Browsing by Author "Mekuria, Basazinew"

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    Assessment of Leishmaniasis treatment commodities management and Leishmaniasis treatment pattern in public health facilities of Amhara Region, Ethiopia
    (Addis Abeba University, 2020-08) Mekuria, Basazinew; Prof. Gedif, Teferi; Prof. Hailu, Asrat
    Background: The Pharmaceutical logistics system in Ethiopia is consistently hindered by several systemic problems that cause frequent stockouts of critical pharmaceuticals. It is even worse when it comes to the supply chain management of neglected tropical diseases, including leishmaniasis. Objective: To assess leishmaniasis treatment commodit ies’ management and treatment pattern in public health facilities of Amhara Region. Method: A descriptive cross sectional survey design was used for the study and a total of 18 health facilities found in Amhara Regional State were included in the study. Information on availability, inventory and storage practices of leishmaniasis treatment commodities and treatment pattern from health facilities were collected using structured questionnaires. In addition, in-depth interviews with key informants were conducted to identify challenges on leishmaniasis treatment commodities, and treatment pattern using interview guide. Three data collectors were trained and involved in data collection process. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to calculate mean and percentage figures. The qualitative data was transcribed and summarized thematically. Results: Utilization of bin cards and Receiving and Requisition Form (RRF) for leishmaniasis treatment commodities were reported in 10(55.6%) of the facilities, whereas 11(61.1%) health facilities used Internal Facility Report and Resupply (IFRR) for leishmaniasis treatment commodities. Fourteen (77.8%) and 7(38.9%) of the health facilities experienced stockouts of one or more commodities during the past one year and on the day of the visit, respectively. Five (100%) and 10(62.5%) facilities were stockout with mean frequency (range) of stockout 3.6(3-4) and 1.6(0-3) for Amphotericin B and rk39 test kit in the past one year, respectively. The mean number of days (and range) of stockouts of health facilities were 86(0-160) for Sodium Stibogluconate and 153(128- 192) for Amphotericin B in the study period (March 2018-Feburary 2019). A total of 18221 leishmaniasis suspected patients in a period, from January 2016- December 2018, were tested by rk39, aspiration, and skin smear test, out of which 6261 were positive. Out of 6261 total leishmaniasis positive cases, the highest annual prevalence, 2414(38.6%), was reported in 2018. In the Amhara Region, 1245 in 2016, 1169 in 2017, and 1349 in 2018 leishmaniasis cases were managed. Out of 1147 patients with leishmaniasis treated in the study facilities in the period (March 2018-Feburary 2019) 122(76.2%) and 317(83.9%) were treated with Amphotericin B and combined Sodium Stibogluconate with Paromomycin for recommended duration respectively whereas 4(33.3%), and 155(26%) of patients treated with Paromomycin and Sodium Stibogluconate monotherapy were below the recommended duration respectively. The highest co- infection with leishmaniasis in the study period (March 2018-Feburary 2019) was severe acute malnutrition which is 38 patients. Out of the received leishmaniasis commodities, 5% of Sodium Stibogluconate, 8.6% of Paromomycin, and 7% of rK39 test kit were expired in the study period (March 2018-Feburary 2019) while 69.3% and 35.8% of rK39 test kit and Paromomycin from stock on hand were near expiry. From the total assessed facilities, two hospitals, 88.2%, and 94.1% perform storage condition guideline criteria which is above the recommendation, and only 11.11% of health facilities maintain acceptable storage conditions. Conclusion: The majority of health facilities had poor inventory management practice for leishmaniasis treatment commodities. Most health facilities experienced one or more commodities stocked out at the time of the visit and during the past year preceding the survey. Amphotericin B was the most frequently stocked out commodity in the health facilities. Some patients took treatment below the recommended duration which is contrary to established treatment guideline protocol. The storage condition of most health facilities was inadequate, and there was an expired and a large number of near expiry products in the health facilities. Generally, there was poorly organized leishmaniasis treatment commodities management in the region.