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