Pharmco-Epidemiology and Social Pharmacy

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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
Access to Essential Psychotropic Medicines in Addis Ababa: A CrossSectional Study
(Addis Ababa University, 2022-01) Ayehu, Molla Teshager; Prof.Fenta, Teferi Gedif; Prof.Araya, Mesfin
Background: Mental disorders are becoming a growing public health problem worldwide, especially in low- and middle-income countries. To provide quality mental health services, regular and adequate supplies of appropriate, safe and affordable medications are required. However, significant percentages of people with severe mental disorders are not getting the treatment. Availability and affordability of psychotropic medicines, amongst others, are the major barriers for many patients in meeting their medication needs. This study aimed to assess the availability, prices and affordability of essential psychotropic medicines in the private and public health sectors of Addis Ababa city. Methods: A cross-sectional study design was used in 60 retail medicine outlets. Quota sampling and purposive sampling was applied to select the retail outlets. Data was entered and analyzed by using the pre-programmed WHO/HAI workbook and SPSS version 25. Outcome measures were described as percentage availability, median price and median price ratios, and the number of days' wages needed to purchase medicines by the lowest-paid unskilled government worker. Finally, the results were presented as statements, tables, figures and graphs. Results: The mean availability of LPG psychotropic medicines was 24.33% in Addis Ababa (28.7% in the public sector and 19.80% in the private sector), and of OB medicines were 2.42 %( 2% in the private and 2.8% in the public sectors). Similarly, the public procurement prices for 16 LPGs ranged from 0.25-4.83 MPRs and the median procurement price was 0.96 MPR. The patient prices for the LPGs ranged from 0.52-6.43 MPRs in public and 1.08- 24.28 MPRs in private sectors. The patient prices for OB medicine were 5.21 MPR in public and 11.17 in private sectors. The cost of standard treatment varied from 0.1–7.8 days' wages in public and 0.8-25 days' in private sectors for the lowest-paid government worker to purchase a month's supply. Conclusions: Essential psychotropic medicines were poorly available with high prices and low affordability in Addis Ababa. To ensure access, an efficient supply across all levels of care and financial protection for key medicines should be in place.
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.
Antibiotics self-medication practices among health care professionals in selected public hospitals of Addis Ababa
(Addis Ababa University, 2019-03) Kassa, Tsehay; Prof.Gedif, Teferi
Introduction: Self-medication is the first option and response to most illness episodes. Use of antimicrobials without health care professionals’ guidance may result in greater probability of inappropriate, missed diagnosis, delays in appropriate treatment, pathogen resistance and increased morbidity. There is no sector in the health care community which is immune to drug abuse or misuse of which the worst offenders include Physicians, Nurses and Pharmacists. Self-medication among health care professionals may be an indicator that the health professional is neglecting his or her own health. This is important because the health habits and attitudes of health care professionals influence the counseling and care they provide to patients. Objective: This study was conducted to assess the prevalence of self-medication practices of antibiotics and factors associated with it among health care professionals in selected hospitals of Addis Ababa. Methods: Cross-sectional survey using self-administered questionnaires was employed to collect information from health professionals working in hospitals which were selected by using simple random sampling method. Data were collected from April to May, 2017. Results: A total of 317 respondents participated in this study. The prevalence of self-medication using antibiotics among health care professionals in one month recall period was found to be 72 (22.7%). The main reasons given for this were being familiar with the treatment options 31 (37%) , to get quick relief 25 (30%), lack of time. Respiratory problems accounted for self-medication 29 (40.3%) followed by gastro intestinal problems 28 (38.9%) were the two most common perceived illnesses for self-medication with antibiotics. Penicillins 30 (42%) and Fluroquinolones 29 (40%) were the most commonly used antibiotics for self-medication. None of the variables had significant association with the practice of self-medication with antibiotics. Conclusions and Recommendations: Overall, the prevalence of self-medication using antibiotics among health care professionals was high, which might contribute for the increasing antibiotic resistance. Therefore, the regulatory body should strictly regulate the sale of antibiotics without prescription. Regular short term training for all health care professionals on antibiotic self-medication and the consequences of antimicrobial resistance should be done to curb these practices.
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)
Assessement of Sanitary Conditions of Food Service Establishments and Food Safety Knowledge, Attitude and Practices among Food Handlers in Burayu Town
(Addis Abeba University, 2021-11) Bekele, Mamo; Tamene, Ayanadis
Background: Poor knowledge, attitude and practices of hygiene can contribute to the outbreaks of food borne illness. Most foods could be affected by food borne pathogens mainly due to poor hygienic conditions and inappropriate food handling practices. Inadequate knowledge,negative attitude and practices on food hygiene and poor sanitary condition of food anddrink establishmentes are among the factors responsible for the occurrence of poor hygienic conditions and inappropriate food handling practices. Objective: To assess knowledge, attitude and practice of food safety among food handlers and investigate sanitary condition of food service establishments in Burayu town. Method of study: Across-sectional descriptive study was conducted to assess knowledge, attitude and practice of food safety among selected food handlers(working on food preparation) and to investigate sanitary condition of selected food service establishments (butcher, café, milk house, and juice house).Food and drink establishments were selected by simple random sampling technique. Data was collected using pre-prepared standardized questionnaire and entered using Epi info and analysis was performed by using SPSS version 25. Results:- Overall,78.8% of the respondents have good knowledge on food hygiene and safety requirements.57.6 % of food handlers have positive attitude towards food safety and handling practices.Regarding the overall practice score of the food handlers, nearly half (51.1%) of the food handlers had good food safety and hygiene practice with a practice score or greater than 50%.Among assessed food and drink establishments,32(19.5%) of them had a green, 37(22.6%) of them yellow,and 29(17.7%) of them had red status and 66(40.2%) of them were not complying with the standerd. Conclusion- Overall, food handlers have good knowledge and practices with positive attitude towards food hygiene and safety requirements. Specifically, almost more than 70% of food handlers knew the fact that hand washing practices before work can reduce risk of food contamination. With regard to sanitary condition issues of the establishments, the study found out that their overall level of food and drinke establishmentes was poor. The largest proportion, 66 (40.2%) of food and drink establishmentes were not complying with the standard and also, 29 (17.7%) of food and drink establishments were at red status.
Assessment of Animal Owners’ Perspective and Facility Practice on Antimicrobial Medicines Use in Food Animals in Gondar City and its Surrounding
(Addis Ababa University, 2023-07) Getaneh,Atsede; Eshetu,Eskinder (PhD)
Background: Due to the increment of utilization of antimicrobial drugs in food animals there is an increased irrational use. However, there is a paucity of data on the perspective of animal owners and antimicrobial medicine use in food animals in Ethiopia. Objectives: To assess animal owners‘ perspectives and facility practice on antimicrobial medicine use in food animals in Gondar city and surrounding. Methods: A cross-sectional study design was conducted from September to December 2021. The study used both quantitative and qualitative methods. To collect qualitative data from animal owners used depth interview and computed manually. The quantitative data were coded, entered, and analyzed in SPSS version 20. P-value < 0.05 was considered significant. Results: In the national list of essential veterinary drugs, all drugs were prescribed under their generic name. Approximately 68.7% were antibiotics and 97.8% were injections. The average amount of drug per prescription was 1.5. Out of 15 essential medications, three were found in every clinic and two weren't available everywhere. Five facilities had both national veterinary drug list and guideline for veterinary treatment, while seven facilities lacked both. Of all interviewees 285 (47.5%), 289 (48.2%), and 26 (4.3%), respectively had low, moderate, and good competency in the use of medicines. III Conclusion and recommendations: In general, various facility indicators and prescribing practices haven't met the standard. Moreover, only a few of the individuals had used medicines successfully in the past. Thus, the facilities should fulfill essential guidelines, provide vital medications, and increase farmers' awareness.
Assessment of Bacterial Resistance Trend and Contributing Factors to Fluoroquinolone among Patients’ Specimens Analyzed At International Clinical Laboratories in Addis Ababa
(Addis Ababa University, 2017-06) Mekuria, Banchirega; Gedif, Teferi (PhD)
Introduction: Fluoroquinolones are a group of antimicrobials which are widely used globally and thus microorganisms becoming resistant to them. As there is limited current data on specific microorganisms’ resistance to fluoroquinolones in Ethiopia; this study aimed to generate information on the bacterial resistance against fluoroquinolones. Objective: To assess the bacterial resistance trend to fluoroquinolone among patients’ specimens analyzed at International Clinical Laboratories and contributing factors in Addis Ababa, Ethiopia Method: A retrospective, cross-sectional study design was employed using records from microbiology laboratory registers of International Clinical Laboratories documented from January 2013 to December 2016. Descriptive analysis and inferential statistics were computed. In addition, qualitative study using phenomenological method was conducted in health facilities of Addis Ababa to explore the contributing factors for resistance from prescribers’ and dispensers’ perspective. A thematic analysis was used to analyze the qualitative data. Result: The overall bacterial resistance to fluoroquinolones was 42.5%. The resistance was high against nalidixic acid (63.3%) followed by norfloxacin (44.4%). Enterococci and E.coli isolates were developing high level of resistance to ciprofloxacin and norfloxacin while enterococci was highly resistant to nalidixic acid (77.8%) followed by Pseudomonas (75.0%) isolates. In general, resistance to fluoroquinolone increases as patients’ age increases. Resistance against fluoroquinolones in patients of age 60 and above years were more than 5 times AOR= 5.63 (4.71, 6.73) that of the resistance in patient’s age less than 15 years. The resistance to fluoroquinolones increased from 40.4% in 2013 to 45.1% in 2014 and reached to the 49.0% in year 2015 and then declined to 46.3% in 2016(P <0.05). Key informants revealed that inappropriate practices of physicians, pharmacists and patients and incomplete diagnostic services contributed to fluoroquinolone resistances. Strengthen the regulation regarding over the counter sell of antibiotics, educating the public to improve awareness, promoting ethical practice would also help rationalizing the prescribing and dispensing practices, and instituting evidence based use of antibiotics are recommended as a solution. Conclusion: The retrospective study showed high bacterial resistance to fluoroquinolones. There was an increasing trend of bacterial resistance with time. Key informants stated that inappropriate prescribing and over the counter sell of antibiotics as well as irrational use by patients contributed to bacterial resistance to fluoroquinolones. Recommendation: The study suggests updating of health professionals on susceptibility pattern of bacteria and rational prescription to improve use of fluoroquinolones, Promoting ethical practice, improving the regulation and supervision on over the counter sell of antibiotics at private medicine retail outlet and continuous awareness raising and behavioral change communication has to be devised towards rational use to the community were some of the proposed containment mechanism for bacterial resistance to fluoroquinolones. Key word: Fluoroquinolone, resistance, bacterial isolates, resistance trends
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 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 disease
Assessment of cross-contamination prevention practices in pharmaceutical production: a comparative case study of two pharmaceutical manufacturing plants in Ethiopia
(Addis Ababa Universty, 2017-12) Assefa, Eyob; Gebremariam, Tsige (Professor)
Introduction: It is vital for pharmaceutical manufacturing companies to protect their customers’ health by manufacturing safe and quality medicines by adopting Good manufacturing practices (GMP), tools which help to ensure achieving this target sustainably. Among others, cross-contamination should be avoided by robust design of the premises, equipment and processes which take place within a manufacturing facility. The Food, Medicine, Healthcare Administration and Control Authority (FMHACA) has prepared a GMP roadmap for compliance of Ethiopian pharmaceutical manufactures by the Year 2018. Conducting scientific assessments on the companies’ status of cross-contamination prevention can provide pertinent information for the companies to take appropriate interventions on cross-contamination aspects of GMP guidelines. Objective: The aim of this study was therefore to assess, evaluate and compare the extent of cross-contamination prevention GMP guidelines implementation in the production areas of two Ethiopian pharmaceutical manufacturing companies, Company and Company B. Methodology: This study was a descriptive study conducted with comparative case study approach. Comprehensive methods that have 2 phases were conducted in June and July 2016 in Ethiopia. Field observation using structured checklist adopted from WHO GMP guideline, data collection from the company’s key personnel and chemical analysis of target residue on randomly selected equipment cleaned with the companies’ existing procedures have been used. Results: This study revealed that Company A has been operating with less compliance risk with 90.3% rating when compared to company B with 77.2% overall rating. The premises and Heating Ventilation and Air Conditioning (HVAC) system of the two companies were considerably different with critical deficiencies observed in company B. Moreover, the effectiveness of cleaning procedures in reducing active ingredient carryover was better in company A. Conclusion and Recommendations: Company A exhibited better compliance with no critical deficiency while Company B operated with critical deficiencies and higher compliance risks. In order to achieve GMP compliance with respect to cross-contamination and protect the safety of its customers Company B has to upgrade the manufacturing site and shall focus on solving validation gaps this study revealed.
Assessment of Health Promotion Services in Community Pharmacies of Addis Ababa, ETHIOPIA
(Addis Ababa Universty, 2019-01) Moges, Hiwot; Gedif, Teferi
Pharmacist‘s role is changing globally from drug compounding and dispensing to health promotion and patient care. Despite the fact that Ethiopia is facing a double burden from non-communicable and communicable diseases, community pharmacists in the country are rarely involved in health promotion services. This study aimed to identify level of involvement, barriers for pharmacists to provide health promotion functions in community pharmacies and assess community pharmacists‘ beliefs, willingness and perceived ability in providing health promotion services in community pharmacies. Qualitative and quantitative methods of data collection were used to answer the study objectives. For the quantitative part, self-administered questionnaires were distributed to 315 community pharmacists who were working in Addis Ababa. Simple descriptive statistics and multiple regression were used to analyze the data. For the qualitative part, in-depth interviews were held with stakeholders from Ministry of Health, Ethiopian Food, Medicine, Healthcare Administration and Control Authority and Ethiopian Pharmaceutical Association. The study revealed that 58% of pharmacists interviewed were not rendering health promotion services in community pharmacies. Age and work experiences found to be associated with provision of health promotion services. In such a way that pharmacists between 22-27 years old and with work experience 3 years and less are more involved on providing health promotional services. Furthermore, majority of community pharmacists 283(95.3%) felt that provision of health promotion services in community pharmacies have favorable impact on preventing disease and promoting health. They are also willing 263(88.6%) to perform health promotional functions. Moreover, they felt they are good at promoting physical activity 223(75%), screening diabetes 219(73.7%), promoting healthy eating 217(73%), on the other hand community pharmacists perceived unable on utilizing the test kits for screening cholesterol 149(50%) and explaining physiologic harms of khat chewing 121(41%). Absence of guideline on pharmacists‘ health promotion role , lack of space to maintain privacy, knowledge and skill gaps were claimed to be barriers for rendering health promotion services in community pharmacies. Thus, community pharmacists‘ involvement in health promotion is low. It is recommended to develop guideline on health promotion role of pharmacists in the scope of practice, strengthen pre-service and in service training on health promotion and implementation of MoHlatest directives towards health promotion role of community pharmacists.
Assessment of Health Promotion Services in Community Pharmacies of Addis Ababa, ETHIOPIA
(Addis Abeba University, 2019-01) Moges, Hiwot; Gedif, Teferi(BPharm, MPH, PhD)
Pharmacist‘s role is changing globally from drug compounding and dispensing to health promotion and patient care. Despite the fact that Ethiopia is facing a double burden from noncommunicable and communicable diseases, community pharmacists in the country are rarely involved in health promotion services. This study aimed to identify level of involvement, barriers for pharmacists to provide health promotion functions in community pharmacies and assess community pharmacists‘ beliefs, willingness and perceived ability in providing health promotion services in community pharmacies. Qualitative and quantitative methods of data collection were used to answer the study objectives. For the quantitative part, self-administered questionnaires were distributed to 315 community pharmacists who were working in Addis Ababa. Simple descriptive statistics and multiple regression were used to analyze the data. For the qualitative part, in-depth interviews were held with stakeholders from Ministry of Health, Ethiopian Food, Medicine, Healthcare Administration and Control Authority and Ethiopian Pharmaceutical Association. The study revealed that 58% of pharmacists interviewed were not rendering health promotion services in community pharmacies. Age and work experiences found to be associated with provision of health promotion services. In such a way that pharmacists between 22-27 years old and with work experience 3 years and less are more involved on providing health promotional services. Furthermore, majority of community pharmacists 283(95.3%) felt that provision of health promotion services in community pharmacies have favorable impact on preventing disease and promoting health. They are also willing 263(88.6%) to perform health promotional functions. Moreover, they felt they are good at promoting physical activity 223(75%), screening diabetes 219(73.7%), promoting healthy eating 217(73%), on the other hand community pharmacists perceived unable on utilizing the test kits for screening cholesterol 149(50%) and explaining physiologic harms of khat chewing 121(41%). Absence of guideline on pharmacists‘ health promotion role , lack of space to maintain privacy, knowledge and skill gaps were claimed to be barriers for rendering health promotion services in community pharmacies. Thus, community pharmacists‘ involvement in health promotion is low. It is recommended to develop guideline on health promotion role of pharmacists in the scope of practice, strengthen pre-service and in service training on health promotion and implementation of MoHlatest directives towards health promotion role of community pharmacists. i
Assessment of Health Related Quality of Life, its Predictors and Utility among Patients with Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Hospital based Cross-sectional study
(Addis Ababa Universty, 2018-09) Gebrehiwot, Selamawit; Gedif, Teferi (B.Pharm, MPH, PhD)
Background: Breast cancer is the most common cause of mortality and morbidity in Ethiopia. So far, the focus has been on clinical management of cancer but nowadays, health-related quality of life (HRQoL) is emerging as an important health outcome. Hence, evaluating the HRQoL and utility is relevant to monitor patient treatment outcome and determine their quality adjusted life year’s gains to be used for economic evaluations. Objective: To assess HRQoL, influencing factors, and utility among patients with breast cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: Hospital-based cross-sectional study was conducted among 404 women with breast cancer from December to February, 2018. The Amharic version of European Organization for Research and Treatment of Cancer-Breast Module, European Organization for Research and Treatment of Cancer, Euro Quality of Life Group’s 5-Domain Questionnaires 5 Levels and Euro Quality of Life Group’s visual analog scale instruments were used to collect the data. The HRQoL data was analyzed using SPSS version 23 while Microsoft Office Excel 2010 was used to analyze the utility score. Mean difference among independent were analyzed using one way ANOVA, Kruskal-wallis-test and Mann-whitney u test. Multivariable logistic regression was employed to assess the possible predictors of HRQoL. Results: The mean age of patients was 43.94 ± 11.72 years with majority (35.1%) of them on cancer stage 3. The mean score for global quality of life (GQoL) and visual scale analog was 59.32±22.94 and 69.94 ± 20.36, respectively while their mean utility score was 0.8 ± 0.25.The possible predictors of HRQoL were found to be stage of cancer (AOR= 7.94; 95%CI: 1.83-34.54), cognitive functioning (AOR=2.38; 95%CI: 1.32-4.31), pain (AOR=7.99; 95%CI: 4.62-13.83), financial difficulties (AOR=2.60; 95%CI: 1.56-4.35), and future perspective (AOR=2.08;95%CI: 1.24-3.49). Conclusions: The GQoL of patients from the present study was comparable to other studies and the utility mean score was estimated to be above average.
Assessment of HIV/AIDS services quality in health centers of East Shoa Zone, Oromia, Ethiopia
(Addis Ababa Universty, 2018-01) Aferu, Temesgen; Gedif, Teferi (PhD, Associate Professor)
Introduction: HIV/AIDS is the most serious worldwide public health problem of the current generation. As part of the multi sectoral response to mitigate the impact of this pandemic, the government of Ethiopia is providing different care services to people living with HIV/AIDS free of charge. The country has made substantial gains in the ART programme by expanding access to peoples living with HIV/AIDS. Nevertheless, retention of enrolled clients in treatment services, capacity for laboratory screening and point-of-care monitoring at health facilities require further improvement. The treatment coverage, particularly for pediatrics groups is very low. There are also additional reported problems with patient satisfaction on different service dimensions. So, the findings from this study may help to better understand the above and other problems associated with HIV/AIDS services in the study area and device a mechanism on how to overcome them. Objective: To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, To assess the quality of HIV/AIDS services in health centers East Shoa Zone, Oromia region, Ethiopia. Oromia region, Ethiopia. Oromia region, Ethiopia.Oromia region, Ethiopia. Oromia region, Ethiopia.Oromia region, Ethiopia.Oromia region, Ethiopia. Oromia region, Ethiopia. Oromia region, Ethiopia.Oromia region, Ethiopia. Method: A mixed method using both cross sectional survey design and qualitative interview was conducted in selected health centers of East Shoa Zone between February and May, 2017February and May, 2017February and May, 2017 February and May, 2017 February and May, 2017February and May, 2017February and May, 2017February and May, 2017February and May, 2017 February and May, 2017 February and May, 2017February and May, 2017 February and May, 2017 . Quantitative data was collected using researcher administered structured questionnaire, logistics indicators assessment tool and observation check list. Patient satisfaction assessment was made through exit interview using five point likert scale based questions. Qualitative data was collected using key informants‟ interview at each health centers. Results: The study was conducted in 8 selected health centers and all of them were providing different services including TB diagnosis and treatment, family planning services, disease and drug adherence counseling and opportunistic infection prophylaxis and treatment. They were also offering ART and anti pain medicines prescription and dispensing, different PMTCT services and ART laboratory serices. All (100%) and 6 (75%) facilities respectively had shortage of trained human power required to give ART and TB services. Five health centers (62.5%) had no CD4 count machine at the time of the survey and facilities having CD4 machine also had scarcity of reagent. Regarding ARV medicines availability, majority of the study facilities, 5 (62.50%) reported that thay had the stockout of AZT300/3TC150/NVP200 in six months prior to study while 4 (66.7%) of the facilities had the stockout of NVP 240ml (50mg/5ml) syrup on day of visit. Among anti TB medicines, E100 was out of stock in three facililities (37.5%) on day of vist and INH100 had been out of stock in 4 (50%) of the facilities in six months prior to the study. From OIs medicines, Cotrimoxazole 960mg tablet stockedout in 4 (66.70%) on day of visit and in 5 (83.30%) health centers in six months prior to the study. Considerable number of study facilities, 4 (66.70%) had the stockout of tramadol 50mg tablet on day of visit and ibuprofen 400mg tablet in six months prior to the study, 5 (71.40%). The overall mean patient satisfaction score was 3.16 (SD=0.87) on a 1-5 scale. Availability of anti TB drugs in pharmacy was an item with the highest mean satisfaction score (4.18± 0.61) while waiting time to get pharmacy service was ranked least by the patients (mean score of 1.92, SD= 0.81). Conclussion and Recommendation: This study indicated that patients were generally slightly satisfied with the services they obtained and that the study facilities were challenged by different factors including, scarcity of trained human power, stockout of various HIV/AIDS related medicines and inability to make patients adhere to the services given by the facilities. The consequenses of these factors can be dangerous to the patients as well as to the wider public and hence making available the appropriate human resource and HIV/AIDS related commodities including medicines should be the priority for the health facilities and the region to improve the quality of HIV/AIDS services in the study area.
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 level and factors affecting adherence to antiretroviral therapy in Nagelle town, Oromia regional state, Ethiopia
(Addis Ababa University, 2023-10) Solomon,Tigist; Gedif,Teferi(Prof.); Haile,Mesfin(Dr.)
Introduction: An adherence level greater than 95% is necessary to get a good outcome out of antiretroviral treatment, and adherence to antiretroviral therapy has also been the strongest predictor of the progression of outcome of antiretroviral therapy. This study intended to assess the level and factors affecting adherence to ART among HIV-infected adult patients in Nagelle town. Method: A cross-sectional study employing both qualitative and quantitative methods was conducted from September 1-30, 2019. A systematic sampling method was used to select the study participants. A total of 285 questionnaires and review of medical records using a semi-structured questionnaire and information capturing sheet were included. Data entry and analysis were performed using SPSS for Windows version 21. Bivariate and multivariate analysis evaluated the association between dependent and independent variables. Thematic analysis was used for qualitative data. Result: The research finding revealed that 69.8% of the study participants had good combined adherence to dose, schedule, and dietary instructions in the past month. Educational status (P=0.035), presence of illness (P= 0.001), use of other drugs (p=0.001), absence of social support (p=0.017), and use of alcohol (p=0.001) were found to be significantly associated with poor adherence to ART. Having good relations with health care providers, the Perceived benefit of adherence by HCP, and long refill appointments were identified as facilitators of adherence. The barriers include stigma and discrimination, lack of skilled HCP, distance to health facilities, and use of other drugs. Conclusion: This study found that participants' education status, presence of illness, use of other drugs, social support, and drinking alcohol were determinant factors that affect adherence to antiretroviral therapy. Interventions are recommended to improve the adherence of patients to antiretroviral therapy.
Assessment of medicines wastage and its contributing factors in selected public health facilities in South West Shoa Zone, Oromia Regional State, Ethiopia
(Addis Ababa University, 2017-06) Tadesse, Esayas; Gedif, Teferi (PhD)
Medicines wastage occurs when medicines are damaged, obsoleted or expired and become unsafe for use. It is a burden to many health facilities and increases cost to the health care system. In Ethiopia, although there are reports that reveal the presence of wasted medicines in the country, there is limited objective evidence on the type and extent of medicines wastage as well as its contributing factors. Therefore, the objective of this study was to determine medicines wastage rate and to identify its contributing factors in the sampled public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. The study employed a facility based cross-sectional survey and qualitative study in one hospital and nine health centers from May 2- 27, 2016. Both quantitative and qualitative data collection methods were used in the study. The quantitative data was collected by data abstraction formats and self-administered questionnaires and analyzed using SPSS version 21.0. The analysis was performed in aggregate and included descriptive statistics. And the qualitative data was collected through in-depth interview with the heads of the health facility and pharmacy case team leaders and analyzed using thematic analysis. The total monetary value of wasted medicines in the surveyed health facilities in EFY 2005-2007 was 500,522.09 Ethiopian Birr, while in the same period all surveyed health facilities received medicines worth of 6,635,910.97 Ethiopian Birr, resulting wastage rate of 7.5%. Of the total value of wasted medicines, anti-infectives (39.1%), medicines used for correcting water, electrolyte and acid-base balance (12.9%) and GIT medicines (10.6%) were the top three therapeutic classes. Oral rehydration salt 245osml/l powder (6.3%), metronidazole 250mg capsule (4.1%), and tetracycline 250mg capsules (3.2%) were also the most commonly wasted medicines. More than half of the wasted medicines were in solid dosage forms (54.3%), followed by liquid dosage forms (40.8%) and nearly 96% of the source for wastage was expiry of medicines. IX In both quantitative and qualitative study, delivery of near expiry date medicines by suppliers, lack of system to move nearly expired medicines from one facility to another, presence of over stocked medicines due to improper forecasting of need in the facilities, lack of electronic stock management tools and shortage of pharmacy professionals in the health facilities were identified as contributing factors for medicines wastage. In conclusion, the extent of medicines wastage in public health facilities of South West Shoa Zone was estimated to be 7.5%. It is recommended that the health facilities should document and maintain a written record of all medicines wastage. A mechanism of exchanging medicines from overstock to under stock areas should be created, and a strong partnership or a common plat forum should be established among key stake holders to have regular discussion on preventive strategies. Key words: Medicines wastage, wastage rate, expired medicines, public health facility, Ethiopia
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 dermatoses

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