Pharmco-Epidemiology and Social Pharmacy

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Inventory Management Performance on Emergency Medicines in Federal Hospitals of Addis Ababa, Ethiopia: A Mixed Method Approach
(Addis Ababa University, 2025-06-06) Bisrat Bogale; Mesfin Haile; Alemayehu Teshale
Introduction: Emergency Medicines are medicines that are used for handling time sensitive Emergency care at facility and/or pre facility level for conditions until stabilization.The unavailability of emergency medications in emergency situations could impact patient outcomes. The absence of essential emergency drugs points to a weakness in emergency preparedness. Proper inventory management on emergency medicines is crucial for insuring the availability of life saving medicines in the health care settings. Objective: This study aims to assess inventory management performance on emergency medicines in Federal Hospitals in Addis Ababa, Ethiopia. Methods: An explanatory mixed study was conducted in six Federal Hospitals in Addis Ababa from January 2024 up to March 2024. The quantitative data was collected using interviewer administered semi structured and structured questionnaire and observational checklists. The qualitative data were collected through in depth interview to explain the challenges and way forward .the quantitative data was analyzed using SPSS version24 and Excel spreadsheet. chi-square test was used to determine the association between variables and spearman`s rho analysis was used to test correlation, the critical value (p<0.05) and (p<0.01) was considered significant respectively. Result: The mean availability of emergency medicines was 63.5%, the mean day‟s duration of stock out was 51.07 days and the mean stock out rate was 55.61%. mean percentage of updated bin card was 79.85%. the inventory accuracy rate for emergency medicines was 78.24%.While all facilities surveyed used report and requisition form for program medicine and bin cards, there were no report and requisition form for budget drugs, revealing inconsistent application of stock management tools across drug groups .Among submitted report 100% was timely reported 77.7% was complete and 72.2 % accurate. The total cost of expired medicines is 1,326,035.31 ETB birr. The mean Wastage rate was found to be 2.53%. Key challenges include poor manual process, discrepancies in stock records and unreliable suppliers. Conclusion: The findings show there were significant emergency medicines stock out across hospitals with some facility facing critical stock outs. Stock-outs of vital medicines highlight weakness in emergency preparedness. Despite the complete utilization rate of bin card there is a gap in inventory accuracy and bin card updating. Inventory accuracy and bin card updating and prioritization of vital drugs shows to be associated with emergency medicines availability. Inconsistent application of stock management tools and high wastage need attention. These financial losses from expired medication along with shortages indicate a series gap in inventory control, the overall adherence to storage standards is generally high. However, there are some areas where improvement is needed Recommendations: Federal hospitals in Addis Ababa should Identify best practice and share through benchmarking, standardize inventory management tools across all federal hospital and across all Items category, conduct regular stock reviews and improve quality of data from logistic management information tools
Health commodity Supply Chain Performance and Challenges at public Health facilities in Addis Ababa City Administration: A Mixed Method Study
(Addis Ababa University, 2025-06-17) Robel Gursm; Zelalem Tilahun; Eyerusalem Brhanemeskel
Background: Supply chain is a network of organizations that are involved through upstream, and downstream linkages in the different processes, and activities that produce value in the form of products and services in the hands of the ultimate customer. Performance measurement is the process of quantifying and comparing the efficiency and effectiveness of action with pre-seated goals by known standards. The efficient functioning of a health supply chain system is crucial for delivering quality health care service, and ensuring the availability of medicine and medical supplies. Objective: This study aims to evaluate the performance of health commodity supply chain and to assess the challenges at public health facilities in Addis Ababa, Ethiopia. Methodology: A facility based cross sectional an explanatory sequential mixed study design were employed from April to May 2024 in public health facilities of Addis Ababa, Ethiopia. The performance in relation to health supply chain was described and challenges of supply chain were explored. Both quantitative and qualitative data were collected. The quantitative data was collect using researcher administered semi structured questionnaire, document review and observational methods at public health facilities. The qualitative data was gathered through key informant interviews with the responsible professional. The quantitative data were entered and analyzed using SPSS version 25 and the results were presented using descriptive statistics. Whereas the qualitative part of the study was transcribed, summarized manually and analyzed using thematic analysis. Result: Forecasting accuracy rate for key essential drugs for health centers under study was 62.35% and average order fill rate was 67.5%. Out of reviewed health centers RRF reporting rate was achieved 100%. Ethiopian pharmaceutical supply service was sending products to health facilities averagely within 19 days. Average wastage rate of the health centers under study was 1.24% and the availability of tracer drug was 89.18%. Only 47% of health centers met acceptable storage criteria and 71% of health facility under study had unfit for use medicine which was not disposed during last 12 month. Out of twenty-five key essential medicine assessed the overall stock out duration was 25.3 days. The main cause of poor health supply chain was shortage of supply at Ethiopian pharmaceutical supply service and in market, lack of trained human resource, budget constraint, and transportation and waste disposal service limitation. Conclusion and recommendation: In general the health commodity supply chain performance of those health facilities was found to be poor. Except for RRF reporting rate, inventory accuracy rate, and wastage rate which had relatively better results, the rest of the majority of the indicators were below the national standard which was confirmed by poor forecasting accuracy, order fill rate practices and poor storage condition and unfit for use practice. Availability and stock out of tracer medicines were the main problem for major health facilities. Limited competent human resource, inadequate management support and budget constraints, were other challenges for health facilities. Public health facilities should work together with stakeholders to ensure uninterrupted supply of key essential medicines.
Patient Satisfaction with Outpatient Pharmacy Services in Public Health Facilities in Metekel Zone, Benishangul-Gumuz Regional State, Ethiopia: A Mixed Method Study
(Addis Ababa University, 2025-10-01) Teshome Wakjira; Birhanu Demeke; Tamrat Assefa; Eskinder Eshetu; Girma Tekle
Background: Patient Satisfaction with Pharmacy Services Is a Healthcare Quality Indicator Impacting Treatment Adherence and Health Outcome. Given The Paucity of Research on Patient Satisfaction in the Study Area, This Study Assesses Satisfaction, Improvement Areas and Provide Actionable Evidence for Policy Makers and Facility Managers. Objective: To Assess Patient Satisfaction with Outpatient Pharmacy Services in Public Health Facilities in Metekel Zone, Benishangul-Gumuz Regional State, Ethiopia. Methods: A Mixed-Methods Sequential Explanatory Study Was Done in Public Health Facilities from August 1, 2023 to November 20, 2024. Quantitative Data Analysis Included Descriptive Statistics and Non-Parametric Tests. Multivariable Tobit Regression Analysis Was Used to Identify Factors Associated with Satisfaction Score. For The Qualitative Component, 28 Key Informants (12 Patients And 16 Pharmacy Professionals) Were Selected by Purposive Sampling. The In-Depth Interviews Continued Until Data Saturation Was Reached. The Audio-Taped Data Was Analyzed Using Inductive Thematic Analysis. Results: Four Hundred Sixteen Patients Participated with the Majority Being Female (60.3%) And Urban Residents (56.3%). The Median Patient Satisfaction Score Was 47.0. While Most Patients Were Satisfied with the Approach and Communication of the Professionals, Satisfaction Was Low Regarding Medication Instruction (18.0% Strongly Satisfied) And Medicine Availability (53.4% Dissatisfied/Strongly Dissatisfied). Multivariable Tobit Regression Analysis Showed That Location of the Pharmacy Setting, Private Counseling Area and Waiting Area Were Significantly Associated with Satisfaction Score (P < 0.05). In The Qualitative Component, Perceptions of the Key Informants Were Categorized into Three Main Themes: Structural Aspects of the Pharmacy Setting, Pharmacy Service Process and Pharmacy Service Outcomes. Conclusion: The Study Demonstrated That Patients Experienced Low Overall Satisfaction. Key Dissatisfaction Areas Included Availability of Medicine, Medication Instruction and Structural Aspects of the Pharmacy Premises. Factors Such As Pharmacy Location, Private Counseling Area and Waiting Area Significantly Influenced Satisfaction. Therefore, Interventions to Improve Structural Aspects of the Pharmacy, Availability of Medicines and Medication Instructions Are Recommended to Enhance Service Quality and Patient Experience.
Assessment of psychometric properties, feasibility and usefulness of the EQ- 5D-5L in Ethiopian stroke patients
(Addis Ababa University, 2023) Wehib,Ewennat; Eshetu, Eskinder (PhD); Belay,Yared Belete( PhD candidate)
Background: Stroke ranks as the second-leading global fatality and affects the quality of life for survivors. Despite limited knowledge about the impact of acute stroke on health-related quality of life in Ethiopia, longitudinal studies on stroke patients offer some insight internationally. Objective: To assess the Psychometric properties, feasibility and usefulness of EQ-5D-5L among Ethiopian stroke patients. Methods: A sequential mixed-method study design was conducted among 200 patient-proxy dyads at 6 public hospitals of Addis Ababa, Ethiopia from November 2021-November 2022. STATA version 15 was used for the quantitative analysis.The internal consistency was assessed using Cronbach‘s alpha (α). Chi-square test was used for the problem/no problem report comparison among patients and proxies across different interview periods. Mean difference between patient and proxy in the EQ-5D index and EQ VAS was reported using paired t-test. In addition, patient/proxy response agreement, convergent validity, and known group validity were assessed. Qualitative data was analyzed thematically using MaxQDA version 20. Results: EQ-5D-5L demonstrated good internal consistency with a Cronbach‘s α of 0.86, 0.92 and 0.93 at baseline, Visit 2 and visit 3 respectively. In visits two and three compared to the baseline report, a better agreement was observed between patient and caregivers. There was a moderate to strong association between the mRS score and the EQ VAS and EQ-5D index. Significant differences in mean utility were noted among patients with different stroke disability levels, as measured by mRS. Patients, proxies, and data collectors found it easier to answer EQ- 5D-5L questions during follow-up visits compared to baseline. Two major themes were identified with respect to discrepancies in patient and proxy ratings, which attributed to reflections on the feasibility of questions and concerns on perceived disease impact. Conclusion: The EQ-5D-5L is a reliable and valid tool for assessing HRQoL in stroke patients. The findings also showed that proxy assessments acquired 3 and 6 months after stroke are more reliable than those obtained in the acute setting.
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 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 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.
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.
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)
Development and Validation of a Predictive Model for Severe Hematological Toxicity in Adult Colorectal Cancer Patients Taking Chemotherapy at Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2021-10) Ayenew, Wondim; Dr.Ali, Eskinder Eshetu
Background: Hematological toxicities are common in colorectal cancer patients taking chemotherapy. The development of a valid predictive model would go a long way in preventing for such toxicities. Objectives: To develop and validate a prediction model for severe hematological toxicities in adult colorectal cancer patients taking chemotherapy at Tikur Anbessa Specialized Hospital Methods: A retrospective cohort study was conducted using medical records of adult colorectal cancer patients who received chemotherapy from 2017 to 2021 at Tikur Anbessa Specialized Hospital. The model was developed using uni-variable and multivariable logistic regression analyses, and it was validated using bootstrapping. The model was developed for severe neutropenia only because of limited number of outcomes for anemia and thrombocytopenia. Discrimination and calibration were used to determine the model’s prediction accuracy. All statistical tests were two-sided and P-value < 0.05 was considered statistically significant. Results: A total of 224 colorectal cancer patients were considered for analysis. About 114 (50.9%), 25 (11.2%) and four (1.8%) patients developed severe neutropenia, anemia and thrombocytopenia respectively. Age, polychemotherapy, type of therapy, and longer duration of chemotherapy were predictors of severe neutropenia. The model had sensitivity of (71.05% versus 73.24%) and specificity of (71.82% versus 68.49%) in the derivation and validation cohorts respectively. The area under receiver operating curve was 0.7995 for the derivation and 0.7741 for the validation cohorts. Conclusions: Neutropenia was the most common hematological toxicity. The application of the developed model could help to identify high-risk patients for severe neutropenia and to institute preventive strategies before neutropenia develops.
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.
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.
The Financial Burden of Out of Pocket Payment for Medicines among Households in Ethiopia
(Addis Abeba University, 2021-09) Asmamaw, Getahun; Dr. Ali, Eskinder Eshetu
Background: In Ethiopia, more than half of all out-of-pocket (OOP) health expenses are for medicine. However, there is a scarcity of information on the cost impact of medicine on households. Objective: This study aims to investigate the financial implications of OOP payment for medicines for Ethiopian households. Methods: A sequential mixed methods explanatory design was employed in this study. The quantitative part involved a secondary analysis of the national household consumption and expenditure surveys of 2010/11 and 2015/16. Catastrophic OOP expenditures for medicines were measured using the “capacity to pay” method. Logistic regression models were used to determine the factors of catastrophic medicine payment. In-depth interviews were used to collect qualitative data from key informants working in relevant government agencies. The framework analysis approach was used also to analyze qualitative data. Results: From 2010 to 2016 the total percentage of households facing catastrophic medicine payments decreased from 1% to 0.73%. This means payment for medicines pushed 11,132 households into poverty in 2015/16. The majority of disparities were explained by economic status, place of residence, and type of health services. The qualitative analysis identified four major themes in the areas of the current context of medicine OOP payment, aggravating factors for medicine OOP, failures to implement planned interventions, and plans. Conclusion: The findings show that, despite improvements over the years, OOP payment for medicines pushed thousands of Ethiopian households to poverty. Hence, introducing and strengthening the implementation of pro-poor policies are recommended.
Cost-Effectiveness of Dolutegravir- Versus Efavirenz-Based First-Line Antiretroviral Treatments and Health-related Quality of Life of Adults with HIV/AIDS in Ethiopia
(Addis Abeba University, 2019-12) Belete, Yared; Beedemariam, Gebremedhin[MSc]
Background: In Ethiopia, the dolutegravir (DTG)-based regimen is as of now favored over the efavirenz (EFV)-based regimen in the treatment of patients with human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS). Objective: To determine the cost-effectiveness of DTG- versus EFV-based first-line treatment and health-related quality of life among Ethiopian adults with HIV/AIDS. Methods: Cost-utility analysis was done using a microsimulation model. The health- related utility value was obtained from adult HIV/AIDS patients receiving antiretroviral treatment at Tikur Anbessa Specialized Hospital. Mann-Whitney U and Kruskal-Wallis tests were done to compare utility values based on patient characteristics. Incremental cost-effectiveness ratio (ICER) was used to determine cost-effectiveness of the proposed regimens and deterministic sensitivity analysis was conducted to assess the parameter uncertainty in cost utility analysis. Results: Median utility values of HIV/AIDS patients were 0.94 (interquartile range (IQR) =0.87, 1) and 80% (IQR= 70%, 90%) on the EuroQol-5 dimensions (EQ-5D) index and EuroQol-visual analog scales (EQ-VAS) score respectively. Comorbidity, cluster of differentiation 4 and number of medicines were significantly associated with EQ-5D and EQ-VAS values with, p <0.001. Compared to EFV-based regimen, the DTG-based regimen was associated with an expected lifetime cost of 12,709 United States dollar ($) (versus $12,701) and expected quality adjusted life month (QALM) gains of 183 (versus176 QALMs) resulting ICER value of $1.14 per QALM. Conclusion: Overall utility value of HIV/AIDS patient is reported as lower than the general population. Replacing EFV- with DTG-based first-line regimen for HIV/AIDS patients in Ethiopian setting was found to be cost-effective.
Assessment of the informal pharmaceutical market and its contributing factors in Guji and West Guji Zones of Oromia Regional State, Ethiopia
(Addis Abeba University, 2020-07) Shonora, Feyissa; Prof. Fenta, Teferi Gedif; Dr. Habte, Bruck Messele
Background: Informal pharmaceutical market is common in developing countries due to constrained regulation, low awareness and poor infrastructure. In Ethiopia this practice is given little attention. This study was conducted to assess the informal pharmaceuticals market and identify factors that contributed to the existence and proliferation of the market in remote and gold mining areas of the study. Methods: The study used descriptive exploratory qualitative research design. Open market places, shops and kiosks were observed. Key Informant Interviews (n=25) and two FGD (n=12) with medicine sellers, health professionals and community were conducted. The data was processed and analyzed manually using thematic analysis Findings: Wide variety of medicines was found in the market. The medicines were sourced from wholesalers, pharmacies, government institutions, private clinics and contraband. The existence of high demand, lack of adequate supply to the formal channel, lack of infrastructure in the remote areas, lack of proper regulation, low awareness and corruption were identified as main contributing factors to the existence and proliferation of the market. Conclusion and Recommendations: This study found that informal pharmaceutical practice is widespread in the area and the community patronizes the practice due to the lack of alternative formal health service. It also found that the formal and informal pharmaceutical market is intertwined. The research recommends the provision of needy medicines to those who have no alternative through sustainable supply; access creation and establishment of satellite health posts as it mitigates the practice through fighting corruption, tightening regulation and awareness creation.
Devolution versus centralization of various logistic functions of Ethiopian pharmaceutical supply Agency; Qualitative study
(Addis Abeba University, 2020-06) G/hans, Micheale; Ensermu, Matiwos(PhD); Messele, Bruck(PhD); Teshome, Dawit (MSc, B.pharm)
Background: The logistic system in most developing countries including Ethiopia is centralized where the central government has excessive responsibility over various logistic functions such as planning/budgeting, forecasting, procurement, warehousing and distribution of essential medicines and medical supplies. However, these countries are suffering from poor stock availability of essential medicines at service delivery point, shortage of storage space and high work load in their central warehouses. Objective: The aim of the study is to explore perception of pharmaceutical supply chain professionals on devolution versus centralization of various logistic functions of Ethiopian Pharmaceutical Supply Agency (EPSA). Method: Qualitative study design was employed. Two cluster offices of EPSA such as Adama and Northern cluster offices including the head office along with their respective regional health bureaus and Ministry of health were purposively selected. Accordingly key informants who have high expertise on pharmaceutical logistic system were selected from designated study sites. The key informant interview was conducted using tape recorder by federal working language (Amharic). Finally, the data was analyzed manually using thematic analysis. Result: Ethiopian public pharmaceutical supply system has raised lots of complaints particularly over revolving drug fund (RDF) supply. Availability of RDF drugs was highly affected by centralization of the pharmaceutical supply system. Budgeting, direct receiving and warehousing, inventory control system were among logistic functions which were chosen to have low degree of centralization, while procurement was preferred to have high degree of centralization particularly for small and expensive items. Conclusion and recommendation: Serving pharmaceutical demand of over hundred million populations through the current system particularly for RDF products was perceived as difficult. Hence, either empowering cluster offices to exercise within central guidance of head office or devolution of central EPSA to autonomous regional offices was demanded.
Assessment of psychotropic medicines utilization pattern for mental disorders treatment in Hadiya Zone Public Hospitals, Southern Ethiopia: a crosssectional study
(Addis Abeba University, 2020-08) Girma, Mengistu; Prof. Gedif, Teferi
Mental disorders are becoming issue of public health priority globally and their prevalence is increasing in recent times. Subsequently, psychotropic medicines are widely used for treatment mental disorders. However, medicines utilization studies have revealed irrational psychotropic medicines use is a serious problem worldwide and there is a dearth of information on psychotropic medicines utilization pattern in developing countries including Ethiopia. This study was conducted to assess psychotropic medicines utilization pattern in Hadiya Zone public hospitals namely Hoomacho and Shone primary hospitals and Wachemo University Nigist Eleni Memorial Teaching Hospital. Hospital based cross sectional study was conducted from June 15 2019 to December 30 2019. Medical charts were reviewed retrospectively using data abstraction format and Patients’ interview and observational assessment were conducted prospectively using questionnaires. Data were entered and analyzed using EPI stata version 3 and SPSS version 20. Out of the 1200 psychiatry patients’ for whom their medical charts were reviewed, majority 655(54.6%) were males; and in age group of 15-29 years 760(63.3%); with mean age 29.5 (SD±15). Regarding diagnosis, majority of psychiatric cases were diagnosed with psychosis 330(27.50%) followed by schizophrenia 188(15.67%). From the total of 1734 prescribed psychotropic medicines, most commonly prescribed medicines were antipsychotics 834(48.1%) followed by antidepressants 446(25.7%%) anticonvulsants or mood stabilizers 288(16.6%). The three most commonly prescribed antipsychotic medicines, chlorpromazine, haloperidol, and thioridazine constituted 71.34% of antipsychotic utilized in Hadiya Zone Public hospitals. Typical antipsychotics were prescribed more often 616(73.86%) than atypical antipsychotics 218(26.14%). Amitriptyline was the most frequently prescribed antidepressant 334(74.9%) followed by Fluoxetine 98(21.8%). Treatment switch was undertaken for 148(12.33%) patients and main reasons were poor control/improvement 46(33.1%), relapse 29(20.9%) and side effect 22(15.8%). Average number of psychotropic medicines per encounter was 1.5. However, the percentage of clients prescribed two or more psychotropic medicines was 36.1% that shows polyphrmacy prescribing practice. The average consultation and dispensing time were 9.1 minutes and 51.87 seconds respectively. Frequency was labeled only on 60(19.5%) dispensed medicines and 113(36.8%) patients had knowledge on doses of their medicines. Conclusion and recommendation: Antipsychotics were most commonly utilized psychotropic medicines followed by antidepressants and anticonvulsants. Chlorpromazine, Amitriptyline and Risperidone showed higher proportion of utilized medicines. More than one-third psychiatric patients were prescribed psychotropic polyphrmacy. Close to a tenth of psychiatric patients had treatment switch. Average consultation and dispensing times was constrained. Most patients’ medications were dispensed without adequate labeling and patients’ knowledge about dispensed medications were limited. Further, prospective continuous study on both prevalence and use pattern need to be undertaken to get more information on psychotropic medicines utilization.
Survival Time to Death and its Predictors among Tuberculosis Patients Who Have Started Anti-TB Treatment in Selected Health Centers of Addis Ababa, Ethiopia: A Retrospective Cohort Study
(Addis Abeba University, 2020-01) Teketelew, Girma; Prof. Gedif, Teferi; Dr.Medhin, Girmay
Background: Tuberculosis remains the leading cause of morbidity and mortality globally and in Ethiopia despite different strategies have been designed and implemented to combat it. Survival time and its predictors among tuberculosis patients who enrolled to care in selected health centers in Addis Ababa were assessed. Method: A retrospective cohort study was conducted in 20 selected health centers of Addis Ababa city, Ethiopia. Data were collected from April 1 to August 30, 2018 by reviewing medical records of tuberculosis patients who were registered from May 2016 to May 2017. Statistical software STATA version 14 was used for analysis of the data. Kaplan–Meier curve and log-rank test was employed to investigate the statistical significance of the difference in survival experience among different categories of patients. Cox-proportional hazard and accelerated failure time model was used to assess the relationship between baseline variables and mortality. The strength of association was presented by hazard ratio with 95% CI and results were reported significant at P ≤ 0.05. Results: The medical records of 371 patients were included in the analysis of which 136 (36.7 %) died during the treatment period. Majority of TB deaths occurred within two months of the start of treatment and the overall estimated median survival time was 157 days. Based on akaikie information criterion, weibull accelerated failure time model manifested better results as compared with other models. In multivariable weibull model, age (HR=0.98, P=0.04), baseline weight (HR=0.96, P=0.03), tuberculosis treatment phase (continuation phase, HR=0.48, P≤0.01) and tuberculosis type (pulmonary negative TB, HR=19.92, P≤0.01) were found to be independent predictors of time to death of tuberculosis patients. Conclusions: Most of the patients died at the end of study period. This warrants that, special attention and follow up with nutritional support for pulmonary negative patients and underweight patients to reduce deaths and for better clinical and treatment outcome.
Patients’ Belief and Knowledge about Medicine and Diabetes disease on Medication adherence and Glycemic control among Type 2 Diabetes Mellitus Patients at Alamata General Hospital, Northern Ethiopia
(Addis Abeba University, 2020-09) Hadush, Fikadu; Dr. Messele, Bruck; Dr. Beedemariam, Gebremedhin
Patients’ belief and knowledge about medicine and diabetes disease on medication adherence and glycemic control among T2DM patients at Alamata General Hospital, Northern Ethiopia Fikadu Hadush Addis Ababa University, 2020 Introduction: About 45% of T2DM patients had poor glycemic control and 45.2% of patients had poor medication adherence, those could be affected by diabetic disease knowledge, belief about medicines, socio-demographic and clinical determinants. However, there is dearth of data in the Northern part of Ethiopia with regards to glycemic control status and medication adherence. Objective: To assess influence of patient’s belief and knowledge about medicine and diabetes disease on medication adherence and glycemic control among T2DM patients at Alamata General Hospital, Northern Ethiopia. Methods: A cross sectional study design was conducted among T2DM patients at Alamata General Hospital from September to December, 2019. Data was collected through medical chart review and face-to-face interview of patients using structured questionnaires. Descriptive statistics and multivariable logistic regression were employed to identify predictors of medication adherence and glycemic control. Results: A total of 305 T2DM patients were included in the study where a little over half were male and had no formal education with mean age of 56.5 ± 12.4 years. Of these, 44.6% of the patients had poor medication adherence, 75.7 % had poor glycemic control and 84.3 % of patients had poor diabetes disease knowledge. Patients who had T2DM disease for more than 10 years (AOR=3.87; 95%CI (1.48-10.07)), high concern belief of anti-diabetic drugs (AOR= 20.63, 95%CI (5.15-82.61) and poor diabetes disease knowledge (AOR=4.54; 95%CI (1.53- 13.46)) were determinants of poor medication adherence. Conversely, having high necessity belief of anti-diabetic drugs (AOR=0.21; 95%CI (0.11-0.40) was inversely associated with poor medication adherence. Meanwhile, being high school student (AOR= 5.54; 95%CI (1.11– 27.60)), TVET/Diploma holder (AOR=9.27; 95%CI (1.98–43.36)) and poor diabetes disease knowledge (AOR=4.34; 95%CI (1.74-10.81)) were predictors of poor glycemic control level. Whereas, patients who were taking combination of oral hypoglycemic agents and insulin (AOR=0.33; 95%CI (0.15- 0.71)) and those who had house hold monthly income more than or equal to 3925 ETB (AOR=0.18; 95%CI (0.06-0.48)) were inversely associated with poor glycemic control. Conclusions: About half of T2DM patients had poor medication adherence and three-fourths of the patients had poor glycemic control. Therefore, regular diabetes health education should be given to enhance their awareness about their disease and medicine use.
Willingness to join and pay for social health insurance and its determinants among teachers in Bahir Dar city, Northwest Ethiopia.
(Addis Abeba University, 2020-06) Seyfu, Abyou; Prof. Gedif, Teferi; Dr. Beedemariam, Gebremedhin
Background: Protecting people against catastrophic medical expenses is a means to ensure equity in health. Health insurance is a means to raise and pool funds to finance health services. Ethiopia approved compulsory social and community-based health insurance schemes. The implementation of social health insurance was delayed due to fear of low acceptance by the public servant. Objective: To assess willingness to join and pay for the social health insurance scheme and identify factors associated among teachers in Bahirdar city, Northwest Ethiopia. Methods: A cross-sectional study design was used to recruit 488 teachers. Multiple logistic regression was used to identify factors associated with teachers' willingness to join. The interval data logit was used to determine mean willingness to pay and predictors of willingness to pay. Result: 337 (70.21%) of the respondents expressed their willingness to join and pay 2.46% of their monthly salary. Those who were married were 54% less likely to be willing to participate. Absence child aged <5 year, absence of acute illness in last one year and absence of chronic illness were factors negatively affecting the decision to join the scheme. Willingness to pay was significantly and positively associated with family size and the presence of acute illness. Conclusion: More than half of the participants were willing to join the scheme with a mean premium contribution of 2.46% of their monthly salary. This is an important policy implication in revising the premium amount.

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