Attitudes of Older Adult Patients and Caregivers Towards Deprescribing of Medications in Ethiopia.

Background: Deprescribing is essential for reducing inappropriate medication use and polypharmacy. For a holistic approach, it is essential to know how older adult patients and their caregivers perceive deprescribing. Objective: To assess the attitude of older adult patients and caregivers towards deprescribing medication at Ambo University Referral Hospital. Methodology: Institutional-based cross-sectional study was conducted using the revised Patients' Attitude Towards Deprescribing tool (rPATD). The data was analyzed using the SPSS-25 software. Backward linear regression and logistic regression were used to measure association between outcome and determinant variables. The two-sided P-value ≤0.05 with 95% confidence interval was utilized for reporting significant factors. Results: One hundred fifty-six (81.3%) of the respondents (ie, 85.0% of older adult and 77.2% of caregivers) agreed to stop one or more of their regular medications if the physician said it was possible despite 98 (51.0%) of them (ie, 49.0% of older adult and 53.3% of caregivers) being satisfied with their/their care recipient's medications. On the overall aggregate mean score, the respondents had a neutral position (2.6-3.59) regarding the burden and concerns of stopping medications whereas the majority of them disagree (1.0-2.59) with the inappropriateness of the medication they were taking and agreed (3.6-5.0) with the need for their involvement in treatment decision making. Concerns about stopping medicine scores (AOR = 0.440, 95% CI = 0.262-0.741, P = 0.035) and perceived levels of medication inappropriateness (AOR = 0.653, 95% CI = 0.456-0.936, P = 0.020) was significantly associated with the willingness to discontinue and overall satisfaction with their medicine regimen respectively. Conclusion: The majority of older adult patients and caregivers would like to deprescribe if the physicians recommended it. The perceived concerns of stopping and inappropriateness of the medicines were associated with the willingness to deprescribe and overall satisfaction with their medicine respectively. Healthcare providers should prompt the deprescribing process with older adult patients and caregivers by addressing their concerns about stopping medications.

Factors Affecting the Quality of Undergraduate Pharmacy Students' Researches in Ambo University, Ethiopia: A Qualitative Study from Advisors' Perspective.

BACKGROUND: One of the problems facing higher education institutions in developing countries such as Ethiopia is the poor quality of undergraduate students' academic work. However, there is a scarcity of empirical data on the specific causes of the poor quality of undergraduate study. Therefore, the aim of this research is to explore factors that influence the quality of undergraduate pharmacy students' research projects at Ambo University in Ethiopia, from the perspective of research advisors. METHODS: A qualitative study was held in Ambo University, Department of Pharmacy from March 2 to March 27, 2020. A total number of 15 research advisors were the participants of the study. A semi-structured interview questionaire was prepared to explore participants' ideas about the current situation of research quality, underlying causes and perception towards outcomes of poor quality of undergraduate pharmacy students' research projects. The necessary data were collected through in-depth interview and qualitative content analysis was employed to analyze the data. RESULTS: The majority of the key informants thought that the quality of undergraduate pharmacy students research projects is decreasing from time to time in their university due to students' research knowledge gap, poor commitment, and motivation, lack of communication between students and advisors, plagiarism, financial problems, shortage of experienced research advisors, advisors less motivation and dedication, insufficient research facilities, lack of research fund, poor management support, and limitation of the undergraduate curriculum. They also revealed weak students' research capacity, absence of knowledge transfer through research publication and presentation, and inadequate baseline evidence for the policymakers are the potential outcomes of poor quality undergraduate pharmacy students' research projects. CONCLUSION: Undergraduate research quality is a persistent problem in the department of pharmacy of Ambo University. The problem is exacerbated due to multiple factors. As a result, the university should establish a framework for collaboration among students, advisors, and university research leaders; it should also boost students' research capacity by hiring qualified researchers, equipping the research facility with appropriate technology, and instituting a system for monitoring and evaluating research project results.

Evaluation of the Undergraduate Pharmacy Student Research Projects in Ambo University, Ethiopia: Retrospective Review.

BACKGROUND: Academic research is an essential part of undergraduate Pharmacy education to produce qualified Pharmacists. However, there are no documented studies that examine the nature of undergraduate Pharmacy students' research projects in Ethiopia. Therefore this study aimed to characterize the nature of students' research project conducted for a bachelor of Pharmacy degree program at Ambo University, Ethiopia. METHODS: A cross-sectional, retrospective review using data extraction form was conducted on 279 research reports of undergraduate Pharmacy students at Ambo University from 2013/14 to 2018/2019. The National Harmonized Modular Curriculum program for the Bachelor of Pharmacy degree in Ethiopia was used as a framework to group research projects by research topics and domains. Students' profile (gender, program), supervisors profile, research types and topics, a domain of pharmacy curriculum, study setting, study design, target population, data collection strategy and techniques, and therapeutic classes of medicines for each project were extracted to see the characteristics of students' research project. Data were entered and analyzed using Microsoft Excel and SPSS version 25. Descriptive statistics were used to present the data. RESULTS: From 279 Pharmacy undergraduate students' research projects, 83.9% were conducted by male students and 64.1% were by regular program students. Two hundred fifty (89.6%) of the projects were surveys. Slightly less than half (49.8%) of the research projects were clinical researches. One hundred twenty-six (45.2%) of the research projects were focused on the pharmaceutical care domain followed by dispensing (22.6%) and research and education domain (10%). Out of the 250 survey research projects, the majority 226 (90.4%) of them were used cross-sectional study design, 205 (82%) were conducted at hospitals and 187 (74.8%) were done on the clinical population. CONCLUSION: The study showed that the majority of the abstracted projects were surveyed type quantitative clinical researches focused on the Pharmaceutical care domain and takes place at hospitals affiliated with the University. On the contrary, a lower proportion of the research projects were laboratory-based researches, focused on Pharmaceuticals manufacturing, drug information service, regulation, and supply chain management domains, and takes place at community Pharmacy and educational institutions. Thus, it is highly recommended the University has to devise a system for expansion of the study settings other than its affiliated hospitals, and the research topics would encompass all areas and domains of Pharmacy Practice and Pharmaceutical sciences.

Clinical Characteristics, Treatment Outcomes, and its Predictors Among Hospitalized Stroke Patients in Ambo University Referral Hospital, West Ethiopia: A Retrospective Hospital-Based Study.

BACKGROUND: Stroke is becoming a leading cause of death and adult disability in the developing world. OBJECTIVE: The objective of the study was to assess the clinical characteristics, treatment outcomes, and its predictors among stroke patients admitted to Ambo University Referral Hospital (AURH), West Ethiopia. METHODS: All 111 stroke patients hospitalized from April 2016 to May 2019 were included using a hospital-based retrospective study. Socio-demographic profile, past medication history, clinical presentation, drugs prescribed for comorbid condition and stroke treatment, and outcomes data were collected using data abstraction formats and results were summarized using both descriptive and inferential statistics. KEY FINDINGS: According to WHO clinical criteria, 89 (80.2%) were diagnosed with ischemic stroke, and 20 (18.0%) were diagnosed with hemorrhagic stroke. The majority of the patients 94 (84.7%) had at least one antecedent risk factor in which hypertension accounted for 44.1%. More than half, 69 (62.2%), of hospitalized stroke patients had good treatment outcomes while 42 (37.8%) had a poor outcome. The overall case-fatality rate was 18 (16.2%), 12 (13.5%) from ischemic stroke, and 6 (30.0%) from hemorrhagic stroke. Acetyl salicylic acid (ASA) with atorvastatin/simvastatin, 67 (73.5%) in ischemic stroke and 12 (60.0%) in hemorrhagic stroke, was the most frequent medications prescribed for stroke during admission while it was frequently prescribed for 48 (53.6%) of ischemic stroke and 10 (50.0%) of the hemorrhagic stroke on discharge. Overall, ceftriaxone + metronidazole 32 (28.8%) was frequently prescribed concomitant medications during admission. The major predictors identified for poor stroke outcomes were substance abuse (AOR=2.839, P=0.024) and have had not received any medication for stroke treatment during admission (AOR=12.503, P≤0.001). CONCLUSION: A significant number of the admitted stroke patients had poor treatment outcome in which the case-fatality rate was relatively high. Substance abuse and having not received medication for stroke were the significant predictors for poor treatment outcome. Hence, a well-established stroke unit setup at AURH is required for accurate diagnosis and management of stroke to overcome stroke-related mortality and/or poor treatment outcome.

Reliability and validity of Amharic version of EORTC QLQ-C30 and QLQ-BR23 modules for assessing health-related quality of life among breast cancer patients in Ethiopia.

BACKGROUND: Breast cancer is the most common cancer among women and it affects quality of life of those women. So far, the two most frequently used tools for assessing health related quality of life in breast cancer patients, EORTC QLQ-C30 and EORTC QLQ-BR23 modules, were not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tools among Ethiopian breast cancer patients. METHODS: Institutional based longitudinal study was conducted from January 1 to May 1, 2017 GC at only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. A total of 146 patients who visited the facility during that period, with no missing quality of life data, were selected for analysis. The psychometric properties of the EORTC QLQ-C30 and EORTC QLQ-BR23 were evaluated in terms of reliability, convergent, divergent, construct and clinical validity using SPSS version 22. RESULTS: Satisfactory internal consistency reliability (Cronbach's α coefficients > 0.7) was confirmed, except for cognitive function (α = 0.516) of EORTC QLQ-C30 and body image (α = 0.510) of EORTC QLQ-BR23. Multiple-trait scaling analysis demonstrated a good convergent and divergent validity. No scaling errors were observed. Most items in EORTC QLQ-BR23 possessed a weak or no correlation with its own dimension in EORTC QLQ-C30 (r < 0.4) except with some of symptom scales. A statistically significant chemotherapy induced quality of life scores changes (P ≤ 0.05) were observed in all dimensions of both instruments between baseline and the end of first cycle chemotherapy, except for body image (P = 0.985) and sexual enjoyment (P = 0.817) of EORTC QLQ-BR23, indicating clinical validity. CONCLUSION: Amharic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 modules are valid and adequately reliable tool and can be used for clinical and epidemiological cancer researches to study the health related quality of life (HRQoL) of women with breast cancer in Ethiopia.

Factors contributing to medicines wastage in public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia: a qualitative study.

BACKGROUND: Medicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. METHODS: A qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants' idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data. RESULTS: Almost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier's issuing of medicines without health facilities' needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision. CONCLUSION: Medicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities.