Assessment of knowledge, attitude, and practice on substandard and counterfeit pharmaceutical products among pharmacy professionals in Gondar City, North-West Ethiopia.

INTRODUCTION: The circulation of substandard and counterfeit pharmaceutical products on the national and international markets has increased. Different studies revealed that there is limited information about pharmacy professionals' awareness of substandard and counterfeit pharmaceutical products. Therefore; the aim of the present study was to assess the pharmacy professionals' knowledge, attitude, and practice of substandard and counterfeit pharmaceutical products. METHODS: A cross-sectional study was conducted to assess the knowledge, attitude, and practice of pharmacy professionals about substandard and counterfeited pharmaceutical products in Gondar City, North-West Ethiopia. Data were collected through a self-administered, structured questionnaire using the Kobo tool. SPSS version 27 was used for the analysis. To assess the association of factors with pharmacy professionals' practice towards substandard and counterfeit medicines, we conducted univariate and multivariate logistic regression analysis. RESULTS: A total of 170 respondents participated in the study. The highest numbers of participants (71.8%) were in the age group of 18-30 years. Only 10.6% of them reported purchasing medicines regularly. Of total, 31 (18.24%) of respondents had a good knowledge and more than one-third 60 (35.29%) of the respondents had a good level of practice. Multivariate logistic regression analysis results revealed that some socio-demography and attitude (AOR = 0.473 (0.225-0.995) were associated with the practice of pharmacy professionals towards substandard and counterfeit medicines. CONCLUSION: In general, less than one-quarters of the respondents had a good knowledge and more than one-thirds of the respondents had a good level of practice. However, half of the respondents had a positive attitude.

Evaluation of logistics management information system and availability of non-program tracer drugs in public health facilities in Bahir Dar City, Northwest Ethiopia.

The logistics management information system (LMIS) plays a crucial role in effective record-keeping and reporting, ensuring efficient management of stock status and consumption data. A proficient LMIS improves accountability and supports informed logistic decisions in healthcare. Conversely, a subpar LMIS negatively affects essential medicine availability, compromising overall healthcare service efficiency. This study aimed to evaluate the status of the logistics management information system and the availability of non-program tracer drugs (NPTDs) in public health facilities within Bahir Dar City. This study employed an institutional-based cross-sectional study. Data were collected from February 20 to April 30, 2022 in 12 public health facilities located in Bahir Dar City. Structured questionnaire and data abstraction formats were used to gather pertinent data. After checking for completeness, the data were analyzed using Microsoft Excel and SPSS version 23. The primary analytical outcomes involved descriptive statistics, encompassing frequencies, averages, and percentages, which were subsequently presented in tables and figures. Bin card and Internal Facility Report and Resupply Form were the only blank LMIS tools available in all health facilities, while stock-record card was the least available, present in only 2(16.7%) facilities. Nine health facilities (75%) used self-prepared forms to request NPTDs from the Ethiopian Pharmaceutical Supply Agency (EPSA) at the end of the review period, whereas 7(58.3%) used official letters for emergency orders. Additionally, seven health facilities (58.3%) used the Health Commodities Management Information System On the day of the visit, 78.68% of NPTDs were available. Tetracycline eye ointment 1% had the longest stock-out duration, lasting for a mean 69.64 days. Rather than using the RRF, most of facilities opted for their own forms to request NPTDs from EPSA. While it is advisable for all health facilities to maintain continuous availability of tracer drugs, this study revealed that the current state of non-program tracer drug availability falls short of meeting this expectation.

Community Pharmacists' Knowledge and Attitude Towards Opioid Pain Medication Use in Bahir Dar City, North-West Ethiopia.

Background: Opioid use is a major global public health problem, affecting 16 million individuals worldwide. According to a 2023 WHO report, out of the 600,000 substance-related deaths worldwide, 80% were attributed to opioid use. Pharmacists play a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. To do so, pharmacists should have sufficient knowledge regarding opioid-containing medications and a positive attitude about opioid use problems. Objective: This study aimed to evaluate community pharmacists' knowledge of opioid-containing medications and their attitude toward opioid use problems. Materials and methods: A cross-sectional study was conducted using a self-administered, structured questionnaire distributed to 105 community pharmacists from July 1-30, 2023 in Bahir Dar City, Ethiopia. The tool included demographic information and questions designed to assess participants' knowledge and attitudes. Results: Out of the 105 pharmacists included in this study, majority were males (54.3%), nearly half held a bachelor's degree (49.5%), and slightly above one-third had over a decade experience (39%). Regarding knowledge and attitude towards opioids, 62 individuals (59%) exhibited good knowledge, and 64 (61%) demonstrated less stigma toward opioid usage. Factors affecting knowledge include: education level (AOR (95% CI): 8.43 (1.76-40.35) and 9.93 (1.04-85.33) for bachelors and postgraduates respectively and age 1.45 (1.20-1.77)]. Meanwhile, experience [AOR (95% CI): 4.64(1.20-17.90) and 4.29 (1.23-15.05)] for 5-9 years and ≥10 years respectively and education level [AOR (95% CI): 4.08 (1.40-11.93) for bachelors and 6.40 (1.42-28.96)] for postgraduates were linked to attitude. Conclusion: A gap in knowledge and more stigmatizing behavior was observed among community pharmacists. These findings imply the importance of tailored educational interventions to address knowledge gaps and promote positive attitudes toward opioid usage among community pharmacists. Therefore, it is imperative to deliver up-to-date information on opioids, emphasizing their high addiction potential, to ensure pharmacists are well-equipped with the latest information.

Characteristics and Quality Appraisal of the Economic Evaluations Done in Ethiopia: A Systematic Review.

BACKGROUND: Health economic evaluation identifies, measures, values, and compares alternative strategies to efficiently allocate scarce resources. The validity, methodological quality, and generalizability of economic evaluations must be assessed, as poorly designed studies can lead to incorrect conclusions. Therefore, this study aimed to evaluate the quality and characteristics of published economic evaluations done in Ethiopia, using the Quality of Health Economics Studies (QHES) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments. METHODOLOGY: Various electronic databases were searched using different keywords. We included only original studies conducted in Ethiopia that evaluated the cost and consequences of at least two health interventions. Abstracts, treatment guidelines, reviews, expert opinions, and studies that included other countries were excluded. Two reviewers independently evaluated each study using the QHES and CHEERS instruments and any disagreements were then resolved by a third reviewer. RESULT: The study included 21 studies published between 2002 and 2021. HIV was the most frequently evaluated medical condition, examined in four (19.06%) of the 21 studies. Seventeen of the studies (80.95%) compared healthcare services or programs, while the other four examined pharmaceutical products. Cost-utility analysis was the economic evaluation technique used in 14 studies (66.67%). Of the studies that disclosed their funding sources, foreign institutions were involved in funding 71.43% of them. Disability-adjusted life-year (DALY) was an outcome metric used in nine (42.86%) studies. The average QHES score of the studies was 82%. Fourteen studies had QHES scores of ≥75% and two had scores of <50%. The studies evaluated using the CHEERS instrument ranged in quality from 42.9% to 92.9%, with an average of 78.23%. CONCLUSION: Our study revealed that Ethiopia lacks health economic evaluations, particularly on non-communicable diseases. This indicates that the economic evaluation of healthcare interventions in Ethiopia is still in its early stages. Additionally, Ethiopian institutions have played a very limited role in funding research, highlighting the importance of active participation from local institutions.

Health-related quality of life and its determinants among patients with diabetes mellitus: a multicentre cross-sectional study in Northwest Ethiopia.

OBJECTIVES: This study assessed the health-related quality of life (HRQoL) and its determinants in patients with diabetes. DESIGN AND SETTING: An institutional-based multicentre prospective cross-sectional study design was conducted in diabetes follow-up clinics of selected hospitals in Northwest Ethiopia from April to July 2022. PARTICIPANTS: All eligible adult patients with diabetes at the selected facilities. MAIN OUTCOME MEASURES: HRQoL was measured using EuroQol 5-dimensions 5-levels (EQ-5D-5L) and the EuroQol-Visual Analogue Scales (EQ-VAS) instruments. A lower EQ-5D-5L utility mean score for each dimension and/or an overall lower utility score of EQ-5D-5L and EQ-VAS scores are intended to show poor HRQoL. Linear regression analysis was used to identify the association of HRQoL and other variables. RESULTS: Out of the 422 samples approached, 402 (95.3%) participated in the study. Most of the participants (>85%) reported having moderate-to-severe problems in all five EQ dimensions. The overall EQ-5D-5L utility and EQ-VAS scores were 0.56 (±0.11) and 56.7 (±10.1), respectively. A higher body mass index (BMI) (p < 0.001), a higher number of medications (p = 0.037), a high level of blood glucose (p < 0.001), the presence of comorbidities and/or complications (p = 0.031), hypoglycaemia (p = 0.043) and taking insulin (p < 0.001) were associated with worsened HRQoL, whereas practicing self-monitoring of blood glucose (p = 0.002) and taking aspirin (p = 0.008) had a significant association with increased HRQoL. CONCLUSION: This study concluded that the HRQoL of patients was compromised in all five measuring dimensions. The EQ-5D-5L utility and EQ-VAS scores were far lower than other findings. Clinical and medication-related variables, such as a higher BMI, a higher number of medications, the presence of comorbidities and/or complications, hypoglycaemia and insulin use were associated with poor HRQoL in patients with diabetes. As a result, interventions should be individualised and focused on determinant factors.

Availability and stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre, North West Ethiopia.

Essential medicines are those that meet the population's most pressing healthcare needs. As a result, they should always be available in sufficient quantities and the proper dosage forms within health facilities. The study aimed to determine the availability and stock-out duration of essential medicines in Shegaw Motta General Hospital and Motta Health Centre. Descriptive study was conducted at Shegaw Motta General Hospital and Motta Health Centre. The data were collected from June-20 to July-20, 2021 G.C. Fifteen essential medicines from both health facilities' tracer drug lists were reviewed. The frequency and percentage of availability and stick-out duration were calculated, and the results were briefly described in the text and displayed in tables. The average availability of essential medicines on the day of the survey was 80% and 93.3% in Shegaw Motta general hospital and Motta health center, respectively. Besides, 60% and 20% of the essential medicines were stocked out at least once in the last six months (before the data collection period) in the hospital and health center, respectively. The average stock-out duration in the last six months period (before the data collection period) was 38.8 days (ranges from 10 days to 157 days) in the hospital and 11.2 days in the health center. Ferrous salt + folic acid 150mg + 0.5mg and Medroxy Progesterone injection were the medicines with the longest stock-out duration in Shegaw Motta general hospital and Motta health center, respectively.The average availability of essential medicines was fairly high both in the hospital and health center. In comparison to the hospital, the health center had better availability and a shorter stock-out duration. Over the last six months, a significant percentage of essential medicines were stocked out at the hospital.

Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia.

BACKGROUND: Integrated Pharmaceutical Logistics System is the primary mechanism through which all public health facilities in Ethiopia get essential pharmaceutical products from their main supplier. Pharmaceuticals should be managed appropriately because they are part of the link between the patient and health services and account for up to half of the healthcare budget. This study aimed to assess the status of Integrated Pharmaceutical Logistics System implementation at both Chagni Primary Hospital and Injibara General Hospital. METHODS: Facility-based descriptive study design supported with a qualitative study design was used. Face-to-face interviews, observation of practices, and document review were conducted to gather quantitative data. Besides, the qualitative data were collected through in-depth face-to-face interviews. Frequency and percentage were computed, and the results were briefly described in text and displayed in tables and graphs. The qualitative data were transcribed manually, and thematic analysis was done. RESULTS: All IPLS materials were available in both hospitals, but the stock recording card was not available at Injibara General Hospital. About 90% and 100% of the dispensing units in Chagni Primary Hospital and Injibara general hospital were utilizing bin-cards, respectively. Besides, 50% and 80% of the bin-cards in Chagrin Primary Hospital and Injibara General Hospital were regularly updated, respectively. About 80% and 75% of the IFRRs in Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Besides, 66.67% and 50% of the RRFs reviewed at Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Medicine stockouts, poor staff commitment, and workload were the major bottlenecks for IPLS execution. CONCLUSION: The status of most of the IPLS implementation indicators in both hospitals was good. Especially, the availabilities of IPLS materials and the calculation accuracy of both RRFs and IFRRs were encouraging in both hospitals. However, the validity of the data reported in IFRRs and RRFs, and the status of the storage conditions in both hospitals need some improvement during the implementations of IPLS.

Evaluation of drug prescription pattern using World Health Organization prescribing indicators in public health facilities found in Ethiopia: systematic reviews and meta-analysis.

BACKGROUND: Drug use evaluation is a structured, methodological, and criteria-based drug assessment system that helps to evaluate the actual trend of drug use in a particular setting. If drug prescription practices are inappropriate, need to examine the patterns of drug use is necessary to change prescribing patterns accordingly. Therefore, this review aimed to determine the drug prescription pattern in public health facilities found in Ethiopia using prescribing indicators developed by the World Health Organization. METHODS: This review was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Extensive searching to identify articles was conducted in PubMed, Medline, Web of Science, Research Gate, Africa Journal of Online, and Google scholar. Finally, 10 eligible articles were selected for analysis based on inclusion and exclusion criteria. The median value, as well as the 25th and 75th percentiles for each WHO prescribing indicator, were computed. RESULT: The pooled median value of WHO prescribing indicators was reported as follows: the average number of drugs prescribed per encounter = 2.14 (IQR 1.79-2.52), the percentage of encounters with antibiotics prescribed = 43.46% (IQR 30.01-58.67), the percentage of encounters with an injection prescribed = 13.20% (6.47-40.7), percentage of drugs prescribed by generic name = 93.49% (89.13-97.96), and the percentage of medicines prescribed from essential medicines list = 92.54% (85.10-97.7). The forest plots determined for each prescribing indicator indicated that there is a high degree of heterogeneity across articles. CONCLUSION: All of the prescribing indicators were not consistent with the standard values recommended by the World Health Organization. Therefore, public health facilities should take appropriate measures for improving the prescription patterns as per the recommendation set by the World Health Organization.

Evaluating Inventory Management Practice of Antiretroviral Drugs in Public Health Facilities of Addis Ababa, Ethiopia.

BACKGROUND: The right to safe and effective treatment is an exclusive right that depends on the robustness of the domestic health care system. METHODS: A facility-based cross-sectional study was conducted from January 01 to February 01, 2020. Ten eligible hospitals and 12 randomly selected health centers were parts of this study. A total of 66 RRFs and 308 bin cards were reviewed. Data were collected through observation, record and report review, and physical count using an observational checklist. In addition, 44 semi structured interviews were conducted. The collected data were entered to MS Excel sheet and analysed using SPSS (version 20) software. The correlation test result was determined statistically significant at p<0.05. RESULTS: Twenty-two public health facilities were included in the study of which 16 (72.72%) health facilities had at least one stock out. Availability of ARVs had very strong positive correlation ship with bin card updating practice (r=0.9 1, P<0.01), inventory accuracy rate (r=0.912, P<0.015) and very strong negative correlation ship with wastage rate (r = -0.66, P<0.001). The wastage rate due to expiration and loss was 3.9%. The mean bin card accuracy was 90.6%. RRF reports were accurate 17 (77.3%), complete 7(32%) and reported on time 14 (63.64%). Only 8 (36.36%) health facilities met acceptable storage conditions. CONCLUSION: The availability of bin cards and reports and resupply forms was promising, but the data quality remains low. The majority of health facilities did not meet acceptable storage conditions and had frequent stock-outs.