Potentially Inappropriate Use of Medication and Its Determinants Among Ambulatory Older Adults in Six Community Chain Pharmacies in Asmara, Eritrea: A Cross-Sectional Study Using the 2023 American Geriatric Society Beers Criteria®.

Background: Potentially inappropriate medication (PIM) use is one of the main drug-related problems encountered in older adults. It is associated with adverse drug events, morbidity, mortality, increased economic costs, and negative effects on the quality of life that requires strict monitoring of prescriptions in older adults. Thus, the study aimed to assess potentially inappropriate medication use and its determinants among older adults. Methods: A cross-sectional study was conducted among all outpatient prescriptions dispensed to older adults (aged 65 years and above) in six community chain pharmacies in Asmara, Eritrea. Data were collected retrospectively, between June 16 and July 16, 2023. PIMs were detected using the 2023 American Geriatric Society (AGS) Beers Criteria®. Descriptive statistics and logistic regression analysis were performed using IBM SPSS® (Version-26.0). Results: A total of 2680 outpatient prescriptions dispensed to older adults were included in this study. The prevalence of PIM among prescriptions was 18.1% (95% CI: 16.7, 19.6). Moreover, a total of 470 medications were found to be avoided in older adults. The most commonly prescribed PIMs were sulfonylureas (27.2%) and substituted alkylamines (16.2%). The prevalence of prescriptions containing medications to be used with caution in older adults was 13.2% (95% CI: 12.0, 14.5). Age (Adjusted Odds Ratio (AOR))=0.98, 95% CI: 0.97, 0.99), polypharmacy (AOR=2.77, 95% CI: 1.49, 5.15), and general practitioner prescriber (AOR=1.38, 95% CI: 1.11, 1.70) were significantly associated with PIMs. Conclusion: A considerable number of ambulatory older adults were exposed to PIMs which require a close attention by policymakers, program managers, and healthcare professionals.

Antibiotic prescribing practice using WHO Access, Watch and Reserve classification and its determinants among outpatient prescriptions dispensed to elderly population in six community chain pharmacies in Asmara, Eritrea: a cross-sectional study.

OBJECTIVE: To assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population. DESIGN: A prescription-based, cross-sectional study. SETTING: Six community chain pharmacies in Asmara, Eritrea. PARTICIPANTS: All outpatient prescriptions dispensed to the elderly population (aged 65 and above) in the six community chain pharmacies in Asmara, Eritrea. DATA COLLECTION AND ANALYSIS: Data were collected retrospectively, between 16 June 2023 and 16 July 2023. Antibiotic prescribing practice was assessed using the 2023 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification system. Descriptive statistics and logistic regression were performed using IBM SPSS (V.26.0). P values less than 0.05 were considered as significant. RESULTS: Of the 2680 outpatient prescriptions dispensed to elderly population, 35.8% (95% CI: 34.0, 37.6) contained at least one antibiotic. Moreover, a total of 1061 antibiotics were prescribed to the elderly population. The most commonly prescribed antibiotics were ciprofloxacin (n=322, 30.3%) and amoxicillin/clavulanic acid (n=145, 13.7%). The Access category accounted for the majority of antibiotics (53.7%) with 32.1% from the Watch category. Prescriber qualification (Adjusted Odds Ratio (AOR)= 0.60, 95% CI: 0.44, 0.81) and polypharmacy (AOR= 2.32, 95% CI: 1.26, 4.27) were significant determinants of antibiotic prescribing in the elderly population. Besides, sex (AOR=0.74, 95% CI: 0.56, 0.98), prescriber qualification (AOR=0.49, 95% CI: 0.30 to0.81) and level of health facility (AOR 0.52, 95% CI 0.34 to 0.81) were significant determinants of a Watch antibiotic prescription. CONCLUSION: Antibiotics were prescribed to a considerable number of the elderly population, with more than half of them falling into the Access category. Further efforts by policy-makers are needed to promote the use of Access antibiotics while reducing the use of Watch antibiotics to mitigate risks associated with antimicrobial resistance.

A cross-sectional study on the proper administration of eye medications and its determinants among outpatients attending Brhan Aini Ophthalmic National Referral Hospital in Asmara, Eritrea.

OBJECTIVE: This study aimed to assess the administration technique of eye medications, its determinants and disposal practices among ophthalmic outpatients. DESIGN: An analytical cross-sectional study was conducted. SETTING: Brhan Aini Ophthalmic National Referral Hospital in Asmara, Eritrea. PARTICIPANTS: Samples of ophthalmic outpatients aged >18 years who visited Brhan Aini Ophthalmic National Referral Hospital in Asmara, Eritrea. Systematic random sampling was used to select the study participants. DATA COLLECTION AND ANALYSIS: Data were collected from August 2021 to September 2021, using an interview-based questionnaire. The collected data were entered and analysed using CSPro (V.7.3) and SPSS (V.26), respectively. Descriptive statistics and independent samples t-test were performed. P-values less than 0.05 were considered as significant. RESULTS: A total of 333 respondents with a mean age of 56.4 (SD: 18.76) years were recruited in the study. More than half of the respondents (57.4%) did not have any information on the time interval between two successive eye medications. However, only 16.5% of the respondents managed to close their tear ducts after the administration of eye medication. The mean (SD) score for proper administration of eye medication was 4.16 (1.07) out of 7.0. Female sex (p=0.002), the absence of glaucoma (p=0.035) and the presence of cataract (p=0.014) were significant determinants of the proper administration technique of eye medication. The most favoured disposal practice for unused and/or expired eye medications was disposing of regular garbage (79.9%). CONCLUSION: This research revealed that there was an inappropriate administration technique and disposal practices of eye medications among ophthalmic outpatients. This requires immediate attention from policy-makers, programme managers and healthcare professionals to ensure the appropriate use of eye medications by the patients.

Determinants of Child Marriage and Its Related Adverse Health Outcomes Among Married Women in Sub-Region of Serejeka, Central Region in Eritrea: A Cross-Sectional Study.

Background: Child marriage is a fundamental violation of human rights that can have numerous adverse effects on girls' social, mental and physical health and wellbeing. Marriage in Eritrea relatively occurs earlier for women. This study aimed to assess the magnitude of child marriage, determinants and its related adverse health outcomes in five selected villages of the sub-region of Serejeka in Central region of Eritrea. Methods: An analytical cross-sectional study was conducted among 200 married women aged 18 to 30 years who are residents of five selected villages of the sub-region of Serejeka between July 12 and August 20, 2018. The sampling design was stratified random sampling and data were collected using an interview-based questionnaire. Descriptive and analytical statistics including chi-square test and logistic regression were employed using SPSS (v.22). Results: The prevalence of child marriage was found to be 42% [95% CI (35.1, 48.9)]. The maximum and minimum age at marriage were 14 and 29, respectively. No formal education/primary level (AOR = 22.08, 95% CI: 4.16, 117.24), junior educational level (AOR = 6.95, 95% CI: 3.48, 13.87) and decision on the marriage (AOR = 4.30, 95% CI: 1.03, 17.92) were the significant determinants of child marriage. Prolonged labour (OR = 2.81, 95% CI: 1. 32, 5.98), abortion (OR = 3.95, 95% CI: 1.63, 9.53), hemorrhage during birth (OR = 4.83, 95% CI: 1.68, 13.87), spousal violence (OR = 2.07, 95% CI: 1.15, 3.75), pressure/stress (OR = 4.83, 95% CI: 1.68, 13.87), termination of education (OR = 8.24, 95% CI: 4.35, 15.63) and stigma or isolation from their society (OR = 7.38, 95% CI: 3.03, 17.98) were significant adverse health outcomes associated with child marriage. Conclusion: This study revealed that child marriage was still a common practice. It is associated with detrimental physical health, psychological well-being and socio-economic status. This mandates policy makers and program managers to focus their programs on delaying entry of children into wedlock and motherhood by providing information, education and enhancing communication with their community.

Self-medication with ophthalmic drugs and its associated factors among ophthalmic patients attending three hospitals in Asmara, Eritrea: a cross-sectional study.

OBJECTIVE: To assess the prevalence and practice of self-medication and its associated factors among ophthalmic patients. DESIGN: An analytical cross-sectional study design was employed. SETTING: Three hospitals inAsmara, Eritrea. PARTICIPANTS: Samples of ophthalmic outpatients aged >18 years who visited the three hospitals in Asmara, Eritrea. Systematic random sampling was used to select the study participants. DATA COLLECTION AND ANALYSIS: Data were collected from September 2021 to October 2021 in a face-to-face interview using a structured questionnaire. The collected data were double entered and analysed using CSPro (V.7.2) and SPSS (V.26), respectively. Descriptive statistics and logistic regression were performed. P values less than 0.05 were considered as significant. PRIMARY AND SECONDARY OUTCOME MEASURES: Main outcome variable was practice of self-medication with ophthalmic drugs (SMOD). Secondary outcome measure was the determinants of self-medication practice. RESULTS: A total of 351 participants were recruited with a response rate of 97.7%. The prevalence of SMOD was found to be 14.9% (95% CI (11.1% to 18.7%)). The most frequently preferred ophthalmic drug groups were antibiotics (63.6%), followed by corticosteroids (22.7%). The main reasons for SMOD were easy accessibility (52.9%) and previous familiarity of the eye medication (27.5%). Eye redness (n=19/51) and foreign body sensation (n=18/51) were the most self-recognised complaints that required self-medication. The most common source of information for SMOD was pharmacy professionals (41.1%). Only attitude score (Crude odds ratio (COR)= 1.25, 95% CI 1.12, 1.39) was significantly associated with the practice of SMOD at bivariate logistic regression. CONCLUSION: Though the majority of respondents considered self-medication with ophthalmic drugs as inappropriate, a significant number of them practising it. This mandates relevant bodies to take stricter measures to protect the public from the misuse of eye medications.

Patient-Centered Communication Among Pharmacy Professionals Working in Hospitals and Drug Retail Outlets in Asmara, Eritrea: Knowledge, Attitude, Self-Efficacy and Barriers.

Background: Globally, preventable medication-related problems are increasing constantly. Patient-centered communication (PCC) is essential to identify and reduce the occurrence of drug-related problems such as inappropriate use of medications, adverse drug reactions and non-adherence. In Eritrea, personal observations and anecdotal reports showed that pharmacy professionals' practice towards PCC was unsatisfactory. This study was conducted to assess pharmacy professionals' knowledge, attitude, self-efficacy and barriers towards the practice of PCC. Methods: An analytical cross-sectional study design was employed among all pharmacy professionals who were employees of the drug retail outlets and hospital out-patient pharmacies of Asmara, Eritrea. A census approach was employed and data were collected from May to June 2021 using a face to face interview-based data collection tool. Descriptive and analytical statistics including independent samples t-test and multiple linear regression were employed using IBM SPSS (version-26). Results: A total of 79 pharmacy professionals with a median age of 36 (IQR: 20) years were included in the study. The mean (SD) knowledge score of PCC was found to be 11.91 (2.0) out of 17. Moreover, the mean (SD) attitude score was 39.55 (4.0) out of 60 and the overall mean (SD) self-efficacy score was 52.51 (12.0) out of 96. Self-efficacy was significantly correlated with attitude (p=0.015). Work setting (p=0.002) and training (p=0.045) were predictors for the sub-scales of self-efficacy 'exploring patient's perspectives' and 'dealing with communicative challenges', respectively. Workload/shortage of pharmacy professionals and time constraint were found to be the main barriers of the pharmacy professionals for not practicing PCC. Conclusion: Generally the pharmacy professionals' fairly encouraging knowledge and attitude score on PCC, it was not supported with their self-efficacy. This necessitates further attention from policy makers and health facility managers in creating an ideal working environment for the pharmacy professionals to practice PCC at their best.

Knowledge and Perceptions of Nurse Practitioners on Adverse Events Following Immunization and Barriers to Reporting in the Central Region, Eritrea: A Cross-Sectional Study.

Background: Though vaccines are generally considered extremely safe and effective, they have been associated with some serious adverse events following immunization (AEFIs). AEFIs might be related to either the vaccine, immunization error, anxiety related to immunization, and/or coincidental events. If they are not reported and investigated in timely fashion, they can create rumors and confidence gaps. In the last few years, reporting AEFIs in the Central Region of Eritrea, compared to other regions, has been found to be very low, with the root cause for this variation unknown, making intervention strategies challenging. This study was conducted to assess nurse practitioners' knowledge and perceptions on AEFI surveillance and barriers to reporting in the region. Methods: An analytical cross-sectional study was conducted among all nurse practitioners who were directly or indirectly involved in immunization services working in all health facilities of the region. Data were collected between October 2019 and February 2020 using an interview-based questionnaire. Percentages and medians (IQR) were used as descriptive statistics, and Mann-Whitney and Kruskal-Wallis tests were used as inferential tools. Results: A total of 130 respondents with a median age of 40 (IQR 23) years were included in the study. The overall median (IQR) knowledge score of the respondents on AEFI surveillance was 87.50 (19) out of 100. Furthermore, median (IQR) comprehensive perception score was 70 (20) out of 100 (range 40-95). Shortage of motivation and not knowing how to report were identified as the main barriers to reporting AEFIs. Conclusion: Knowledge and perceptions of nurse practitioners in the Central Region on AEFI surveillance were generally encouraging. They should however need to be further trained on the basics of AEFI surveillance to bridge the identified barriers to reporting.

Herbal Medicine (HM) among pharmacy professionals working in drug retail outlets in Asmara, Eritrea: knowledge, attitude and prevalence of use.

BACKGROUND: Globally, the usage of herbal medicines (HMs) is increasingly growing in treating and preventing various ailments. Although, HMs play a vital role in healthcare, concerns have been raised over their safety. Since pharmacy professionals are at the right position to provide patients with evidence-based information on herbals, they should be knowledgeable enough on the subject matter. Thus, the aim of the study was to assess the knowledge, attitude and prevalence of HMs use and its associated factors among pharmacy professionals. METHOD: An analytical cross-sectional study was conducted among pharmacy professionals working in drug retail outlets in Asmara (the capital city of Eritrea). A census design was employed and data were collected through face-to-face interview. Data were entered and analyzed using Census and Survey Processing System (version-7.2) and IBM Statistical Package for Social Sciences (version 26), respectively. Descriptive and analytical statistics including Mann-Whitney U test/Kruskal-Wallis test and logistic regression were employed. P-values less than 0.05 were considered as significant. RESULTS: A total of 50 pharmacy professionals (90.9% response rate) were enrolled in the study. Majority of them (62%) were males and two-thirds had a bachelor's degree. The overall median (Interquartile range, IQR) knowledge score was found to be 24 (12.16) out of 100 with a minimum score of 8 and maximum score of 53. Generally, the median (IQR) attitude score was 70.4 (4.2) out of 100. Majority (78%) of them had used HM for self-treatment. Only religion was found to be a significant determinant of knowledge on indication of HMs (p = 0.015), while attitude score was independent of the potential determining factors. Moreover, prevalence of use was significantly associated with pharmacy ownership (Adjusted Odds Ratio (AOR) =14.44, 95%Confidence Interval (CI): 1.67, 124.52) as well as with the percentage attitude score (AOR = 0.632, 95%CI: 0.41, 0.96) at multivariable level. CONCLUSION: Generally, the overall knowledge score of pharmacy professionals was low. However, they possessed positive attitude towards herbal medicines. Besides, there was prevalent usage of herbal medicine for self-treatment. This outcome triggers the need for educational courses and workshops centered on herbal medicine.

Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators.

Rational use of medicine (RUM) for all medical conditions is crucial in attaining quality of healthcare and medical care for patients and the community as a whole. However, the actual medicine use pattern is not consistent with that of the World Health Organization (WHO) guideline and is often irrational in many healthcare setting, particularly in developing countries. Thus, the aim of the study was to evaluate rational medicine use based on WHO/International Network of Rational Use of Drugs (INRUD) core drug use indicators in Eritrean National and Regional Referral hospitals. A descriptive and cross-sectional approach was used to conduct the study. A sample of 4800 (600 from each hospital) outpatient prescriptions from all disciplines were systematically reviewed to assess the prescribing indicators. A total of 1600 (200 from each hospital) randomly selected patients were observed for patient indicators and all pharmacy personnel were interviewed to obtain the required information for facility-specific indicators. Data were collected using retrospective and prospective structured observational checklist between September and January, 2018. Descriptive statistics, Welch's robust test of means and Duncan's post hoc test were performed using IBM SPSS (version 22). The average number of medicines per prescription was 1.78 (SD = 0.79). Prescriptions that contained antibiotic and injectable were 54.50% and 6.60%, respectively. Besides, the percentage of medicines prescribed by generic name and from an essential medicine list (EML) was 98.86% and 94.73%, respectively. The overall average consultation and dispensing time were 5.46 minutes (SD = 3.86) and 36.49 seconds (SD = 46.83), respectively. Moreover, 87.32% of the prescribed medicines were actually dispensed. Only 68.24% of prescriptions were adequately labelled and 78.85% patients knew about the dosage of the medicine(s) in their prescriptions. More than half (66.7%) of the key medicines were available in stock. All the hospitals used the national medicine list but none of them had their own medicine list or guideline. In conclusion, majority of WHO stated core drug use indicators were not fulfilled by the eight hospitals. The results of this study suggest that a mix of policies needs to be implemented to make medicines more accessible and used in a more rational way.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Usage and co-prescription with other potentially interacting drugs in elderly: A cross-sectional study.

Globally, usage of non-steroidal anti-inflammatory drugs (NSAIDs) in elderly with chronic pain has been reported as frequent. Though NSAIDs are fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. This study was conducted to assess the appropriateness of NSAIDs use and determine the risk of NSAIDs related potential interactions in elderly. An analytical cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara, Eritrea, between August 22 and September 29, 2018. A stratified random sampling design was employed and data was collected using an interview-based questionnaire and by abstracting information from patients' prescriptions and medical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using IBM SPSS (version 22). A total of 285 respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users and NSAIDs risk practice was reported in 24%. Using chronic NSAIDs without prophylactic gastro-protective agents, self-medication, polypharmacy and drug-drug interactions were the main problems identified. A total of 322 potential interactions in 205 patients were identified and of which, 97.2% were classified as moderate, 0.6% severe and the rest were mild. Those who involved in self-medication were more likely to be exposed to drug interactions. Diabetes (AOR = 2.39, 95% CI: 1.14, 5.02) and hypertension (AOR = 9.06, 95% CI: 4.00, 20.51) were associated with chronic NSAIDs use and incidence of potential drug interactions (AOR = 3.5, 95%CI: 1.68, 4.3; AOR = 2.81, 95%CI: 1.61, 4.9 respectively), while diabetes AOR = 4.5, 95% CI: 2.43, 8.35) and cardiac problems (AOR = 4.29, 95% CI: 1.17, 15.73) were more likely to be associated with incidence of polypharmacy. In conclusion, chronic use of NSAIDs without gastro-protective agents and therapeutic duplication of NSAIDs were commonly which requires attention from programmers, health facility managers and healthcare professionals to safeguard elderlies from preventable harm.

Assessment of completeness and legibility of handwritten prescriptions in six community chain pharmacies of Asmara, Eritrea: a cross-sectional study.

BACKGROUND: Incompleteness and illegibility of prescriptions are prescription errors that account for a high proportion of medication errors that could potentially result in serious adverse effects. Thus, the objective of this study was to assess the completeness and legibility of prescriptions filled in the community chain pharmacies. METHODS: An analytical and cross-sectional study was conducted in the six government owned community chain pharmacies of Asmara, Eritrea from June 3rd to 10th, 2019 using a stratified random sampling technique. A total of 385 prescriptions were analyzed for completeness and legibility by three pharmacists (two experienced and one intern pharmacist). Descriptive statistics and multinomial logistic regression were employed using IBM SPSS® (Version 22). RESULTS: A total of 710 drugs were prescribed from the 385 prescriptions assessed. On average, a prescription was found to have 78.63% overall completeness. In the majority of the prescriptions, patient's information such as name, age, sex, and prescriber's identity were present. Prescribed drugs' information such as dose, frequency and quantity and/or duration were present in 83.7, 87.7, and 95.1% respectively. Moreover, generic names were used in 83.3% of the drugs prescribed. About half (54.3%) of the prescriptions' legibility were classified in grade four (clearly legible) and 30.6% in grade three (moderately legible). It was observed that legibility significantly increased with an increase in percentage completeness (rs = 0.14, p = 0.006). However, as the number of drugs written in brand name increased, legibility decreased (rs = - 0.193, p < 0.001). Similarly, as the number of drugs prescribed increased, legibility decreased (rs = - 0.226, p < 0.006). CONCLUSION: Majority of the handwritten prescriptions received in the community pharmacies of Asmara are complete and clearly legible.

Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study.

Background: Antibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines. Methods: A prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22). Results: The average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71-5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10-2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35-3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62-2.52). Conclusions: This study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20-26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4-24.0%. Patients' age, gender and number of medicines were significantly associated with antibiotic prescribing.