against Soil-Transmitted Helminth Infections in School Children in Jimma Town, Ethiopia

Background

There is a worldwide upscale in mass drug administration (MDA) programs to control the morbidity caused by soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura and hookworm. Although anthelminthic drugs which are used for MDA are supplied by two pharmaceutical companies through donation, there is a wide range of brands available on local markets for which the efficacy against STHs and quality remain poorly explored. In the present study, we evaluated the drug efficacy and quality of two albendazole brands (Bendex and Ovis) available on the local market in Ethiopia.

Methodology/Principal Findings

A randomized clinical trial was conducted according to the World Health Organization (WHO) guidelines to assess drug efficacy, by means of egg reduction rate (ERR), of Bendex and Ovis against STH infections in school children in Jimma, Ethiopia. In addition, the chemical and physicochemical quality of the drugs was assessed according to the United States and European Pharmacopoeia, encompassing mass uniformity of the tablets, amount of active compound and dissolution profile. Both drugs were highly efficacious against A. lumbricoides (>97%), but showed poor efficacy against T. trichiura (~20%). For hookworms, Ovis was significantly (p < 0.05) more efficacious compared to Bendex (98.1% vs. 88.7%). Assessment of the physicochemical quality of the drugs revealed a significant difference in dissolution profile, with Bendex having a slower dissolution than Ovis.

Conclusion/Significance

The study revealed that differences in efficacy between the two brands of albendazole (ABZ) tablets against hookworm are linked to the differences in the in-vitro drug release profile. Differences in uptake and metabolism of this benzimidazole drug among different helminth species may explain that this efficacy difference was only observed in hookworms and not in the two other species. The results of the present study underscore the importance of assessing the chemical and physicochemical quality of drugs before conducting efficacy assessment in any clinical trials to ensure appropriate therapeutic efficacy and to exclude poor drug quality as a factor of reduced drug efficacy other than anthelminthic resistance. Overall, this paper demonstrates that “all medicines are not created equal”.

Soil-transmitted helminths (STHs) infect millions of children worldwide. To fight STH, large-scale de-worming programs are implemented in which anthelmintic drugs (either albendazole (ABZ) or mebendazole (MEB)) are administered. However, there is a wide range of other brands, which are even more accessible, but for which the efficacy and quality remain poorly explored. We evaluated efficacy against STHs and quality of two ABZ brands commonly available on the local markets in Ethiopia (Bendex and Ovis). Both brands showed high efficacy against roundworm infections and poor efficacy against whipworms. However, for hookworm infections, Bendex was significantly less efficacious than Ovis. In terms of drug quality, a significant difference was observed in the dissolution profile, with Bendex having a significantly slower dissolution rate than Ovis. Since dissolution behavior is critical for a drug to be appropriately absorbed into the helminth (through host-blood and/or parasite-cuticle) and produce therapeutic efficacy, the poor dissolution of Bendex compared to Ovis can explain the observed difference in efficacy against hookworms. Our results emphasize the importance of periodically assessing of drug quality to ensure appropriate therapeutic efficacy and to exclude poor drug quality as a potential factor of reduced drug efficacy other than drug resistance.

Pharmacokinetics of marbofloxacin after intravenous and intramuscular administration in Hanwoo, Korean native cattle

Pharmacokinetic (PK) parameters of marbofloxacin (MRFX) in Korean cattle, Hanwoo, were determined following its intravenous (i.v.) or intramuscular (i.m.) administration at a dose of 2 mg/kg. Area under the curve (AUC0-24 hr), half-life (t1/2) and total body clearance (CLB) of i.v. MRFX were 6.87 hr∙µg/ml, 2.44 hr and 0.29 l/kg∙hr, respectively, and the corresponding values for i.m. administration of MRFX were 5.07 hr∙µg/ml, 2.44 hr and 0.39 l/kg∙hr. The suggested optimal doses of MRFX in Hanwoo cattle, calculated by integration of PK data obtained in the present study and previously reported minimum inhibitory concentration (MIC) for MRFX against susceptible (MIC ≤1 µg/ml) and intermediate (MIC ≤2 µg/ml) pathogenic bacteria, were 2.1 and 4.2 mg/kg/day by i.v. route and 3.9 and 7.8 mg/kg/day by i.m. route.

Susceptibility assay of Haemonchus contortus to commonly used anthelmintics in Jimma, southwest Ethiopia

An experimental study to investigate the susceptibility pattern of Haemonchus contortus to commonly used anthelmintics (albendazole, tetramisole, ivermectin, and triclobendazole) was conducted between June and September 2009. Adult H. contortus parasites were collected from a total of 30 sheep slaughtered at Jimma municipal abattoir. The anthelmintics were assessed for egg hatch inhibition ability against H. contortus eggs. The eggs (500 eggs/ml) were incubated with different concentrations (0.25, 0.125, 0.0625, 0.03125, and 0.015625 μg/ml) at 26°C for 48 h. Egg hatching inhibition of different anthelmintics at different concentrations was recorded. The overall mean percent inhibition showed that there was a significant difference (p < 0.05) among the different concentrations. Mean egg hatch inhibition of ivermectin showed the highest result (84.90 %) at 0.25 μg/ml, followed by albendazole (78.77 %), triclobendazole (76.66 %), and tetramisole (78.98 %), respectively. The overall mean percent inhibition showed a significant difference (p < 0.05) among the different anthelmintics. Further evaluation of these anthelmintics was recommended.