Pharmco-Epidemiology and Social Pharmacy

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Anti-Malarial Drug and Mosquito Net Use Pattern in Pawe Special Woreda: A Community Based Survey
(Addis Ababa University, 2009-06) Mussa, Seid; Gedif, Teferi (PhD)
Anti-Malarial Drug and Mosquito Net Use Pattern in Pawe Special Woreda: A Community Based Survey
(Addis Ababa University, 2009-07) Mussa, Seid; Gedif, Teferi (PhD)
Background: Malaria is a major public health problem and the leading communicable disease in Ethiopia. Interruption of contact between humans and mosquitoes through the use of insecticidetreated bed nets (ITNs) is a promising approach to protect people from malaria infection. Treatment failures and mortality due to malaria has risen in recent years, probably due to increasing resistance to anti-malarial medicines. Improper drug storage and rampant selfmedication are some of the factors that may contribute to an increase in the development of drug resistance by malaria parasites towards anti-malarials. Study objective: To assess the utilization pattern of anti-malarial drugs, and mosquito net coverage in Pawe special Woreda, Beneshangul-Gumuz National Regional State. Methodology: The study was conducted in Pawe Special Woreda, Beneshangul-Gumuz Regional State between August and September 2008. Both quantitative and qualitative methods were employed in the data collection. Qualitative methods employed include focus group discussions and key-informant interviews. The quantitative method used is a community based cross-sectional household survey. The study utilized a trained interviewer administered questionnaire for data collection. Data was collected primarily from mothers. Quantitative data was entered using EPI-Info software Version 6.04 and analyzed by SPSS version 11 statistical packages. Qualitative data were analysed through thematic content analysis in an attempt to answer key questions of the study. Results: Perceived malaria prevalence was found to be 6.1 %. Sixty nine, (38.8%) of those with reported malaria/symptom complexes in the last two weeks preceding the interview date se lfmedicated themselves with anti-malarials. Households with a family size of less than or equal to 5 persons (OR=0.47, CI=0.25, 0.90, P=0.02) were less likely to self-care with anti-malarials than those with a family size of more than 5 persons.
Quality Of Pharmaceutical Care In Government Hospitals Of Addis Ababa, Ethiopia
(Addis Ababa University, 2010-04) Eshetu, Eskinder; Gedif, Teferi(PhD)
Background: As the quality of medication use is the central aspect of quality health care, measuring and thus improving the quality of pharmaceutical care plays a pivotal role in improving medical care in hospitals. Quality of pharmaceutical care can be measured at the levels of the structure, process and outcome. And it is recommended that measurement of the quality of pharmaceutical care should give emphasis on the feelings of the customers of the service. The job satisfaction of pharmacy professionals is also expected to influence and be influenced by the quality of pharmaceutical care. Objective: to assess the quality of pharmaceutical care in some selected government hospitals of Addis Ababa, Ethiopia. Methodology: A descriptive cross sectional survey of the pharmacy units of selected hospitals in Addis Ababa was conducted between August and December, 2009. Six government hospitals were involved in the study (two university hospitals and the rest under the Addis Ababa city administration health bureau). The structural quality of pharmaceutical care, pharmacists’ level of involvement in pharmaceutical care provision, clients’ level of satisfaction, pharmacy professional’s job satisfaction and their perceived quality of pharmaceutical care were studied. The study used both quantitative and qualitative methods. Structured observation checklist, structured interview guides and self administered questionnaires were used to collect quantitative data. And qualitative data was collected by an in-depth interview with the heads of the pharmacy departments. Results: a total of nineteen pharmacy units in the six hospitals were studied for structural quality. Deficiencies were observed with most of the structural aspects. Simple dispensing aids like tablet counting tray were absent in 8 (42.1%) of the pharmacy units. And all had inadequate space for different purposes especially for storage of pharmaceuticals. Some of the hospitals also suffer from shortage of pharmacy professionals. Fifty one pharmacy professionals responded to questions regarding their level of involvement in the provision of pharmaceutical care. And the documentation and implementation of therapeutic objectives and monitoring plans aspects of pharmaceutical care were the most underperformed domains by the pharmacy professionals. The majority of pharmacy professionals (68.6%) never participated in ward rounds and the major reason for this was reported to be absence of system in the hospital for the involvement of pharmacists in ward rounds. A total of 2641 clients visiting the outpatient pharmacies of the studied hospitals were interviewed on exit from the pharmacies. The interviews were made in Amharic and factor x analysis of the Amharic questionnaire resulted in the factors: interpersonal relationship, general satisfaction and pharmaceutical care. Chronbach’s alpha for the whole questionnaire was found to be 0.90 and 0.82, 0.83 and 0.78 for the three factors, respectively. The least satisfaction scores were obtained in the pharmaceutical care domain. And many significant differences in satisfaction with some aspects of pharmaceutical services were observed with clients’ gender, frequency of visit, type of hospital and payment status. The mean job satisfaction score for pharmacy professionals in the studied hospitals was found to be 2.9 + 0.52 in a scale of 1-5. Statistically significant differences were observed among pharmacists and pharmacy technicians (pharmacists less satisfied than technicians) with respect to the full utilization of talents on the job (t = -2.21; p = 0.032) and knowledgeableness of the lay person about the level of education of pharmacists (t = -2.19; p = 0.033). Majority of the pharmacy professionals (≥ 50%) rated the availability of medicines and important dispensing aids as poor or fair. The qualitative aspect of this study complemented the quantitative part in many aspects (i.e. structural deficiencies, level of involvement in pharmaceutical care and job satisfaction). Conclusion and Recommendation: this study showed that there is a low level of pharmaceutical care quality in the studied hospitals with respect to the availability of important materials and space; the involvement of pharmacy professionals in pharmaceutical care and clients’ satisfaction. Accordingly improved government attention to the pharmaceutical sector, increased involvement of pharmacists in the provision of pharmaceutical care and further quality assessments of hospital pharmacy services are recommended. Key words: quality, pharmaceutical care, Addis Ababa, hospitals, job satisfaction, clients’ satisfaction
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.
Antidiarrheal and Antispasmodic Activities of Stephania Abyssinica (Minspermaseae) Used In Ethiopian Traditional Medicine
(Addis Ababa University, 2010-06) Deneke, Tatek; Engidawork, Ephrem (PhD)
Diarrhea is a leading cause of morbidity and mortality in developing countries. Diarrhea may result from disturbance in bowel function in which case there is increased bowel transit, excessive intestinal secretion of water and electrolytes, decreased intestinal reabsorptions as well as more frequent defecations of loose, watery stool. Many plant preparations have claimed activities and traditional used as antidiarrhea and antispasmodic. S. abyssinica is traditionally used for treatment of diarrhea and stomachache in Ethiopia. The aim of this work was to evaluate the antidiarrheal and antispasmodic activities of the aqueous and methanol extract of the root and leaf of S. abyssinica. Antidiarrheal activities were studied in mice using castor oil-induced diarrhea at doses of 25, 50,100, and 200 mg/kg body weight. The extracts significantly prolonged the time of diarrheal induction, increased diarrhea free time, reduced the frequency of diarrhea episodes, decreased the weight of stool, and decreased general diarrheal score in a dose dependent way. With dose of 200 mg/kg the extracts produced higher in-vivo antidiarrheal index (ADI) than the reference loperamide. ADI of loperamide, SALM, SALA, SARM and SARA was 77.33, 88.79, 89.21, 91.08 and 82.23, respectively. In Entropooling test in mice the extract significantly (p < 0.01) inhibited intestinal fluid accumulations of mice in a dose dependent fashion; with dose of 100 mg/kg from1.03±0.093 ml of the control to 0.403±0.019ml, 0.210±0.018 ml, 0.494±0.012ml and 0.288±0.026ml by SALM, SARM, SALA and SARA respectively. The antispasmodic activity studies were performed as in vitro and in vivo models. The in-vitro antispasmodic activity studies were performed on isolated GPI. The methanol and aqueous extracts of the leaf showed significant and concentration dependent inhibition of acetylcholine induced contraction of isolated GPI. The extracts depressed Emax of Ach, and decreased PD2 value of the Ach. The Emax of Ach at conc of 10-3M is decreased (from100 for the control group) i viii by SALM with concentration of 200 and 100 ug/ml to 45.6±2.13 and 73.2±3.04 respectively, whereas by SALA with 200 and 100 ug/ml to 62.0±2.98 and 74.8±2.46 respectively. In the in vivo antispasmodic activity test, the extract significantly decreased the peristaltic index (PI). In normal transit test, the PI of SALM, SALA, SARM and SARA with dose of 200 mg/kg was all 0.00 (100% suppression of normal peristalsis). However in castor oil induced transit with dose of 200 mg/kg the peristaltic index (PI) of SALM, SALA, SARM and SARA was 26.67, 36.85, 22.00 and 40.65 respectively. The result of this study indicated that the plant extract possesses antidiarrheal and antispasmodic activities and proves the fact that this plant is used in traditional medicine for treatment of diarrhea, stomachache and abdominal cramp. Key words: S. abyssinica, antidiarrheal, antispasmodic, antienteropooling, aqueous and methanol extract, animal (mice or guinea pig)
Ethnobotanical Study of Medicinal Plants Used By Local People in Ofla Wereda, Southern Zone of Tigray Region, Ethiopia
(Addis Ababa University, 2010-06) Abdurhman, Nurya; Asfaw, Zemede(PhD); Kelbessa, Ensermu(Professor)
ABSTRACT: An ethnobotanical study of medicinal plants was conducted between October 2009 and April 2010, in Ofla Wereda of Southern Tigray, Ethiopia. The study employed common ethnobotanical methods including semi-structured interviews, field observations, preference ranking, paired comparisons and informant consensus. A total of 84 informants from 12 Kebeles (7 informants from each Kebele) were selected randomly and 36 key informants with the help of local administrators, recommendations from elders and members of the local community. In this study, 113 traditional medicinal plants were collected and identified. These species represent 95 genera and 51 families. The family Asteraceae with 12 species (10.62%), Lamiaceae and Solanaceae with 11 species (9.73%) each were commonly used medicinal plants in the study area. From the total of 113 medicinal plants, 82 species (72.57%) were used to treat human ailments for 55 health problems, 16 species (14.16%) were used to 14 livestock health problems and the remaining 15 species (13.27%) were used to treat both humans and livestock diseases. Herbs are the most used plants, accounting for 52 species (46%), shrubs 34 species (30.1%) and trees 27 species (23.9%). Leaves, roots, and fruits are the most used plant parts accounting for 68 species (45.3%), 31 species (20.7%) and 18 species (12%) in that order. Fresh plant parts from 74 species (65.5%) are frequently used in the study area than dried plant materials (27 species, 23.9%) and both dry and fresh materials (12 species, 10.6%). From the collected traditional medicinal plants informants reported that species used as crushed preparations were 39 (26.2%) followed by pounded which were 34 (22.8%) and those used as fumigants were 20 (13.4%). Most herbal preparations are administered externally compared to internal applications accounting for 51.6% and 48.4% respectively. Keywords: Ethnobotany, Ofla, medicinal plants, traditional medicine
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, Ethiopia
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.
Awareness and Utilization of Emergency Contraceptive among Second Cycle Primary Female Evening Students in Hawassa
(Addis Ababa University, 2013-05) Adinew, Alemayehu; Gedif, Teferi (PhD)
An unintended pregnancy is mistimed or unwanted one. It is a public health problem which affects maternal and child health. Unintended pregnancies are also significant among adolescents. Unintended pregnancy is a big problem in Ethiopia particularly among these age groups. Sexual violence is another major health problem because of consequences such as unwanted pregnancy abortion and sexually transmitted diseases and physical and mental trauma all of which could contribute to the high rate of female drop out from schools. Emergency contraception utilization can potentially reduce unintended pregnancies resulted from unprotected sexual intercourse or sexual violence and thus the risks related to it. Disparities in knowledge, access and use of family planning methods have also been observed in the country. This study assessed awareness and utilization of emergency contraceptive among second cycle primary school female evening students. A cross sectional study design was used. A total of 628 self administered questionnaire were distributed in class rooms for second cycle primary school (Grade 5-8) female evening students in Hawassa whose age was ≥ 15 years to assess their awareness, attitude and practice of emergency contraceptive and to identify their determinants which will be helpful in designing strategies to address reproductive health needs. The response rate was 463 (73.73%). To complement the quantitative data, key informant interview was also held with Family Guidance Association Ethiopia; Hawassa Branch, school directors, community pharmacy professional and DKT Ethiopia Hawassa branch manager. To determine the association between dependent and independent variables, multivariate logistic regression model at 95% confidence interval was used. Thematic analysis was used for qualitative data. Among 463 students surveyed, 120 (25.9%) of them ever had sexual intercourse the mean age at first sexual intercourse was 15.5 (SD+ 2.17); (10-20 years) and 74 (16%) had ever used contraceptives. Of those who had ever heard about emergency contraception (EC), 120 (55.8%) knew at least one correct method of EC. Only 34 (28.3%) of respondents who have ever heard about EC, had good knowledge of EC. 73 (60.8%) of the respondents had favorable attitude towards EC. However, only 27 (5.8%) study participants had ever used EC. In spite of this, of those who had ever used Emergency Contraceptive Pills (ECPs), 6 (42.9%) of respondents used it more than one time with mean frequency of 4.00 (SD±3.00). xii In the adjusted logistic regression model, ever heard of Family Planning (FP) and grade level were identified to be positively associated [(AOR= 1.885; CI (1.032-3.443), (AOR=2.119; CI (1.083-4.147) for grade seven and AOR=2.068; CI (1.126-3.797) for grade eight respectively] with awareness about EC. Marital status, contraceptives use experience, fair and good knowledge of EC were identified as [(AOR=0.060; CI (0.005-0.771) for widowed, AOR=0.100; CI (0.22-0.446) for divorced, AOR=0.007; CI (0.002-0.022) and AOR=0.006; CI (0.002-0.023) respectively] negatively associated with attitude. Sexual intercourse experience, fair and good knowledge of EC had positive association [AOR=67.578; CI (6.382-715.533), AOR=15.565; CI (2.316-104.623) and AOR=89.324; CI (10.821-737.313) respectively] with utilization of EC. Awareness and utilization of EC among primary second cycle female evening students were found to be low. In addition, ever heard about FP, grade level, marital status, contraceptives use experience, fair, good knowledge of EC, sexual intercourse experience were identified to be determinants of awareness and utilization of EC. Due to this fact, stakeholders should collaborate and come up with ways by which awareness could be improved.
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.
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.
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 Student
Assessment of the knowledge and practice of Health Extension Workers regarding the medicine they handle, in selected districts of Sidama Zone, Southern Ethiopia
(Addis Ababa University, 2014-04) Shuke, Ayalnesh; Gedif, Teferi (PhD); Dejene, Michael
The involvement of the CHW (community health workers) in drug provision has increased the availability of essential drugs lowest feasible cost to the population at the peripheral level. Some experts remain cautious about this approach, because of concerns that allowing CHWs to distribute anti-infective will increase the inappropriate use of drugs and accelerate the development of drug resistance. So this thesis assessed the knowledge and practice of HEWs regarding the medicines they handle in Sidama Zone. A cross-sectional study was conducted from December 2011 to January 2012. A structured questionnaire was used to collect data from a total of 55 HEWs available in the health posts (HP).Thirty HPs were selected from 3 districts. Medical record review was also made. Results showed that only 36.4% respondents were aware of the correct adult doses of Chloroquine and 29% and 40% of the respondents could not tell the dose of Coartem® and Chloroquine without referring to the treatment guideline, respectively. Fifty-two(94.5%) of the respondents did not knew the drug interaction between Coartem® and oral contraceptives and only 12.5% of the respondents were aware of food requirement while taking Coartem®. Only 3.6% and 29(52.7%) of HEWs reported correct doses of Amoxicillin and Cotrimoxazole, respectively. Of a total of 356 prescriptions, 50(14%) were not consistent with recommended guidelines. Therefore, the Zonal health department/ Woreda Health Office should organize refresher trainings for the HEWs to improve their knowledge about doses, drug interactions and contraindications of antimalarial drugs and antibiotics. And they should also encourage the consistency of the HEWs practice to the recommended guidelines regarding appropriate treatment choices.
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,
Self-Medication Practices with Antibiotics among Urban Dwellers of Bahir Dar Town, North West Ethiopia
(Addis Ababa University, 2014-06) Mekonnen, Tena; Gedif, Teferi(PhD)
Self-medication is becoming a common type of self-care behavior among the population of many countries. Many international studies have investigated the prevalence and nature of self- medication practices at the population level. In Ethiopia, some workers have also looked at the population prevalence of self-medication in general; however the prevalence of antibiotic self-medication not been well described. In addition, an increase trend in antibiotic resistance that calls for exploring the underlying factors. This study was performed to estimate the prevalence of self-medication with antimicrobial drugs and to record the stored medicine at home. The study employed a community based cross-sectional survey on a sample of 595 households. Both quantitative and qualitative data collection methods were used in the study. The quantitative data was collected by structured and pre-tested questionnaire and analyzed using SPSS/PC version 17.0 and the qualitative data was collected through in-depth interview and analyzed using thematic analysis. The prevalence of self medication with antibiotics in this study was 12.8%. Respiratory 58.8% and diarrhea 41.2% were most frequently reported symptoms of illness. No significant associations were observed in the practice of self medication with antibiotics and socio demographic variables. From all visited households, 17% were found to store drugs at home. Self-medication with antibiotics is prevalent among urban dwellers of Bahir Dar town, North West Ethiopia. Therefore, there is a need for an intervention to address this practice. Key words: self medication, antibiotics, Ethiopia
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 elimination
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, LIAT
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.
Assessment of Pharmaceutical Logistic Management System in Amhara, Oromia and SNNP Regions of Ethiopia; the Case of Maternal Health Medicines
(Addis Ababa University, 2015-02) Zewge, Essete; Gedif, Teferi (BPharm,MPH,PhD)
Pharmaceutical system assessments are useful to diagnose problems and plan interventions in order to enhance performance of a logistic system. This study was conducted to assess the pharmaceutical logistic system focusing on Maternal Health Medicines (MHMs) in Oromia, Amhara and SNNP regions of Ethiopia. The study employed cross sectional study design and used both qualitative and quantitative data collection tools to collect the required information. Adopted versions of Logistics System Assessment Tool (LSAT) and the Logistics Indicators Assessment Tool (LIAT) were used to collect data. Key informant interview, document review and structured observation were used as data collection tools. Data was collected from November 6 to December 5 2013. The quantitative data was analyzed using Microsoft excel spreadsheet and the qualitative data was analyzed thematically. The MHMs were managed by revolving rug fund scheme and the assessment result of the logistic management information system showed that logistic data reports which provide information to decision makers at various levels were not used consistently. Guidelines and procedures were available for inventory control mechanisms which were being implemented mostly to program medicines integrated in to the Integrated Pharmaceuticals Logistics System (IPLS) which did not include the selected MHMs. Utilization of inventory control cards, which are the basics of proper inventory control procedures were low at the visited rural health centers. There was shortage of vehicles to transport and distribute medicines at each level of the system. There are guidelines for storage and handling of all medicines at all levels of the supply system. However, at central and regional stores, there was inadequate storage capacity at the time of data collection. To solve this problem, new warehouses were being built both at central and hubs of Pharmaceuticals Fund and Supply Agency (PFSA). Supervisory visits were conducted at the visited health facilities although not on regular basis. Integrating MHMs fully in to the IPLS could improve quality of logistic records and reports. Stakeholders of pharmaceutical supply chain management should particularly work on integrating supervision activities and strengthening the capacity of regional, zonal and woreda health offices logistic officers in order to build their capacity.
Ethno medcinal Study of Plants In Jigjiga Woreda, Eastern Ethiopia
(Addis Ababa University, 2015-03) Issa, Arebu; Gedif, Teferi (PhD); Asres, Kaleab (PhD); Gebre-Mariam, Tsige (Professor)
Traditional medicine (TM) is the ancient and culture bound medical practice which existed in human societies before the application of modern science to health. The practice of TM varies widely, in keeping with the societal and cultural heritage of different countries. The heritage has not been well documented in the developing countries including Ethiopia and this is even more so in the emerging regions of the country. The objective of this study was to determine the prevalence and identify factors determining the use of TM and record medicinal plants used by Somali ethnic group in Ethiopia. A community based cross-sectional study in which ethno medicinal information was collected from the community by using semi-structured questionnaires, supplemented by an in-depth interview with the healers, field observations, and market survey was conducted. The questionnaire was administered to 800 heads of households, 9 healers and 2 markets & 3 herbal drug shops. The study documented an overall prevalence rate of 40% in the use of herbal medicine in one month recall period. A total of 107 plant species were reported, among these plant species, 34 were fully identified by their scientific names. The reasons for preferring for herbal drugs were lower price, efficacy and geographic inaccessibility of modern medicine. The study found that leaves are the most frequently utilized plant part (30.5%), followed by roots (23%). Religion is the main source of knowledge for the healers. Age, gender, educational status and occupation are important factors that determine the use of TM. This comprehensive ethno- medicinal study showed that the community in Jigjiga Woreda II relies on considerable number of traditional medicinal plant species to treat wide spectrum of human ailments. Key words: Ethnomedcine, Herbal medicine, In-depth interview, Market survey, Medcinal plants, Prevalence, Traditional medicine

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