The effect of prescription patterns on the performance of the pharmacy department of a Regional Referral Hospital, Uganda.

Background: Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries. Objective: This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda. Methods: This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables. Results: The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers. Conclusion: Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized.

Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda.

Purpose: This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated. Methods: We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach. Results: Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1-3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01-24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions. Conclusion: Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.

Performance of Jazia Prime Vendor System in ensuring availability of health commodities in Singida Region, Tanzania: a pre- and post-evaluation study.

BACKGROUND: Availability of the health commodities in public health facilities in Tanzania remains a challenge, and has been reported to be below 70%. Moreover, Medical Stores Department's capacity to supply health commodities has been only 40%. Therefore, Jazia Prime Vendor System (Jazia PVS) was outsourced to complement the Medical Stores Department. In 2017 Jazia PVS was introduced in Singida Region after being piloted in three other Regions. This study therefore, was conducted to assess the performance of Jazia PVS in enhancing the availability of the health commodities in the public health facilities between 2017 and 2019 in Singida Region, Tanzania. METHODS: A mixed method pre- and post-evaluation analytical study design was used in all the selected public health facilities in the Municipal and District Councils of Singida Region, Tanzania. These included 138 public health facilities: One Regional Referral Hospital, four District Hospitals, 19 Health Centres and 114 Dispensaries. Percent availability of health commodities was abstracted from electronic logistics management information system. Documentary review involved quarterly orders, Jazia PVS delivery notes, and payment vouchers; while all the 138 pharmacists incharge were interviewed. RESULTS: The mean availability of health commodities was modestly higher after adoption of Jazia PVS (mean = 59.17%, SD = 6.12%) than before Jazia PVS (mean = 54.39%, SD = 5.36%); and the difference between means was 4.78% (t = -9.49, df = 136, p < 0.001). Furthermore, 20.3% (109/421) of orders were fulfilled, while 58% (312/421) were not, (χ2 = 10.46, df = 6, p = 0.1067). About 73.7% of orders (320/434) were delivered on time, while 26.3% (114/434) delayed, (χ2 = 121, df = 6, p < 0,001). Prompt payment to Jazia PVS was 43.0% (164/381) deliveries, while 57.0% (217/382) were not punctual, (χ2 = 26, df = 6, p < 0.001). Satisfaction level of the pharmacists incharge for Jazia PVS was 11.8%, (χ2 = 78.04, df = 3, p < 0.001). CONCLUSION: With Jazia PVS, availability of health commodities improved by 4.78% in 2 years. Prompt payment of Jazia PVS will enhance performance of the vendor.

Malaria rapid diagnostic tests in community pharmacies in Rwanda: availability, knowledge of community pharmacists, advantages, and disadvantages of licensing their use.

BACKGROUND: Presumptive treatment of malaria is often practiced in community pharmacies across sub-Saharan Africa (SSA).To address this issue, the World Health Organization (WHO) recommends that malaria Rapid Diagnostic Tests (m-RDTs) be used in these settings, as they are used in the public sector. However, their use remains unlicensed in the community pharmacies in Rwanda. This can lessen their availability and foster presumptive treatment. Therefore, this study investigated the availability of m-RDTs, knowledge of community pharmacists on the use of m-RDTs, and explored Pharmacists' perceptions of the advantages and disadvantages of licensing the use of m-RDTs in community pharmacies. METHODS: This was a cross-sectional study among 200 licensed community pharmacists who were purposefully sampled nationwide from 11th February to 12th April 2022. Data was collected using an online data collection instrument composed of open-ended and closed-ended questions. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25.0. The chi-square test was used to evaluate the association between the availability of m-RDTs and independent variables of interest. Content analysis was used for qualitative data. RESULTS: Although 59% were consulted by clients requesting to purchase m-RDTs, only 27% of the participants had m-RDTs in stock, 66.5% had no training on the use of m-RDTs, and 18.5% were not at all familiar with using the m-RDTs. Most of the participants (91.5%) agreed that licensing the use of m-RDTs in community pharmacies could promote the rational use of antimalarials. The chi-square test indicated that being requested to sell m-RDTs (x2 = 6.95, p = 0.008), being requested to perform m-RDTs (x2 = 5.39, p = 0.02),familiarity using m-RDTs (x2 = 17.24, p = 0.002), availability of a nurse in the Pharmacy (x2 = 11.68, p < 0.001), and location of the pharmacy (x2 = 9.13, p = 0.048) were all significantly associated with the availability of m-RDTs in the pharmacy. CONCLUSIONS: The availability of m-RDTs remains low in community pharmacies in Rwanda, and less training is provided to community pharmacists regarding the use of m-RDTs. Nevertheless, community pharmacists had positive perceptions of the advantages of licensing the use of m-RDTs. Thus, licensing the use of m-RDTs is believed to be the first step toward promoting the rational use of antimalarial medicines in Rwanda.

Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities of the Eastern Province of Rwanda.

BACKGROUND: Despite the prominent evidence of cold chain monitoring in the health system to reduce wastage and maintain product potency, there are still inefficiencies in the storage and transportation of cold chain products. This study assessed medicine cold chain storage conformity in health facilities in the Eastern Province of Rwanda. METHODS: A cross-sectional and prospective with quantitative and qualitative approaches study was approved, and 44 health facilities (public, faith-based and private) were selected using both convenience, stratified, and purposive sampling techniques. Temperature data loggers were mounted in refrigerators to measure the Mean Kinetic Temperature (MKT). RESULTS: The overall performance of cold chain storage conformity of refrigerators assessed was 54 (73.0%). The conformity found in refrigerators of pharmacy stock in public health facilities was 22 (56.0%), in vaccination program was 25 (100.0%), and in private retail pharmacies was 7 (70.0%). The MKT measured fit the required cold chain storage at this rate. Most refrigerators used in pharmacy stock (27.0%) were aged between 8 and 10 years, while those used in vaccination programs were less than 4 years. Regular calibration of refrigerator and temperature monitoring device (TMD) was 39.0% and 24.0%, respectively. Most respondents, 44 (80.0%), knew the proper cold chain storage. However, few identified the impact of storing cold chain products with vaccines at 16 (29.1%). The transportation of cold chain products from two central medical stores assessed showed inefficiencies as only one of them uses temperature data loggers during transportations of the products mentioned above. CONCLUSIONS: The medicines cold chain storage conformity investigated in seven districts of the Eastern Province in Rwanda was better than reported previously in other LMICs. However, cold chain storage for pharmacy stock often did not meet the requirements. The observed drawback represented a serious risk to public health. Calibrating cold chain equipment, regular maintenance, and commissioning new cold chain equipment should be done to improve cold chain storage.

Exploration by molecular networking of Strychnos alkaloids reveals the unexpected occurrence of strychnine in seven Strychnos species.

INTRODUCTION: Plants of the Strychnos genus, which include about 200 species, are used for multiple traditional purposes as hunting poison, for example, and have shown interesting pharmacological properties, especially curarizing and tetanizing, but also against malaria. Many monoterpene indole alkaloids have already been isolated and identified. Among them, there is strychnine, a famous alkaloid that can cause death by asphyxiation. OBJECTIVE: Investigate alkaloidic molecular diversity from Strychnos genus using molecular networking technique and study the Strychnos genus from a chemotaxonomic point of view. MATERIAL AND METHODS: Twenty-eight different species and different plant parts were ground into powder using a grinder. The methanolic extracts were carried out using a pressurized solvent extraction and the alkaloid extract was performed manually with a separating funnel. The extracts were analyzed by HPLC-ESI(+)-Q/TOF. The data were processed using MZmine 2 software and the molecular network was generated on the GNPS platform. The study of the generated molecular network allowed the detection of various alkaloids. Among these is the famous strychnine which has been detected in 7 new Strychnos species not yet described as strychnine producers. This identification was investigated using orthogonal approaches, namely TLC, NMR, HPLC-UV and UHPLC-ESI(+)-Q/TOF analyses. The LOD by HPLC-UV of strychnine was also determined. RESULTS: Further analyses allowed to confirm the presence of strychnine in S. densiflora trunk barks but also to show the presence of strychnine with high probability in the trunk barks of S. camptoneura, S. congolana, S. boonei, and S. tchibangensis, and in the leaves of S. usambarensis. About the trunk barks of S. tricalyisoides, the probability of a strychnine content remains low. CONCLUSION: This work exemplified the efficiency of molecular networking in identifying known metabolites (major and minor alkaloids) involved in the chemotaxonomic study of plants from Strychnos genus.

Investigation of the Quality of the 12 Most-Used Antibiotics Available in Retail Private Pharmacies in Rwanda.

Using poor-quality antibiotics leads to increased risk of the development of microorganism-resistant strains, treatment failure, loss of confidence in health systems, and associated socio-economic impacts. The prevalence of poor-quality antibiotics has been found to be high in some of the Low and Middle-Income Countries (LMICs), but no data were available on the situation in Rwanda. This study was conducted to obtain data and inform health professionals on the quality of the 12 most-used selected antibiotics from private retail pharmacies in Rwanda. The investigation was conducted on 232 batches collected from randomly selected private retail pharmacies in all provinces of Rwanda, and concerned only with visual inspection and assay tests. Visual inspection was performed using a tool adopted by the International Pharmaceutical Federation (FIP) to identify manufacturing defects. An assay test quantified the Active Pharmaceutical Ingredient (API) in each collected batch using high-performance liquid chromatography (HPLC) coupled with an ultraviolet-visible (UV) detector, and the results were reported as the percentage content of the amount of APIs stated on the label. A total of 232 batches were analyzed, manufactured in 10 countries; the main country of manufacture was Kenya, with almost half of the batches (49.6%). The results of the visual inspection did not show the presence of counterfeit/ falsified antibiotics on the Rwandan market in this study but revealed weaknesses in labeling: more than 90% of the analyzed batches of the 12 antibiotics did not present the dosage statement on their label, and the complete list of excipients was missing in more than 20% of the analyzed batches. The assay test using HPLC confirmed the presence of APIs in 100% of the analyzed batches. However, moderate deviations from acceptable ranges of the API content defined by M. M. Nasr & C. M. Stanley in 2006 for erythromycin and the United States Pharmacopoeia 2018 for the other 11 molecules were found. The failure rate to meet the quality requirements in terms of the percentage content of active pharmaceutical ingredients declared on the labels was estimated at 8.2% in total, with 3.9% and 4.3% containing more and less than the amount of APIs stated on the labels respectively. The most-represented antibiotics on the Rwandan market were amoxicillin, co-trimoxazole and cloxacillin. No counterfeit antibiotics were found in this study. However, substandard batches with moderate deviations were found, suggesting that regular quality control of antibiotics is needed in Rwanda.

Pentas longiflora Oliv. (Rubiaceae), a plant used in the treatment of Pityriasis Versicolor in Rwanda: Chemical composition and standardization of leaves and roots.

In Rwanda, the roots of Pentas longiflora Oliv. (Rubiaceae) have been used for a long time to treat Pityriasis versicolor. However, many people reported the use of leaves instead of roots. This research was conducted to compare the phytochemical composition and establish chromatographic methods for the standardization of roots and leaves extracts of P. longiflora. During this process, three new pentalongin glycosides (pentalonginoside A, pentalonginoside B, and pentalonginoside C) and two known glycosides of the same type (harounoside and clarinoside), as well as rutin, luteolin-7-rutinoside were isolated from methanol extract of leaves. In addition, pentalongin and psychorubrin, previously isolated from ethylacetate roots extract, were also identified in Pentas longiflora ethylacetate leaves extract. The presence of the antifungal compound pentalongin in leaves may explain the traditional use of leaves in the treatment of Pytiriasis versicolor. Furthermore, harounoside, psychorubrin, and pentalongin were selected as markers for HPLC fingerprints of MeOH extract. The accuracy and risk profile demonstrated the reliability of the validated method. In general, considerable variations of concentration in plant metabolites, including pentalongin, were observed between samples from different sites. The content in pentalongin (expressed as juglone) in collected samples ranged between 1.7 and 70.0 mg/100 g. The highest concentration (70.0 ± 17 mg/100 g) was registered in the cultivated samples from Mukoni. This important variation of pentalongin concentrations according to sampling sites, shows that in order to guarantee equivalent efficacy, finished products with P. longiflora should be standardized based on their pentalongin content.

The Inhibition of NLRP3 Inflammasome and IL-6 Production by Hibiscus noldeae Baker f. Derived Constituents Provides a Link to Its Anti-Inflammatory Therapeutic Potentials.

The activation of NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome and/or its components is associated with the physio-pathogenesis of many respiratory diseases including asthma, COPD (chronic obstructive pulmonary disease), SARS Cov-2 (severe acute respiratory syndrome coronavirus 2), and in several autoimmune diseases. Hibiscus noldeae Baker f. has been widely reported to be traditionally used in the treatment of different ailments, some of which are of inflammatory background such as asthma, wounds, headache, etc. However, the claims have not been supported by evidence at the molecular and functional levels. Here, we report on the bio-guided fractionation of H. noldeae and assessment of the inhibitory properties of some fractions and purified compounds on NLRP3 inflammasome and Interleukin 6 (IL-6). The activation of the NLRP3 inflammasome was determined by detecting the activity of caspase-1 and the production of Interleukin 1ß (IL-1ß) in Lipopolysaccharide (LPS) and ATP-stimulated Tamm-Horsfall Protein 1 (THP-1) macrophages, while the production of IL-6 was studied in LPS-stimulated RAW264.7 mouse macrophages. It was observed that hexane and ethyl acetate fractions of the crude extract of the aerial parts of H. noldeae, as well as caffeic acid, isoquercetin, and ER2.4 and ER2.7 fractions revealed significant inhibitory effects on Caspase-1 activities, and on IL-1ß and IL-6 production. The ER2.4 and ER2.7 fractions downregulated the production of IL-1ß and IL-6, in a similar range as the caspase-1 inhibitor AC-YVAD-CHO and the drug Dexamethasone, both used as controls, respectively. Overall, our work does provide the very first scientific based evidence for Hibiscus noldeae anti-inflammatory effects and widespread use by traditional healers in Rwanda for a variety of ailments.

Heavy metal removal by combining anaerobic upflow packed bed reactors with water hyacinth ponds.

The removal of four selected heavy metals (Cu, Cd, Pb and Zn) has been assessed in an upflow anaerobic packed bed reactor filled with porous volcanic rock as an adsorbent and an attachment surface for bacterial growth. Two different feeding regimes were applied using low (5 mg L(-1) of heavy metal each) and high (10 mg L(-1) of heavy metal each) strength wastewater. After a start-up and acclimatization period of 44 days, each regime was operated for a period of 10 days with a hydraulic retention time of one day. Good removal efficiencies of at least 86% were achieved for both the low and high strength wastewater. A subsequent water hyacinth pond with a hydraulic retention time of one day removed an additional 61% Cd, 59% Cu, 49% Pb and 42% Zn, showing its importance as a polishing step. The water hyacinth plant in the post-treatment step accumulated heavy metals mainly in the root system. Overall metal removal efficiencies at the outlet of the integrated system were 98% for Cd, 99% for Cu, 98% for Pb and 84% for Zn. Therefore, the integrated system can be used as an alternative treatment system for metal-polluted wastewater, especially in developing countries.