A prospective descriptive study on emergency medicines used most frequently from the emergency medicine packs at Universitas Academic Hospital and the associated financial loss of expired emergency medicines

Resuscitation trolleys with equipment and medicines for emergencies are required in all clinical areas in hospitals. Emergency medicines kept separately are more likely to expire than non-emergency medicines, as these are generally used less frequently. An updated list of essential emergency medicines was implemented in 2016 at an academic hospital in central South Africa. The aim of this study was to determine the frequency of both the use and the expiry, with associated financial losses, of the emergency medicines on this list. Methods: A prospective, descriptive study was conducted over a six-month period in 2019. Forms accompanying the emergency packs were returned to the pharmacy whenever packs expired or were opened. These forms were collected and the type and quantity of medicines either used or expired were recorded. Results: In total, 168 of the returned forms were included. The most frequently used emergency medicines were adrenaline, sodium bicarbonate and Ringer's lactate. Adrenaline use was recorded on 52.8% and 25% of the forms from the adult/paediatric and neonatal emergency packs, respectively. Medicines that were never used included: betamethasone, Darrow's half-strength solution and most of the neonatal pack medications. Neonatal emergency medicine packs were rarely used and the neonatal fluid packs were never used. The total cost of the expired medicines was R7 960.29 (US$569.41 at the time of the study). Adrenaline was the medication that expired most frequently but the greatest financial losses occurred from expired sodium bicarbonate. Conclusion: The total financial losses were low but can be reduced further. The contents of the emergency packs should be reviewed to possibly reduce the amount of items used infrequently. Also, the removal of those items not recommended in emergency care guidelines could be considered. Ensuring the policy was followed of returning unused medicines close to expiry and redistributing these to high-use areas would further reduce wastage

The Quality of Logistics Management Information System and the Availability of Tracer Drugs at Health Posts in Rural Ethiopia: A Mixed-Method Study

BACKGROUND: Proper implementation of the logistics management information system (LMIS) would facilitate access to essential pharmaceutical products. It also prevents wastage at health posts. The aim of this study was to assess the implementation of the LMIS and the availability of tracer drugs at health posts in rural Ethiopia. METHODS: We employed a cross-sectional descriptive design with a mixed-method approach. The data used for this paper was collected from March to May 2019 as part of the National HEP assessment. The study involved 343 health posts randomly selected from nine regions of Ethiopia. Women's Development Army members and household heads participated in the qualitative study (i.e. in FGD and KII). The quantitative data were exported from Open Data Kit (ODK) to Stata 15.1 for statistical analysis, and the qualitative data were entered into NVivo 12 and analyzed using thematic content analysis. RESULTS: Of the health posts, 59.4% had a space for storing drugs; less than half (41.9%; 95% confidence interval (CI) [36%, 48%]) had a functioning refrigerator. The mean percentage of the availability of selected tracer drugs at health posts was 59.6%, with a 95% CI (58.9%, 60.3%). Bin cards were available at 43% (95% CI [40%, 46%]) of health posts, and among these, only 27.5% of the health posts adequately used the bin cards. CONCLUSION: The absence and poor use of LMIS tools was observed at health posts. Proper implementation of the LMIS has the potential to improve the availability of essential drugs that, in turn, improve health post level delivery of health services.

Caractéristiques de l'automédication en ORL à l'Hôpital d'Instruction des Armées-Cotonou au Bénin / Characteristics of self-medication in ENT at Military Teaching Hospital Cotonou in Benin

Etudier l'ampleur et les caractéristiques de l'automédication en consultation ORL. Méthode: Etude descriptive du 1er juin 2020 au 1er février 2021 dans le service d'ORL-CCF/ Hôpital d'Instruction des Armées. Ont été inclus tous les patients reçus en consultation ORL ayant déclaré avoir utilisé des substances actives sans prescription médicale pour soulager leur plainte actuelle. 6 Résultats: L'automédication a été retrouvée chez 373 patients soit une prévalence de 47,88%. La moyenne d'âge était 32,26 ans (02 mois et 80 ans). Les sujets âgés 0 à 20 étaient plus représenté (68,4%). La sex-ratio était de 0,86. Les professions libérales étaient plus représentées (30%). La quasi-totalité des patients (98%) a pu énumérer au moins deux effets nocifs de l'automédication. Les médicaments en cause étaient les médicament en vente libre OTC (80%). Les principales raisons ayant motivé l'automédication ont été le coût élevé des prestations médicales (41,3%) et le manque de temps (33,2%). Conclusion: L'automédication a été retrouvée chez des patients volontiers jeunes, de sexe féminin, porteurs d'affections rhinologiques. Les OTC étaient en cause dans huit cas sur dix. Les principales motivations à l'automédication ont été le coût élevé des prestations médicales et le manque de temps

Implementation and contribution of temperature screening and handwashing practice at points of entry for COVID-19 pandemic response in a humanitarian crisis setting

Introduction: over the last decade, insecurity in the Lake Chad Basin has triggered an unprecedented humanitarian crisis in the Niger´s Diffa Region with a significant population movement. In this humanitarian setting, we reviewed the implementation process and the contribution of temperature screening and handwashing practice at points of entry as part of non-pharmaceutical interventions against COVID-19. Methods: in Diffa, border officers were trained on the fundamentals of infection prevention and control in relation to COVID-19 readiness and response and a 14-day district response team was constituted. To examine the significance of the implementation process of temperature screening and handwashing practices at points of entry, we conducted a secondary analysis of data submitted by the six health districts of the Diffa Region between March and July 2020. Results: travellers screened for fever ranged from 10,499 (in March 2020) to 62,441 (in April 2020) with the health districts of Diffa (mean: standard error of the mean: 25,999: 9,220) and of Bosso (mean: standard error of the mean: 30.4: 19.1) accounting for the most and the least of activities during the entire period, respectively. Overall, 125/169,475 travellers presented fever and were effectively quarantined. Only the Ngourti Health District reported travellers who declined handwashing (54/169,475); this was during the first three months of the first wave of the COVID-19 pandemic. Conclusion: we have documented a successful implementation of measures related to temperature screening with some unsubstantial denial of handwashing. Given the importance of border traffic due to insecurity in the Diffa Region, maintaining temperature screening and handwashing in this humanitarian setting is necessary but requires coordinated actions of all stakeholders involved in the region.

Moringa supplementation improves immunological indices and hematological abnormalities in seropositive patients receiving HAARTs

Background: Moringa oleifera Lam. is known to be of high nutritional and medicinal importance and has been demonstrated to possess a variety of biological activities. Objective: This study investigated the beneficial role of M. oleifera (moringa) supplementation in HIV positive subjects receiving antiretroviral drugs. Methods: Adult HIV positive individuals (104) attending the medical outpatient clinic in a tertiary health institution in Nigeria receiving highly active anti-retroviral therapies (HAARTs) were recruited in a randomized fashion for the study. Half of the subjects received moringa supplement (20 mg daily) additionally, while the others received only HAART and represented the control group. All subjects were monitored for 3 months during which their immunological status (CD4 counts and TNF-α), and hematological abnormalities at pre (baseline) and post study periods were determined. Results: Baseline levels of CD4 increased while TNF-α decreased significantly in control and moringa supplemented groups (p < 0.01). However, the post study CD4 values in the moringa group were higher and TNF-α values were lower compared to the control group (p < 0.01). In addition, baseline hematological abnormalities (anemia, thrombocytopenia, leucopenia, lymphopenia, and neutropenia) were improved but most significantly in the moringa supplemented subjects. Conclusion: The results suggest that moringa has immune-beneficial properties and improved hematological abnormalities in HIV positive individuals receiving antiretroviral therapy.

An assessment of infant medication administration and storage practices in selected communities in the Vhembe District of Limpopo Province, South Africa

Background: Effective infant medication administration and storage is a major public health challenge outlined by the World Health Organization.These challenges may be exacerbated in rural or limited-resource areas.Aim: The aim of this study was to investigate infant medication administration and storage practices.Setting: This study took place in selected communities in the Vhembe District of Limpopo Province, South Africa.Method: Data was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch's model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder. Results: Six themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration.Conclusions: Many factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District

Knowledge, Perception and Practice of Medication Use Review among Community Pharmacists in Southwestern Nigeria

Background: Medication use review (MUR) is an emerging concept in medicine management that has recorded success in many developed countries.Purpose: To evaluate knowledge, perception and practice of MUR among community pharmacists (CP) in southwestern Nigeria.Method: A cross-sectional study was carried out among 100 CP recruited from Oyo and Osun states between January and March, 2015, using a pre-tested questionnaire. Demographic information and CP's knowledge, perception and current practice of MUR were evaluated using open-ended, closed-ended and Likert-scale questions. Respondents' scores for 6-item knowledge test questions and description of specific component of MUR services were categorised as score>3 (good knowledge) and score≤3 (poor knowledge). Descriptive statistics were used to summarize data. Ranked variables were evaluated using Kruskal-Wallis test at p<0.05.Results: Fifty-nine (59.0%) CP from Oyo and 41(41.0%) from Osun state participated. Sixty-five (70.7%) had score>3 indicating "good" knowledge of MUR, while 27 (29.3%) had score≤3 suggesting "poor" knowledge. Forty-two (42.0%) claimed to provide MUR service; of this, 14 (33.3%) had scores>3 indicating those who gave correct description of specific component of MUR. Lack of adequate time for counselling (49; 49.5%) and lack of specialized training for pharmacists (45;45.5%) were cited as barriers to MUR practice. Majority (51; 51.5%) agreed that MUR service should be incorporated into community pharmacy practice.Conclusion: Knowledge of MUR concept among community pharmacists in Oyo and Osun states is considerable, but description of specific component of MUR services by respondents was poor. There is therefore a need for continuous training on emerging concepts among pharmacists, so as to stimulate interest in patient-oriented service

Formulation and Physical Characterization of Ibuprofen-DEAE-Dextran Nanoconjugates via Surfactant Solubilization

Background: The optimization of polymer-drug conjugate design is important in effective and efficient delivery of poorly soluble drugs. Objectives: This work focuses on the formulation of novel amorphous ibuprofen-polymer nanoconjugates based on the polymer-drug complexation in order to improve its physical characteristics in the absence of toxic organic solvents. Methods: Amorphous Ibuprofen - DEAE-Dextran nanoconjugates were prepared using surfactant solubilization method. Physical characterization of the nanoconjugates was carried out via conductivity; surface tension; viscosity; transmittance/turbidity; particle size measurement; zeta potential; conjugation efficiency and Scanning Electron Microscopy (SEM) techniques. Results: A remarkably high loading capacity was achieved ranging from 89.05 to 96.34%. The conductivity measurements showed that the critical association concentration (cac) was exhibited at 2.34 mg/mL and critical micellar concentration (cmc) at 8.0 mg/mL. The presence of DEAE-Dextran decreased the cac of ibuprofen significantly (p 0.05; n

Overview of Pre-Clinical Techniques for Predicting the Immunogenicity of Therapeutics in Drug Development

Immunogenicity testing is a vital component of drug development as it leads to drugs that are safer and more effective. This review provides an overview of the pre-clinical models that can be used to predict the immunogenic potential of novel protein therapeutics prior to administration in humans. Tools important for the prediction of the immunogenicity of protein therapeutics include animal models; in vitro cell assays; and in silico techniques. Animal models including rodents; transgenic mice; and non-human primates are reviewed. Among the immunoinformatics tools commonly used to predict immunogenicity include the Structural Epitope Database; Immune Epitope Database and Analysis Resource (IEDB); The MHCBN database; Dana-Farber Repository for Machine Learning in Immunology; and TEPITOPE. Identifiation and subsequent removal or inhibition of epitopes and MHC agretopes minimizes immunogenicity. Strategies for minimization of immunogenicity in biotherapeutics including epitope and MHC agretope removal; improvement of solubility; derivatization with polyethylene glycol (PEG); and use of chimeric antibodies are also discussed. Immunogenicity testing is an important part of the drug development process as it leads to drugs that are safer and more effective. Animal models including rodents; transgenic mice; and non-human primates; in vitro cell assays; and immunoinformatics tools are used to identify epitopes and MHC agretopes which are then eliminated or inhibited so as to minimize immunogenicity

Production des medicaments traditionnels ameliores au Cameroun : cas d'un hypoglycemiant oral

Introduction/but de l'etude.Le diabete est une affection metabolique chronique; multifactorielle; aux complications fatales en recrudescence dans le monde en general et au Cameroun en particulier. Le cout eleve des traitements conventionnels; ainsi que la modicite des revenus des populations suscitent depuis quelques annees; un interet croissant et une forte demande pour les medicaments traditionnels a base de plantes. Cet enorme potentiel medical souffre malheureusement du manque de preuves scientifiques de l'innocuite et de l'efficacite therapeutique de ces phytomedicaments. Methodes:Des etudes ethnobotaniques et ethnopharmacologiques et des analyses de laboratoire realisees sur Laportea ovalifolia ont permis d'etablir la preuve de son innocuite et la confirmation de ses activites hypoglycemiantes chez les rats. Le choix de la recette a base de cette plante parmi tant autres recensees au Cameroun en 2008 a ete fait a travers les indices de credibilite. Resultats:Cette recette a permis de produire un medicament traditionnel ameliore (MTA) antidiabetique sous quatre formes : les comprimes; les gelules; la poudre en sachets et le solute buvable. Conclusion: La determination de la posologie et le conditionnement non reconnus en medecine traditionnelle et obeissant aux methodes de fabrication modernes des formes galeniques; facilitent l'administration et la conservation du produit

Evaluation of Drug Use and Patient Care Practices in a Referral Health Facility in Yenagoa; Bayelsa State; Nigeria

Background: Evaluation of drug use and patient care practice is a very vital aspect of patient care. It also measures the quality of care provided by health practitioners for patients. Data from this study is very essential in healthcare management and planning. Objectives: To assess drug use and patient care practices at the outpatient section of a referral hospital in Yenagoa; south-south; Nigeria; using WHO drug use indictors. Methods: The study was conducted at Federal Medical Centre; Yenagoa; Bayelsa State. A total of 2450 prescriptions from the outpatient pharmacy were selected by systematic sampling and retrospectively studied. A prospective study of the patient care practices and health facility indicators; which include consultation and dispensing times; revenue time; Patient's knowledge of their medications and availability of key essential drugs; was also undertaken. Data collected was analyzed using WHO guideline for assessment of drug use in healthy facilities. Results: The average number of drugs prescribed per encounter was 3.4; Percentage of encounters with at least an antibiotic prescribed was 35.5. Injections were prescribed in 22of encounters. 62of drugs were prescribed by generic name while 87of drugs prescribed were from the essential drug list. The mean consultation and dispensing times were 11.5 and 3.5 minutes respectively. Two out of every three patients interviewed knew both the names and the duration of their medications while four out of every five knew the correct dosage of their medications. Conclusion: Many of the prescribing and patient care indicators assessed were found to be inappropriate and need to be improved upon. . There was high tendency of poly- pharmacy and over prescription of antibiotics. The patients' knowledge of vital aspects of medication management was found to be inadequate. The overall picture of drug use suggests that the indicators at this facility are not yet at the optimal level

Towards sustainable local production of traditional medicines in the African Region

The majority of the population in the WHO African Region and other developing countries; particularly rural dwellers use plant-based traditional medicines for health care. Most developing countries are endowed with vast resources of medicinal and aromatic plants; which have been used over centuries for the treatment of diseases. The global resurgence of interest in herbal medicines has created a large market for plant derived remediesthat developing countries could exploit to their advantage; provided they could be produced with acceptable quality and safety specifications. This article highlights the current limitations of traditional medicinal productsin the Member States; the essential requirements for the local production of traditional medicines; the status of local production in WHO African Region; approaches to sourcing plant raw materials as well as challenges. Methods for value addition; processing and product improvement for the commercial utilization of medicinal plants are indicated

Availability of Essential Medicines in Sudan?

Introduction: Although availability of essential medicines is one of the most important objectives of national medicines' policies; the unavailability of essential medicines remains a major problem for poor countries. Objective: The study was carried out to measure availability and duration of out of stock of essential medicines in Sudan. Method: The study was carried out using the World Health Organization (WHO) Operational Package for Assessing and Monitoring Pharmaceutical Situation in Countries format for data collection. Results: On the average; availability of selected essential medicines at the public pharmacy; medicine stores and the private pharmacies was found to be 80.6; 90.0and 93.0; respectively. The survey found the mean duration of stock out at medicines store was 26.5 days and no records available about inventory control at the pharmacy level. Among the states; the study found low availability of medicines at North Kordufan public pharmacies. The study found no statistical significant difference as far as a Developing country concerning availability of medicines at rural or urban areas (p 0.05). Conclusion: Generally availability and stock out duration of essential medicines in the Sudan were acceptable