Browsing by Author "Gedif, Teferi(PhD)"
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Item Acceptability of Azithromycin Mass Treatment for Trachoma Elimination in Injibara Town and Adjacent Banja Woreda of Awi Zone, Amhara Region(Addis Ababa University, 2014-06) Tilahun, Zelalem; Gedif, Teferi(PhD)Trachoma is the leading cause of infectious blindness worldwide. Globally 1.2 billion people live in endemic areas. In Ethiopia, approximately 67 million people are at risk for trachoma. The Amhara National Regional State of Ethiopia is the most trachoma-endemic among all nine regional states and two city administrations, with Trachomatous inflammation Follicular prevalence of 62.6%. Mass azithromycin treatment is the one arm of the SAFE strategy. The trachoma elimination program would be successful if and only if the coverage is as high as possible with full community participation. If not all the community members attend the mass treatment, the trachoma infection will return to the baseline prevalence after the treatment stopped due to high transmission rate. The objective of this study was to assess the acceptability of the azithromycin mass treatment and its determinants in Injibara town and the adjacent Banja woreda of Awi zone, Amhara National Regional State. A community based cross sectional survey with both quantitative and qualitative methods was conducted from July 7-25, 2013. Households’ survey with structured questionnaire, FGDs and key informant interviews were used for data collection. A total of 5826 eligible household members from 1267 households were enrolled in the survey. The 2012 annual azithromycin mass treatment coverage obtained from the present study was 92.9%. From the total 6 rounds of azithromycin mass treatment in the study area, only half (50.6%) of the community took for more than three times. On average, each illegible person in the community had taken the drug for 3.6 times. The percentage of rural household members who had taken azithromycin more than three times was higher than the corresponding urban members. The rural residents were at better performance in taking the 2012 treatment as compared to the urban residents (AOR=2.35; 95%CI [1.80-3.06]). Household heads interference with the drug uptake of their family members’ has negative association with azithromycin uptake (AOR=0.153; CI=95% (0.086-0.272). All the study participants who were X greater than 30 years more likely took azithromycin more than 3 times as compared with children less than 15 years (COR=2.81, AOR=2.74, 95% CI [1.95-3.02]). Azithromycin uptake status of female household heads was less than the corresponding male household heads (AOR=0.41; 95% CI [0.24-0.720]). Household heads awareness about trachoma (AOR=2.55; 95% CI [1.19-5.44]) and azithromycin mass treatment (AOR=7.19; 95% CI [3.27-15.82]) had positive association with acceptability. The 2012 azithromycin mass treatment coverage in Injibara town and Banja woreda was higher than the WHO minimum target. But, concerning to the overall coverage, the data taken from the present study contradicts the coverage data taken from the woreda. The communities’ Azithromycin mass treatment acceptability had increased in the recent campaigns as compared to the previous campaigns. There is low coverage and acceptability of the treatment in the urban community as compared to the rural residents. Supplementary benefits of azithromycin, health education about trachoma and the drug, willingness and being old are some of the factors positively related with acceptability whereas educational status, marital status and experience with side effects were not associated with the drug uptake status. Strengthen the program in the urban and consideration of additional campaigns for both areas as well as providing additional health education with skilled health professionals is mandatory. Key words: Azithromycin mass treatment, Mass drug administration, Acceptability, Trachoma, Trachoma eliminationItem Assessment of Antimicrobial Resistance Containment Practices in Selected Public Hospitals of Addis Ababa, Ethiopia(Addis Ababa University, 2014-09) Gemeda, Feven; Gedif, Teferi(PhD)Introduction: Ethiopia experiences a heavy burden of infectious diseases with a growing prevalence of disease morbidity and mortality. With the increased intensity of antimicrobial use following the increased burden of infectious disease in Ethiopia, AMR remains being a huge concern in the progress of treating infectious diseases. Health care facilities, particularly those which provide service to large number of patients, are a focal point in the emergence of AMR. Objectives: To assess the AMR containment practices in selected public hospitals of Addis Ababa, Ethiopia. Methods: Cross sectional survey was conducted in six selected public hospitals of Addis Ababa, Ethiopia between September and November, 2013. The study involved the use of mixed method approach. Quantitative data was collected by using structured selfadministered questionnaires whereas the qualitative data collection methods employed key informant interviews and an observation using check list. Results: Of those approached 763 healthcare professionals, 667 completed the survey questionnaires making up 87.4% response rate. The study revealed that as many as 321 (48.1%) of the total respondents had poor knowledge on AMR containment. Physicians and nurses were found to have the largest and lowest proportion of good knowledge level respectively. A significant association (p<0.05) was found between professional qualification and knowledge level of the respondents. The apparent lack of recent training experience was supported by the findings of lower knowledge level about AMR containment. Conclusion and Recommendations: The study revealed poor knowledge level of health care professionals and poor implementation of AMR containment practices in the selected hospitals. Hence, strengthening infection prevention and control practices, ensuring adequate and consistent supply of antibiotics and infection prevention and control materials, organizing training programs on AMR containment for healthcare professional, enhancing laboratory service and initiating surveillance of new infections and AMR are the prominent recommendations for improving the AMR containment practice in the assessed hospitalsItem Assessment of Ceftriaxone Utilization in Different Wards of Federal Police Referral Hospital; A Retrospective Study(Addis Ababa University, 2015-01) Shimels, Tariku; Gedif, Teferi(PhD)The irrational use of antimicrobials such as ceftriaxone is one of the current public health issues. The problem becomes twofold when it happens in low income countries like Ethiopia. The objective of this study is to assess the utilization of ceftriaxone in different wards of FPRH, Addis Ababa. An institution based retrospective cross sectional study design was used to evaluate the use of ceftriaxone. The assessment was done by reviewing medication records of patients who received ceftriaxone during hospitalization in the different wards of Federal Police Referral Hospital from 1 May, 2013 to 30 April, 2014. A systematic random sampling technique was used to select the samples from all the inpatient prescriptions containing ceftriaxone. Patient medication records/ charts were located based on the medical record number on the prescription papers. Data was collected by using a structured format and evaluated against the Standard Treatment Guideline of Ethiopia as well as the IDSA and ASHP guidelines. Out of the 682 patient medication records sampled, 571 were found to be complete and subsequently evaluated against the guidelines. Ceftriaxone was prescribed for 2048 (44.3%) of the 4423 admissions in the respective wards. Overall evaluation of ceftriaxone therapy for indication, dose, frequency and duration revealed that 346 (60.6%) of the patient medication records were compliant to recommendations set in the guidelines. Frequently noted non-compliant uses included continued uses as pre & post-operative prophylaxis, unsupported indication in certain iv diagnoses and deviated duration of therapy in medical cases. Among the co-prescribed medications checked for potential interaction with ceftriaxone, warfarin, heparin and doxycycline were found to have a significant drug-drug interaction. Days of hospital stay, type/payment scheme of medical service and type of ward patients had been admitted in were the factors associated with compliant ceftriaxone use in FPRH. The compliance of ceftriaxone utilization in FPRH, to the guidelines, is moderate. However, all concerned bodies and the hospital should be engaged for developing antimicrobial guideline, provide ongoing trainings, establishing a DIC and promote health professionals‟ adherence to the national STG to fill the remaining gap. Key words: Drug use evaluation, Ceftriaxone, Federal police referral hospital.Item Assessment of Concomitant Use of Herbal and Conventional Medicines among Diabetic Patients in Addis Ababa, Ethiopia(Addis Ababa University, 2017-07) Getnet, Solomon; Gedif, Teferi(PhD); Yonathan, Mariamawit (PhD)Introduction: Majority of population in developing countries including Ethiopia are dependent on traditional medicines. Patients who have chronic illness like diabetes mellitus were dissatisfied with conventional drugs are more likely to take simultaneously herbal remedies from traditional medicine (TM), with conventional treatment. However, such use could result in potential herb-drug interaction. Objective: To assess the prevalence of concomitant use of herbal and conventional anti diabetic medicines; and to identify the commonly used herbal medicines among patients with diabetes in public hospitals of Addis Ababa, Ethiopia. Method: A mixed approach of quantitative and qualitative designs was employed. A health facility based cross sectional study design was employed to determine the magnitude of concomitant use of herbal and conventional medicines among patients with diabetes in Addis Ababa. A qualitative study design with an in-depth interview data collection method was also employed to describe prescribers' history taking practice about TM during their encounter with the patients. Patients with diabetes from four public hospitals in Addis Ababa who were attending outpatient diabetic clinics were the study population for the quantitative study. All prescribers working in the diabetic clinic during an interview were considered as both the source and study population for the qualitative study. Data was collected from April 17 to August 30, 2016. Quantitative results from 791 questionnaires were entered in EPI-INFO version 3.5.1 and analyzed by SPSS Version 20 computer statistical software's. Simple descriptive statistics were used to describe variables and content analysis had been conducted manually for qualitative data. Result: From a total of 845 questionnaires, 791 were complete; making the response rate 93.6%. Out of 791 respondents, 409 (51.7%) used TM at least once in their life time and 357 (45.1%) used TM in the last six months prior to data collection. Majority 288 (80.7%) of respondents used herb/herbal products after starting the conventional anti diabetic drugs. Leaves of plants were used by most 187 (64.9%) of the patients and oral administration was the major route as cited by 281 (97.6%) of the respondents.. Moringa, thyme, fenugreek, black seed and garlic were among the frequently mentioned herbs used by diabetic patients. Sizable number of respondents 199 (69.1%) also perceived that herbal medicines they took were effective. vii None of the prescribers in the qualitative study gathered patients' herbal medicine use history in their history taking practice. They only would like to take any herbal medicine related information when they saw sign of liver toxicity and skin disease. Almost all key informant interviewees revealed that they had no adequate knowledge about drug-herb interactions. Conclusion: The study revealed that majority of respondents used herb/herbal products concomitantly with conventional antidiabetic drugs. Moringa, thyme, fenugreek, black seed and garlic were identified as the most commonly used herbs by patients with diabetes. This combined use of herbal medicines and conventional antidiabetic medicines could cause potentially serious herb-drug interactions. More studies with scientific methodology are required on dose, frequency, duration and modes of interaction to better healthcare of patients. Key words: Herb-drug interaction, Diabetes Mellitus, Herbal medicine, Chronic diseaseItem Assessment of Knowledge, Attitude and Practices regarding Medication Abortion among Regular Undergraduate Female Students in College of Social Sciences, Addis Ababa University(Addis Ababa University, 2014-04) Thomas, Gizaw; Gedif, Teferi(PhD)Unintended pregnancy is common and abortion rates are rising worldwide in general in Africa in particular and pose great challenge in achieving the MDGs. Safe abortion method especially MA related awareness and practices of females are known to have crucial contribution in the prevention and control of unsafe abortion and the resulting mortality and morbidity. The aim of this study was therefore to assess knowledge, attitude and practices regarding medication abortion among regular undergraduate female students of the CSSs, AAU. A cross-sectional quantitative study supplemented by key informants’ interview was conducted between 1st of June to 5th of July 2013. The quantitative data were collected using structured, self-administered questionnaire and the qualitative data were collected by the PI using interview guide. The age of the study participants ranged from 18 to 25 years with a mean age of 20.6 ± 1.5. Three-fourth of the respondents (159,74.6%) knew what MA meant where 11 (6.9%) and 97(61%) of them had high and low knowledge on MA respectively. Majority (142,66.7%) of the study participants would advise someone with unwanted pregnancy to undergo an abortion and 86 (40.4%) would consider abortion if they had unplanned pregnancy. From 21 respondents who had abortion experience, 13 (61.9%) used MA. The study revealed that majority of the female undergraduate students in the CSSs has low knowledge regarding MA, though most of them have positive attitude towards medication abortion. It would be much beneficial to female students if medication abortion awareness given by AAU in collaboration with DKT-Ethiopia, Ipas- Ethiopia, AACARHB and local mass media. Key words: Abortion, Medication abortion, safe abortion, College of Social Sciences, Addis Ababa University, Undergraduate female StudentItem Assessment of over-the-counter utilization of topical corticosteroids in Addis Ababa, Ethiopia(Addis Ababa University, 2015-12) Bantayehu, Netsanet; Gedif, Teferi(PhD)Topical corticosteroids (TC) are generally safe when used rationally which otherwise may cause significant morbidity among people. Over-the-counter (OTC) use of TC is prevalent worldwide and is found to cause undesirable adverse effects. Particularly its use for cosmetic purpose is a very common practice in Africa including in Ethiopia. The purpose of this study was to assess the extent of OTC use of TC, identify factors contributed for the same, the most common types of facial dermatoses noted among the dermatology outpatient department attendees of the selected health facilities, and also to assess the extent of availability of TC in selected cosmetics shops of Addis Ababa. A cross sectional study was carried out in the dermatology OPD attendees of Alert Hospital and Rank clinic, and also in selected cosmetics shops of Addis Ababa from February 10 to March 10, 2015. Data was collected by using screening question format, pretested questionnaires, observation check list and key informant interview. A total of 927 patients with facial dermatoses were screened; of those 200 (21.6%) reported to have used TC on their face. The age of the patients ranged from 18 to 65 years with mean age of 29.96 years (SD=8.56 years). Of the 200 patients who had used TC on their face, 158 (79.0%) obtained the drug as OTC. More females reported OTC use of TC as compared to males (p = 0.049). The types of facial dermatoses noted in majority 46 (29.1%) of the patients was found to be Acne, followed by Melasma in 32 (20.3%) and Rosacea in 23 (14.6%). Community pharmacies for 78 (49.4%) of the patients and cosmetics shops for 50 (31.6%) were the commonest drug sources. Out of the total 9 cosmetics shops surveyed; TC containing preparations were available in 7 cosmetics shops. The easy access as OTC, the unregulated sales and use of TC for cosmetics purpose are the contributing factors identified for misuse of these groups of drugs. Public education, proper regulation of sales practice of TC and the introduction of a continuing medical education programme or training for health professionals are critical to reduce irrational use of TC. Keywords: Topical corticosteroids, OTC, drug retail outlets, facial dermatosesItem Assessment of Pharmaceutical Logistics System in Health Centers of Addis Ababa, Ethiopia(Addis Ababa University, 2014-08) Mudzteba, Mezid; Gedif, Teferi(PhD)In Ethiopia, majority of the common leading causes of morbidity and mortality can be substantially reduced if essential drugs (EDs) are made available and appropriately used, where functioning of the pharmaceutical logistics system is necessary. Thus, tracking changes and improvements of the pharmaceutical logistics performance is important. The aim of this study was to assess the pharmaceutical logistics system of health centers (HCs) in Addis Ababa giving emphasis to non-program drugs (NPDs). A facility based descriptive cross sectional survey of the pharmacy of HCs in Addis Ababa was conducted using both quantitative and qualitative methods. Twenty four HCs were included in the study. Most 23(95.8%) of the HCs had their own Essential Drug List (EDL). All HCs determined their own NPDs resupply quantity, majority of them using standard formula. On average, only 47.52% of the HCs received the full quantity of NPTDs they ordered. It was the responsibility of all HCs to collect NPDs from Pharmaceutical Fund and Supply Agency (PFSA); majority 13(54%) of them using renting private vehicles. The availability of either of non-program tracer drugs (NPTDs) or tracer drugs from program source was 85.4%. Adequacy storage condition was 71.8%. Majority of the NPTDs had bin cards, and the accuracy in keeping stock records was < 10% for majority of NPTDs. Most 21(87.5%) of the HCs used computer system to manage NPDs. In 12 out of 22 HCs, not all personnel involved in handling of medicines waste were aware of the potential risks of hazardous medicines and 11(45.8%) of the HCs usually stored medicine wastes for 6 to 12 months. From the in-depth interview, all key informants (KIs) agreed that the strength of DTC determined the practice of selection. All the KIs related facilitators and barriers of forecasting and procurement with the services at PFSA. All KIs agreed that budget was determinant on availability of NPDs while the limited capacity of PFSA reported to contribute for the stock outs in HCs. Store X size was identified by all KIs as a facilitator and barrier for storage condition when it is large and small, respectively. The Health Commodity Management Information System was a major input for the Logistics Management Information System according to majority of the KIs. In conclusion, there was no major problem common to all HC’s regarding drug selection. Inadequate supply of NPDs at PFSA was a major obstacle for the overall logistics system. Transportation of NPDs and infrastructures related to medicine waste management were not adequate, Therefore, PFSA should enhance its capacity in all aspects. HCs’ management should support HCs’ pharmacy, and stakeholders should construct standard stores and medicine waste disposal sites. Key words: pharmaceutical logistics, non-program drugs, pharmaceutical storage, logistic management information system, medicine waste, LIATItem Assessment of Physicians’ Awareness on Drug-drug Interactions and Common Sources of Information in General Hospitals of Addis Ababa, Ethiopia(Addis Ababa University, 2013-04) Moges, Getachew; Gedif, Teferi(PhD)BACKGROUND: Drug-drug interactions are an ever-evolving and still critical safety issue in disease management and treatment. Health care professionals‟ ability to recognize DDIs is important in reducing the risk of their adverse consequences. OBJECTIVES: To assess physicians‟ awareness on DDIs and common sources of information in general hospitals of Addis Ababa. METHODS: Cross sectional survey using simple random sampling and convenience sampling methods was conducted among physicians in general hospitals of Addis Ababa, Ethiopia between January and March 201. Data was collected using self administered questionnaire. To test physicians‟ knowledge of drug-drug interactions, 15 drug pairs were used. RESULTS: A total 140 questionnaires were found valid. The percentage of physicians who correctly classified the drug pairs ranged from 12.9% to 65.7%. The average number of correctly categorized drug pairs was 5 (33.3%). Physicians who specialized in internal medicine or pediatrics had better DDI knowledge than those who specialized in other areas. Physicians who perceived the risks of DDIs are high and those who used other information sources had better DDI knowledge. The mean DDI information source usefulness score was found to be 3.59. Physicians who worked for more than 20 years, physicians who agreed up on the importance of learning about DDIs and those who agreed to consider DDIs as part of prescribing decisions had a higher mean DDI information source usefulness score. CONCLUSIONS and RECOMMENDATIONS: Physicians in this study had poor DDI knowledge. Area of specialization, perceptions on risks of DDIs and DDI information sources were factors associated with physicians‟ DDI knowledge. Physicians in Addis Ababa had poor perceptions towards the importance of DDI information sources. Years ii of professional experience, the extent to which the risk for a DDI affects drug selection, perceptions towards the importance of learning about DDIs and perceptions towards considering DDIs as part prescribing decisions were predictors of DDI information sources perceived usefulness. On job trainings such as workshops and seminars and continuing education programs especially for specialists other than internists and pediatricians should be provided for physicians so as to increase their awareness of the importance of DDIs information sources and encourage them to pay close attention to DDIs. Physicians should update their DDI knowledge through continuing education and should improve their familiarity with information sources such as smart phone applications, Compendia of drug products.Item Assessment of post operative pain management in Saint Paul’s Hospital Millennium Medical College(Addis Ababa University, 2015-05) Hailemariam, Eyerusalem; Gedif, Teferi(PhD)Postoperative pain is very common in almost all surgeries. Its inadequate management will result in suffering, increased risk of morbidity and mortality, longer stay in hospital and higher cost. In most developed and developing countries, postoperative pain is not adequately managed. The aim of this study is to assess the prevalence, management and risk factors of postoperative pain in St. Paul’s Hospital Millennium Medical College. A prospective cross sectional survey was conducted from April to June 2014 among post surgical patients (N=416). Data on the level of postoperative pain, its management, and socio demographic characteristic were collected using verbal rating scale, data abstraction tool and patient interview respectively. In addition, data on status of depression was collected using patient health questionnaire-9. A total of 416 patients that underwent surgery were assessed; out of whom 376 (90.4%) had pain of different degrees. Accordingly, mild pain 257 (61.8%), moderate pain 106 (25.5%), severe pain 13 (3.1%) were reported by the patients. The most frequently used medication to manage postoperative pain was diclofenac 157(37.7%). The presence of depressive symptoms and the use of non opioid analgesics were shown to have an association with the iv development postoperative pain. The prevalence of moderate to severe postoperative pain in this hospital was found to be 28.6%. Postoperative pain was insufficiently managed in this hospital. Therefore, assessing pain and contributing factors should be considered to come up with optimum management of postoperative pain in the surgical wards of this hospital. Key words: Postoperative pain, analgesics and St. Paul’s Hospital Millennium Medical CollegeItem Assessment of Prescribing and Administration Errors in Pediatric Inpatients in Black Lion Specialized Hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2013-12) Fekadu, Hamrawit; Gedif, Teferi(PhD)Medication errors are cause of patient morbidity and mortality. The implication on the health care organization and the cost confirmed its importance as global problem. The aim of this study was to assess the type and frequency of prescribing and medication administration errors (MAEs) in the pediatric wards of Black Lion Specialized Hospital and Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Facility based cross-sectional study was conducted. Retrospective data from 2008-2010 G.C of 2401 medical records to assess prescribing error and prospective observation on 27 nurses administering drug to pediatric inpatients was done. Five thousand eleven prescribing errors were documented in the indicated period. The prescription writing error were the most frequent 2386 (99.4%), followed by wrong dose 1673 (69.67%), drug-drug interaction 767(31.9 %) and wrong frequency 185(7.7%). The most frequently occurring drugs involved in wrong dose and frequency was ceftriaxone (586 times). The most frequent drug-drug interaction was the concurrent prescribing of ampicillin and gentamicin (610 times). More than two diagnoses (AOR = 1.66 95% CI= 1.32- 2.13) was significantly associated with wrong dose. Two (AOR=1.87 95%CI=1.39- 2.52) and more than two diagnoses (AOR=6.00, 95% CI 4.64- 7.77) were significantly associated with drug-drug interaction. Age group and number of diagnoses were not found to have a statistically significant effect on prescription writing error. The frequency of medication administration errors were 71 (35.5%). Wrong dose administration 50 (70.4%), omitted drug 18(25.4%) and wrong iii iv timing 3(4.2%) were the types of medication administration errors occurred. Ceftriaxone was the most commonly involved drug in all the three errors. Frequency of occurrence of prescribing and administration error was high. Awareness creation, continuing medical education and comprehensive researches on medication errors should be done to know more about it and improve the situations. Keywords: Medication administration error, prescribing error, medication errors, inpatient, pediatrics.Item Assessment of public’s use and perception on the extended roles of pharmacists in community pharmacies of Addis Ababa, Ethiopia(Addis Ababa University, 2015-03) Zeleke, Kefyalew; Gedif, Teferi(PhD)Community pharmacies are the most convenient place for providing preventive health care services for the local community because of their characteristic accessibility. Studies in many countries have documented positive outcomes concerning community pharmacists‟ involvement in preventive health care services such as diagnostic screening and chronic disease management services. In Ethiopia, however; these services have been under-utilized resources. The perspective of the community is important to consider when expanding the horizon of pharmacy practice. The purpose of this study is to determine the extent of use of community pharmacies and assess the perception of community on pharmacists‟ extended roles in Addis Ababa. Community based cross-sectional study was conducted and semi structured questionnaire was used to collect information from the community. Response rate was 91 % (1152/1268) and 66% of the respondents had made at least one visit to the community pharmacies before the interview date. Most of the respondents visited community pharmacy for purchasing prescription medicines (88.7%) and non-prescription medicines (43.3%). Convenience of location (85%), quality services (36%) and presence of wide range of products (37%) were the major predictors of the respondents‟ choice of particular community pharmacy. Majority of the respondents (61%) welcomed the introduction of the extended roles of community pharmacists, particularly screening for blood pressure (94.7%), blood cholesterol (89.5%) and blood glucose (91.0%), immunization, chronic disease management and counseling services (93.6%). iv Community pharmacists‟ integration in preventive health care services is required. Regulatory framework of practice for involvement in expanded services is needed. Keywords: community pharmacist, community‟s perception, extended roles, EthiopiaItem Assessment of Supply Chain Management of HIV/AIDS Related Commodities in Selected Public Hospitals and Health Centers in Addis Ababa, Ethiopia(Addis Ababa University, 2014-06) Berhanemeskel, Eyerusalem; Gedif, Teferi(PhD)A wide range of medicines and other pharmaceutical products are needed for diagnosis, treatment, care, and prevention of HIV/AIDS. However, interrupted supplies and stock outs are the major challenges in the supply chain of ARV drugs. Therefor the aim of this study was to assess the supply chain management of HIV/AIDS related commodities at hospital and HCs level in Addis Ababa, Ethiopia. A descriptive cross sectional survey complemented by qualitative approach was conducted in 24 government owned health facilities (4 hospitals and 20 health centers) that provide ART, VCT and PMTCT service in Addis Ababa. The sample of health facilities were calculated by using the Logistic Indicators Assessment Tool (LIAT) for ARV drugs and Test kits developed by USAID/DELIVER. The data was collected r using semistructured questionnaires and observation check lists. The study revealed that 16(80%) of Health Center and 1(25%) of hospital pharmacies properly report and have the record of patients by regimen data. Almost all facilities had Electronic Dispensing Tool and used it for recording patient information on daily bases. Only, 14(70%) of the Health Centers used paper based ARV drugs dispensing register as a backup. Six months prior to the study, 14(70%) of Health Centers and 2(50%) of the hospitals stopped VCT service due to lack of adequate supply. The majority of the hospitals 3(75%) and 18(94.7%) of Health Centers were able to submit the requisition and report of ARV drugs to Pharmaceutical Fund and Supply Agency according to the schedule. More than three- fourth of the Health Centers had one or more emergency order of ARV drugs, while all of hospitals had emergency order more than 3 times within 6 months prior to the study. All of the hospitals and nearly half of the Health Centers had an emergency order of test kits more than 3 times in the past 6 months. The mean percentage difference between quantity ordered and received was high for 3TC300/TDF300 (69.6% in hospitals and 51.7% in HCs). Over all 14(73.7 %) of the Health Centers and 3(75%) of the hospitals faced stock out of one or more ARV drugs on the day of visit. Stock out was high for nvp200 in hospital 2(50%) and it was high for tdf300/3tc300 in HCs 7(36.8%). Regarding the stock status of test kits on the day of visit; only 7(36.8%) of the HCs were fully stocked, while the rest of them were stock out of one or more selected test kits. Whereas, all of the hospitals were stock out one or more test kits on the day of visit. Unlike ARV drugs, only 10(52.6%) of HCs and 2(50%) of hospitals had bin card for the selected test kits on the day of visit. All of the health facilities used both computerized ii and paper based LMIS; they used computerized electronic dispensing tool at dispensary and Health Commodities Management Information System in the store. The study concludes that there was not adequate data on patient by regimen and stock status of ARV drugs and Test kits. There were frequent stock outs of ARV drugs and HIV test kits, which are an indicator of weak supply chain. The reporting and receiving system of ARV drugs were more organized compared to HIV test kits. It was also noted that in majority of the cases the professionals were unable to handle the computerized LMIS, as desired. It was recommended for the hospitals and health center handling HIV/AIDS related commodities to have adequate and reliable patient information and drug utilization data on hand and improve their storage conditions and prevent expiry and wastage of expensive ARV drugs and HIV test kits. Key words: HIV/AIDS, ARV drugs, HIV test kits, supply chain Management, pharmaceutical storageItem Assessment of Tuberculosis Treatment and Quality of Anti-Tb Drug Management in Health Facilities in Gambella Regional State, Ethiopia(Addis Ababa University, 2010-05) Hailu, Kidu; Gedif, Teferi(PhD)Introduction: Tuberculosis is among the chronic infectious diseases in the world which is responsible for a great number of global mortality and morbidity. Its prevalence is highest in developing countries among which the Sub-Saharan Africa is in the front line. Effectiveness of tuberculosis treatment is measured by the level of treatment success and cure rates achieved. The main factors contributing to low tuberculosis cure rate are prevalence of multi-drug resistant tuberculosis, high level of TB/HIV co-infection, inappropriate prescribing practices by service providers, low quality of DOTS, low level of knowledge among TB patients about their treatment and infrequent and poor quality drug supply to TB patients. This study is, therefore, intended to assess tuberculosis treatment in health facilities in the region in general and the factors which may influence tuberculosis cure rate in particular in order to conclude whether these factors are really contributing to the problem at hand or not. This will greatly help in taking appropriate measures against tuberculosis and the associated factors. Objective: To assess tuberculosis treatment and quality of anti-TB drug management in health facilities in Gambella Regional State, Ethiopia. Methodology: A cross-sectional health institution based survey was conducted from 10th July to 20th Results: The results of this study showed that total TB/HIV co-infection level in the region was 46.7%, above the national level (31%). There was no significant difference in HIV positivity among female and male tuberculosis patients. Extra pulmonary tuberculosis patients were 1.95 times at a higher risk of contracting HIV than pulmonary tuberculosis patients. August, 2009 in six health institutions, where records were reviewed for 823 patients, exit interviews were done among 113 outpatients, key informant interview were done among six tuberculosis care providers and six pharmacy personnel. Observation was made to the store and dispensary units of the respective health institutions. Data was entered using Epi Info version 2002 and analysed using SPSS version 15 statistical soft wares. Qualitative data was manually processed and analysed. ix Similarly, re-treatment tuberculosis patients were 2.63 times at a higher risk of contracting HIV than new cases. Non-adherence to the treatment guide lines was one major prescribing problem among prescribers in all weight categories of patients. Among the anti-TB drugs, Isoniazid, Rifampicin and Pyrazinamide were the most common drugs prescribed in either under doses or over doses. Around forty-eight percent (47.8%) of the total patients interviewed reported to have been directly observed during the intensive phase and 50.6% of new cases, 39.3% of re-treatment cases, 48.1% of male and 46.7% of female tuberculosis patients said that they were directly observed during the first two months of their treatment. About seventy five percent (75.5%) of the total respondents confirmed that they were informed about the duration of their treatment. But this was 69% among new cases, 75%, 68.75% and 73.3% among re-treatment, male and female TB patients, respectively. Nearly fifty percent (49.6%) of the interviewees reported that the disease would relapse and 46.9% said that they would die of the disease if they failed to take their anti-TB drugs as prescribed. There was poor drug storage conditions in two out of the six health facilities and moderately adequate in the regional store. Some facilities in support of TB care like water, sputum cups and slides were not available, some in all health facilities and others in certain health facilities. There was staffing problem in the TB clinics and the stores of the health facilities. Conclusion and Recommendations: The study concluded that the level of TB/HIV co-infection was high in Gambella Regional State. Non-adherence of prescribers to national guide lines and low degree of DOT implementation were prevalent problems in health facilities in the region. It can also be inferred from the study that inadequate storage conditions, staffing and unavailability of facilities in support of TB care were problems in health facilities in the region. Hence, it is recommended that mechanisms should be devised to tackle TB and HIV in a coordinated manner, enforce prescribers to follow national guide lines, facilitate provision of facilities to improve anti-TB drug storage condition and facilities in support of TB care and solve staffing problems.Item Assessment on the implementation of Hospital Reform Guideline with reference to Pharmacy service in Addis Ababa(Addis Ababa University, 2014-06) Gulelat, Bethelehem; Gedif, Teferi(PhD)Assessment on the implementation of Hospital Reform Guideline with reference to Pharmacy service in Addis Ababa Bethelehem Gulelat Addis Ababa University, 2014 The Ethiopian hospital reform which is develop in 2010 is one of the important documents which established standardized, more patient oriented service in hospitals along with tools to monitor the performance. And one of the chapter in the document discussed minimum standards of hospital pharmaceutical service with its indicators. This study was performed to assess the implementation of Hospital Reform Guidelines in Addis Ababa with reference to Pharmacy service. The study employed a descriptive, cross sectional study design, using both quantitative and qualitative methods between August and November, 2013.As data collection technique the study used structured observation, in-depth interview and selfadministered questionnaire. The quantitative data was entered and analyzed by a research data electronically capturing soft – ware called RedCap. Whereas, the qualitative data was analyzed thematically. Fifty percent of participating hospitals have quality offices over all do monitoring and evaluation. Most of this hospitals governed by FMOH. On the other hand, those hospitals under AACAHO do not have such office (except one hospital). Although FMOH and AACAHO hospitals follow different implementation processes, there is no big difference regarding the awareness level of pharmacy professionals. But there is a difference in the outcome of hospital performance. The awareness of pharmacy professionals about EHRIG was around 61% and the implementation of the 12 operational standards included in pharmacy chapter of EHRIG was found to be in range 33% – 83%. Regarding challenge, all hospitals face problems associated with motivation, and commitment of pharmacy professionals towards their job. Key words: Ethiopian Hospital Reform Implementation GuidelineItem Illness and Treatment Experiences of Adult patients with type 2 Diabetes Mellitus in the Urban and Peri-urban of Central Ethiopia – a Qualitative Study(Addis Ababa University, 2017-06) Messele, Bruck; Gedif, Teferi(PhD); Boon, Heather (Professor)Introduction: Type 2 diabetes, which is increasingly becoming a public health problem in developing economies including Ethiopia, is associated with a high level of microvascular and macrovascular complications. Evidence from the Western world indicates that gaining an understanding of patient perceptions and experiences would serve as useful inputs in the design of effective strategies aimed at improving their care and health outcomes. This research project utilized different theoretical models, namely Kleinman’s explanatory model, Horne’s necessity-concerns framework as well as de Haes and Bensings’ medical communication model to explore the illness and treatment experiences of patients with type 2 diabetes in selected hospital settings in Addis Ababa and Butajira. Methods: Qualitative interviews were held with 39 purposively sampled patients with type 2 diabetes who were selected to represent varied socio-demographic and a range of illness and treatment experiences. Interviews were conducted until saturation of key themes. The analysis and interpretation was carried out using a thematic analysis approach. Findings: The findings from this study revealed that participants’ explanatory frameworks were influenced by the biomedical and traditional models (including cultural and religious influences). It was also apparent that participants’ biomedical knowledge was low which was expected given their low formal education status. Cultural influences were apparent for instance in the manner that participants labelled their illness as ‘sugar disease’ and their perception of suitable treatment strategies. Religion likewise exerted its own influence with respect to the perceptions of causation and the appropriateness of treatments. With regards to the anti-diabetes medication, findings indicated that participants’ perceptions revolved around their necessity and concerns which were also indicative of the utility of the Horne’s necessity-concerns framework. In this regard participants’ concerns about their iii medications were not that much different to those of their Western counterparts in certain aspects (e.g., about the adverse effects and the number of medications) while they differed in others (e.g., associating diabetes-related complications such as eye problems to medication adverse effects) which seem to be influenced by their socio-cultural and low educational backgrounds. Perceptions about the necessity of their medications were however given less attention as compared to the concerns about safety issues. Though participants’ concerns were mostly about adverse effects, inconveniences in handling and accessing their medications were also found to be sources of concern. It was also apparent that some of the participants’ concerns were quite strong or not based on evidence but may nevertheless potentially affect adherence to prescribed medications. Findings with regards to participants’ perception towards their healthcare providers were organized following de Haes and Bensings’ communication model. Perceptions focused on fostering the relationship and the provision and gathering of information aspects. By and large, participants detailed their suboptimal experiences in the care provided by their healthcare providers that were below their expectations. Participants’ adherence to prescribed anti-diabetes medications were negatively affected by a range of factors that included: perceptions about their illness especially related to symptoms and hope for a cure, perceptions about prescribed medications especially related to concerns, their relation to the healthcare providers and the health system factors such as the provision of diabetes education and availability of medications and religious healing practices especially use of holy water and religious duties. Factors that served as facilitators to adherence included the presence of diabetes complications and perceived health benefits that enhanced medication necessity perceptions, religious practices and social support. On the other hand, some of the participants reported using medicinal plants such as Shiferaw (Moringa spp.) and Anamuro (Ajuga spp) in a complementary manner to their biomedical regimens. While their use did not seem to negatively affect adherence, some participants reported adverse effects which led to discontinuation of these medicinal plants. Different factors influenced the use of medicinal plants including perceptions that bitter things were good for diabetes, claimed or experienced efficacies and mass media messages. Findings also revealed that the use of medicinal plants was occuring in the context of limited information which may further result in suboptimal health outcomes. iv Conclusion: The perceptions held by the study participants towards their illness and its treatment were found to negatively influence their experience and adherence to prescribed anti-diabetes medications. The suboptimal care provision experienced by these participants appears to be another factor that contributes to the nonadherence issue. It is therefore recommended that a chronic care model be implemented that incorporates current care standards, strengthened and context specific diabetes education and adherence support programs. Key words: Type 2 diabetes, Kleinman’s model, Horne’s Necessity-Concerns model, de Haes and Bensing Medical Communication model, Adherence to Anti-diabetes Medications, Qualitative research, Ethiopia, Addis Ababa, ButajiraItem Impact of First Generation Antipsychotics in the Long Term Outcome of Bipolar Disorder, A Community-Based Naturalistic Follow-Up Study, Butajira, Ethiopia(Addis Ababa University, 2013-01) Debero, Nigussie; Gedif, Teferi(PhD); Fekadu, Abebaw(PhD)Background: Bipolar disorder is one of the most severe forms of mental disorders, and is clinically characterized by profound mood swings. Bipolar disorder is an episodic condition requiring long-term, often life-long, treatment to control acute symptoms and stabilize mood. Despite recommendations by some treatment guidelines to avoid use of first generation antipsychotics(FGAs) in maintenance treatment of bipolar disorder, their use is highly prevalent especially in resource limited countries like Ethiopia. Objective: To assess the impact of the long term use of FGAs in the course and outcome of bipolar I disorder. Methods: The Longitudinal Interval Follow-up Evaluation(LIFE) chart was used to collect detailed psychosocial, psychopathologic and treatment outcome information. Results: Among the study participants who were at risk for relapse, 86.5% had experienced relapse during their follow-up. Duration on daily FGAs dose ≥ 300mg Chlorpromazine(CPZ) equivalents was significantly associated with relapse rate in bipolar I disorder. While FGAs use did not predict remission and overall functioning improvement, remission was negatively associated with duration of treatment on daily FGAs dose ≥ 300mg CPZ equivalents. Furthermore, duration on FGAs significantly increased the risk for EPS. On the other hand, FGAs use did not predict suicidality in bipolar I patients. iv Conclusion: Findings from the current study suggest that benefits of the long term use of FGAs in bipolar disorder are doubtful. Therefore, providing access to effective medications such as mood stabilizers may be relevant next steps to optimize the outcome of bipolar disorder in settings where FGAs are widely used. Key words: First generation antipsychotics, bipolar disorder, maintenance treatment, prophylaxis, outcome, EthiopiaItem Indigenous Ill-health Perception and Healing Practices: Socio- Cultural Study in North-Eastern Ethiopia(Addis Ababa University, 2017-06) Haile, Mesfin; Gedif, Teferi(PhD); Boon, Heather(PhD)Introduction: When integrated with ‘modern’ medicine, well developed indigenous medicinal knowledge and practices have the potential advantage of reducing overcrowding of primary care services. However this aspect is not well studied in the Ethiopian setting. Therefore, this study explored the indigenous medicinal beliefs and practices used by communities in North Eastern Ethiopia in the management of health problems in their homes using a conceptual framework adopted from Kleinman’s Cultural Systems Model, the Murdock illness causation model, and the Padela God-centeric healing model. Methods: Ethnographic methods were used for this study. Participant observation was supplemented by ten focus group discussions (FGDs) (n=96) and 20 in-depth interviews conducted with the key informant community members. The analysis and interpretation was informed by thematic and narratives strategies. Findings: The findings indicated that the Tehuledere people’s worldview of health, health problems and healing systems is closely linked to their day-to-day cultural lives. They had widespread perceptions about causes of illness. They perceived that illnesses might be caused by the wrath of God or gods, ‘qolle or quteb (spirit possessions); natural causes (e.g., environmental sanitation and personal hygiene, poverty, biological such as organic deterioration and accident and psychological factors such as stress) and societal causes (e.g., social trust, experiences of family support and harmony; and violation of social taboos). Therefore, the explanatory model of illness causation in this community was very similar to that of the Murdock model with one key difference: social elements need to be added to the model. The major factors associated with use of indigenous medicine included: the perceived etiology of illnesses; the availability and acceptability of healthcare services; the relationship between the health-care practitioners and the patients; socioeconomic factors (cost of health care expenditure); and the influence of social networks and/or social relationships. It was found that in Tehuledere pluralistic health-care resources were used either independently or concurrently with biomedicine. The study identified that religious and spiritual healing, bio-medicine, ‘folk’ or indigenous healing systems, and popular or home-based medicine, were the major types of health-care options. V Many of the Tehuledere people attribute illness to the wrath of supernatural forces. Thus, healing is thought to be mitigated by divine assistance obtained through supplication and rituals and through the healing interventions of nature spirit actors such as Woliy (Muslim saints) and Kalicha (Muslim voodoo). Also seeking God/Allah/ and nature-spirit forgiveness with ritual ‘Dua (Prayer), Tsebel/holy water/, ‘wodaja’ (harmonizing the spirit to heal evil), ‘Chelle’/ goddess of fecundity/ were practiced for certain ailments such as jinn and Buda. Moreover, Traditional health practitioners (kitel betash or herbalists, ‘awalaj’ or birth attendants and ‘wogesha’ or bone setters) were consulted for preventive, protective and remedial care of the participants and their families. Instances of selfmedication were also encountered in the participants. The participants apply home remedies for prevention and remedial purposes. Treatment is meant for those apparent ailments such as Nedad (malaria), Mich (acute febrile illness) and Gunfan (flu) and other relatively common health problems. Otherwise the popular agents refer to the biomedical experts if no progress was seen subsequent to treating with home remedies. The findings further demonstrated that bridge of caring was built between the traditional healers and the primary health service (i.e. the health posts) in the management of perceived common ailments, such as yewof beshita (jaundice) and yelig tilat (herpes zoster) in the village. Another bridge of care was also built between the health posts and the health center for the management of the other health problems, such as HIV/ AIDS and tuberculosis, which the study communities experience as critical incidents. The role of health extension workers was very important for this integration. The increased accessibility in the modern health care appears to have been both a blessing and curse to the area, as the indigenous communities competed to find a place for their healing system within the new health system. The findings also identified communication and attitudinal problems that exist between the communities and modern health care providers. Conclusion: The indigenous health care mechanisms of the study community address basic elements of primary health care such as fostering self-care and self-reliance, community participation and the use of indigenous medical practices for the maintenance of good health. It is within this area that the study communities appear to express the greatest concern related to the ‘natural’, ‘spiritual` and `societal` health of their homes and villages. Since people in the study communities believe that spiritual , indigenous healer and home VI remedial healings are health care options among multiple health-care resources, successful rural primary health care strategy would give due attention to such local resources. This will help to ensure the optimal utilization of Ethiopia’s limited resources. This study suggests that there should be a clear plan as to how indigenous medicinal practices can be supported within a health care systems approach. Key Words: Indigenous health knowledge, primary health care, Illnesses, health, Religion, Spirit, home remedies, qualitative, Beliefs, Tehuledere, Ethiopia.Item Interprofessional Collaboration between Physicians and Pharmacists in Selected Public Hospitals of Addis Ababa, Ethiopia(Addis Ababa University, 2014-06) Timothewos, Sewit; Gedif, Teferi(PhD)Interprofessional Collaboration between Physicians and Pharmacists in Public Hospitals of Addis Ababa. Sewit Timothewos, Addis Ababa University, 2014 Since recent times there has been an expansion in the horizon of pharmacy practice. To optimize the contribution of pharmacists to their extended role, pharmacist and physicians need to learn to work in a collaborative manner. Hence, assessment of current level of interaction and factors affecting their working relationships need to be investigated. To this effect, the present study employed hospital based descriptive cross sectional study design, with qualitative and quantitative data collection methods. The study was conducted from June-November 2013 in two selected public hospitals of Addis Ababa. Key informant Interview (KI) and the Pharmacist Physician Collaborative Index (PPCI) was used to measure the degree of collaboration. The study population were pharmacists and physicians working in RDMH and TASH. The study had a response rate of 76%. The mean PPCI score for the respondents were 60.4 and 67.5 for physicians in TASH and RDMH, and 62 and 70.5 for pharmacists in TASH and RDMH, respectively. The professionals jointly worked in DTC and morning sessions and wish that these activities would be further strengthened. The pharmacists were making more of an effort to collaborate than the physicians and the professionals in RDMH were getting more support from the hospital administration in favor of collaboration compared to TASH. InterprofeInterprofe Interprofe Interprofe Interprofessional collaboration in RDMH was found to ssional collaboration in RDMH was found to ssional collaboration in (from the pharmacists perspective) or greater be equal to (from the pharmacists perspective) or greater be equal to (from the pharmacists perspective) or greater be physicians perspective) that of from physicians perspective) that of from physicians perspective) that of from physicians perspective) that of from physicians perspective) that of from physicians perspective) that of TASHTASH . And it is recommended that two way and open communication between physicians and pharmacists should be facilitated so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would so that the role each professional should play in team work would be known. be known. Key words; Interprofessional Collaboration, Pharmacist Physician Collaborative Index,Item Knowledge, Attitude and Practice of Hepatitis B Virus and Its Vaccination Among Health Care Professionals in Selected Public Hospitals of Addis Ababa, Ethiopia(Addis Ababa University, 2015-03) Afework, Gashu; Gedif, Teferi(PhD)Occupational exposure occurs frequently among health care workers (HCWs). The most serious occupational health hazard faced by HCWs worldwide is exposure to hepatitis B virus (HBV). Having enough Knowledge and proper attitudes toward this infection is crucial in prevention of occupational hepatitis infection. Therefore this study was conducted to assess knowledge, atti-tude and practice of HBV and its vaccination among health care professionals (HCPs) in selected public hospitals of Addis Ababa, Ethiopia. Both qualitative and quantitative methods were used. Qualitative study involved key informants interviews whereas quantitative method was carried out by using structured self-administered questionnaire. This study revealed that HCPs’ knowledge regarding occupational exposure of HBV is found to be good as majority of our par-ticipants correctly answered most of the question pertaining to it. Relatively larger proportion, 103 (44.8%) of the respondents were found to have neutral attitude score. One hundred seventy eight (77.7%) of them had been screened for and received hepatitis B Vaccine, and one hundred sixty (94.1%) of them had received full course of the vaccine. Knowledge score was significantly associated with: education level, type of profession and area of practice; whereas profession type and history of training were the only predictors of vaccination status. In conclusion, majority of the survey participants had moderate to high knowledge score, however, larger percentage of HCPs had negative or neutral attitudes on HBV and its vaccination. In spite of this, vaccination iv status was encouraging. The gaps identified in some areas of knowledge, attitude and practice of HBV call for concern among all stakeholders since HCPs have a high risk of being infected with HBV owing to their high frequency of exposure to infectious fluids coupled with the high infec-tivity of HBV. Key words: Hepatitis B virus, Knowledge, Attitude, Practice, Occupational exposureItem Knowledge, attitude and practice on generic medicine among community pharmacy clients’ and pharmacy personnel in Hawassa; a facility based cross sectional study(Addis Ababa University, 2014-01) Sahile, Muluwork; Gedif, Teferi(PhD)Rational use of generic medicines can provide substantial savings in health care cost of government, patients and insurance funds without affecting the therapeutic effect of the medicine. However, studies in different countries indicated that poor knowledge and negative attitude towards generic medicine among clients and pharmacy personnel is the most challenging barriers for the use of generic medicines. So this thesis assessed knowledge, attitude and practice on generic medicine and associated factors among community pharmacy clients’ and pharmacy personnel in Hawassa. A facility based cross sectional study was conducted from April 2012 to September 2012 at all community pharmacies of Hawassa. Six hundred sixty two study participants were selected from six community pharmacies based on the average number of prescription filled each day. In-depth interview was also conducted with pharmacy personnel working in community pharmacies, drug shops, hospital pharmacy, whole sale, FMHACA and health bureau. The result showed that only 22.4% of clients’ were knowledgeable about generic medicine while most pharmacy personnel had good knowledge of generic medicines. Barely 32 % of clients have positive attitude towards generic medicines and over one in three of clients and pharmacy personnel had distrust on generic medicine approval system of Ethiopia. Majority (72.4%) of the clients had ever used generic medicines. Age and educational status were shown to be significant predictors of knowledge on generic medicine. Age, educational status and experience with generic medicines had a strong and positive association with attitude. The use of generic medicine was found to be significantly associated with respondents’ education, knowledge, attitude and Therefore, concerned bodies should provide public education about generic medication to fill knowledge gap and to enable clients to undertake an informed decision in choosing either generic medicine or branded alternative. The generic policy implementation should be strengthened by introducing incentives for pharmacy personnel and prescribers to prescribe and dispense generics.