Abdelmoneim Awad

Self-Medication Practices with Antibiotics and Antimalarials Among Sudanese Undergraduate University Students:

Background: In many developing countries, up to 60–80% of health problems are self-medicated. Objective: To estimate the prevalence of self-medication with antibiotics and/or antimalarials and identify factors promoting such use among university students in Sudan. Methods: A descriptive cross-sectional study was performed, using a pretested questionnaire on a sample of 1300 students selected from 5 universities in Khartoum State, Sudan. Results: Eight hundred ninety-one (79.5%; 95% CI 77.0 to 81.8) students from the study population had used antibiotics or antimalarials without a prescription within 1–2 months prior to the study. Four hundred ninety (55%; 95% CI 51.7 to 58.3) of the respondents stated that they had used antibiotics, 39 (4.4%; 95% CI 3.2 to 6.0) had used antimalarials, and 362 (40.6%; 95% CI 37.4 to 43.9) had used both. Overall, self-medication with antibiotics or antimalarials was significantly more common among students 21 years of age or older compared with those 20 years of age or younger (OR 1.55; 95% CI 1.15 to 2.09; p = 0.004) and among students attending private universities compared with those attending public universities (OR 1.42; 95% CI 1.04 to 1.95; p = 0.028). Self-medication with antibiotics followed a simitar pattern, which was significantly more common among students 21 years of age or older (OR 1.36; 95% CI 1.03 to 1.81; p = 0.03) and private university respondents (OR 1.52; 95% CI 1.15 to 2.02; p = 0.003). Self-medication with antimalarials was found to be significantly less common among females (OR 0.76; 95% CI 0.59 to 0.97; p = 0.028) and higher among the 21 years or older age group (OR 1.84; 95% CI 1.42 to 2.40; p < 0.001), The most common reason indicated for self-medication was the respondents’ previous experiences with similar ailments. The main source of drugs was community pharmacies. Conclusions: The prevalence of self-medication with antibiotics/antimalarials among undergraduate university students in Khartoum State is high. Our findings highlight the need for planning interventions to promote the judicious use of antibiotics/antimicrobials.

Self-medication practices in Khartoum State, Sudan.

ObjectiveThe aim of this study was to estimate the prevalence of self-medication with proprietary medicines and herbs in Khartoum State, Sudan, and to evaluate factors associated with self-medication.MethodsA pre-piloted questionnaire was used to collect data from a sample of 1,200 individuals, selected from all three cities of Khartoum State using a multistage stratified clustered sampling.ResultsThe response rate was 83.3%. Medicines, including herbs, were used by 81.8% of the respondents without a medical consultation within 2 months prior to the study period. Proprietary medicines alone were used by 28.3% (CI: 25.6–31.2), herbs alone by 20.7% (CI: 18.3–23.4), while 32.8% (CI: 29.9–35.8) had used both. Self-medication with proprietary medicines was least common with the middle-aged (OR: 0.12; 0.09–0.17), the elderly (OR: 0.29; 0.20–0.42) and low level of education [illiterate (OR: 0.26, 0.18–0.37) and primary/intermediate school (OR: 0.07, 0.04–0.11)]. It was most associated with low (OR: 5.3; 3.8–7.4) and middle income (OR: 4.3; 3.1–5.9), but no gender difference was found (P>0.05). Self-medication behaviour with herbs was most associated with middle-age (OR: 1.7; 1.3–2.2), female gender (OR: 2.2 (1.7–2.8) and lowest income earners (OR: 2.5; 1.9–3.5).ConclusionsThe prevalence of self-medication with medicines including herbs in urban areas of Khartoum State is high. Self-medication behaviour varies significantly with a number of socio-economic characteristics. Our findings have major public health policy implications for countries like Sudan.

Public knowledge and attitudes toward epilepsy in Kuwait

Purpose: The study was conducted to determine the familiarity with, knowledge of, misunderstandings, and attitudes toward epilepsy among the Kuwaiti population.

Medical doctors’ perceptions and expectations of the role of hospital pharmacists in Sudan

AimsTo investigate medical practitioners’ perceptions, expectations and experience with the role of hospital-based pharmacists in Sudan.SettingTeaching hospitals in Khartoum State, Sudan.MethodsA self-administered, pre-tested, structured questionnaire was distributed to 300 randomly chosen medical practitioners of different grades and specialities in four teaching hospitals in Khartoum State. The questionnaire consisted of closed-ended questions.Main outcome measuresThe level of medical practitioners comfort to, and their expectations and experience of, a range of pharmacist roles and activities.ResultsThe response rate was 66.7%. One-half (50.0%; 95% CI: 42.9–57.2%) of respondents never or rarely had interaction with pharmacists with regard to patient’s medication, 36.9% (CI: 30.2–44.0%) and 13.1% (CI: 8.9–18.8%) had this type of contact once per week or once a day or more, respectively. Respondents were most comfortable with pharmacists: Detecting and preventing prescription errors (49.2%; CI: 42.0–56.5); monitoring outcomes of pharmacotherapeutic regimens and plans (45.9%; CI: 38.8–53.2); designing and monitoring pharmacotherapeutic regimens (43.4%; CI: 36.4–50.8) and suggesting use of prescription medications to physicians (40.3%; CI: 33.3–47.8). Respondents were least comfortable with pharmacists suggesting the use of certain prescription medications to patients (52.8% ‘uncomfortable’; CI: 45.6–59.9). Respondents’ expectations of pharmacists were positive for most domains.ConclusionRespondents appeared receptive to most statements regarding expectations of pharmacists, suggesting that many elements of patient-centred pharmaceutical care could be introduced with the co-operation of physicians. A key to extending the role of pharmacists in Sudan teaching hospitals should involve making pharmacists more accessible to doctors and patients, ideally, supported by an organised program of continuing professional development.

Knowledge, Attitude and Practice towards Antibiotic Use among the Public in Kuwait

Background The emergence and spread of bacterial resistance to antibiotics is a growing problem worldwide, which presents a significant threat to public health globally in the 21st century. A substantial evidence has shown that the general community plays a role in the increase and spread of antibiotic resistance. The present study was designed to determine knowledge, attitude and practice towards antibiotic use. Methods A cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 770 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. Results The response rate was 88.3%. Nearly three-quarters (72.8%) of respondents had been prescribed antibiotics within 12 months prior to the study period, and 36% of them had not finished the course of treatment. Over one-quarter (27.5%) were self-medicated with antibiotics to treat mainly common cold, sore throat and cough. Self-medication was more prevalent among those who were prescribed antibiotics and those who had attitudes towards using and accessing antibiotic inappropriately. Almost 47% of participants had low knowledge regarding action, use, safety and resistance of antibiotics. Forty one percent of respondents had attitudes towards using and accessing antibiotic inappropriately. Better knowledge was found to be a predictor for positive attitude. Respondents level of agreement that doctors often prescribe antibiotics to meet the patient’s expectation, and that doctors often take time to consider carefully the need for an antibiotic were 52.7% and 35.3%, respectively. Conclusions These findings will aid in the assessment of the adequacy of present public educational campaigns. Also, it will provide further insight in designing future multifaceted interventions to promote specific messages to rationalize antibiotic use, and compensate for knowledge and attitude gaps as an effort towards preventing development of antibiotic resistance.

Health promotion and education activities of community pharmacists in Kuwait

Objectives To investigate self-reported practice of pharmacists regarding health promotion and education activities, explore the barriers that may limit their involvement in health promotion and education, and identify their willingness to participate in continuing education programs related to health education. Setting Community pharmacies in Kuwait. Method A descriptive cross-sectional study was performed using a pre-tested questionnaire on a sample of 223 community pharmacists. Main outcome measures The extent of the pharmacists’ involvement in counselling patients about health promotion and education topics, their preparation to counsel patients in health promotion and education topics, and their perceived success in changing the patients’ health behaviour. Results The response rate was 92%. Information on medication use was the most frequent reason for consumers seeking community pharmacists’ advice. The majority of respondents believed that behaviour related to the proper use of drugs was very important. There was less agreement on the importance of other health behaviours. Respondents indicated they were involved in counselling patients on health behaviours related to use of drugs as prescribed/directed, weight management, medicine contents and side effects, diet modification and stress reduction, but were less involved in counselling on other health behaviours. Respondents’ perception of themselves as “most prepared” to counsel patients closely reflected their involvement. Pharmacists reported high levels of success in helping patients to achieve improvements in using their drugs properly compared to low levels in changing patients’ personal health behaviours. The majority of respondents believed that pharmacists had a responsibility for counselling consumers on health behaviours (97%, 95% CI 95–99%), and indicated their willingness to learn more about health promotion (84%, 78–88%). Lack of pharmacists’ time was reported by about 58% of respondents as the major barrier limiting pharmacists’ provision of health promotion. Conclusion The role of community pharmacists in health promotion and education is primarily focused on pharmaceutical issues rather than health behaviour modification. The majority of respondents have a positive attitude towards counseling the population on health behaviours and indicated their willingness to learn more about health promotion.

Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey

BackgroundCardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population’s prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists’ role in CVD prevention and management.MethodsA descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis.ResultsThe response rate was 90.7%. Respondents’ knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were ‘confusion or trouble speaking’ (36.4%) and ‘numbness or weakness’ (34.7%). Respondents’ knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50–59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management.ConclusionsThere are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.

Drug-use practices in teaching hospitals of Khartoum State, Sudan

PurposeThe present study was carried out to investigate current prescribing and dispensing practices in the largest two teaching hospitals in Sudan and compare them with those of published studies in developing countries.MethodsA descriptive, quantitative and cross-sectional study was conducted among hospital outpatients. The sample was selected using systematic random sampling. In each hospital, prescribing indicators were investigated through collection of data on 100 patient encounters, determination of consultation time and dispensing time for 100 patients, and by interview of 100 patients for the evaluation of dispensing practices.ResultsThe present findings showed that 96% (95% CI: 92.0–98.1%) of patient encounters did not include one or more necessary elements. Strength of drug and the quantity to be dispensed were omitted in 57.5% (95% CI: 50.3–64.4%) and 91% (95% CI: 85.9–94.4%) of patient encounters, respectively. Other variables measured per patient encounter were mean (SD) number of drugs prescribed, 1.9 (0.9); percentage prescribed by generic name, 43.6 % (95% CI: 38.6–48.8%); percentage of patient encounters involving an antibiotic, 65.0% (95% CI: 57.9–71.5%); percentage of patient encounters with an injection prescribed, 10.5% (95% CI: 6.5–15.8%). The mean (SD) consultation and dispensing times were 4.5 (2.8) min and 46.3 (21.8) s, respectively. The percentages of dispensed drugs that were adequately labeled was 37.6% (95% CI: 33.1–41.8%), whilst adequate patient knowledge was demonstrated for 37.2% (95% CI: 32.3–42.0%) of drugs.ConclusionsCost-effective, multifaceted interventions are needed to improve current prescribing and dispensing practices at the teaching hospitals in Khartoum State, Sudan.

Knowledge, Perceptions and Attitudes toward Complementary and Alternative Therapies among Kuwaiti Medical and Pharmacy Students

Objective: To determine the knowledge, perceived effectiveness and harmfulness of complementary and alternative medicine (CAM) modalities, general attitude and the need for education in the use of CAM therapies among medical and pharmacy students. Methods: A descriptive and cross-sectional study was performed using a pre-tested questionnaire on a randomly selected sample of 250 students in Faculties of Medicine and Pharmacy, Kuwait University. Descriptive and logistic regression analyses were used in data analysis. Results: The response rate was 88.4%. CAM usage was reported by 122 (55.2%) of students, and mostly associated with females (OR 4.4, 95% CI 1.7–11.3). Herbal products were the most commonly used (83, 37.6%). Knowledge about 11 CAM modalities was generally poor, even among the respondents who claimed to know them most. The knowledge about herbal products was significantly better among 58 pharmacy students (49.2%) than 32 medical students (31.4%) (OR 2.0, 95% CI 1.1–3.6). Massage, herbal products and prayer/Qur’an reciting were perceived as being the most effective, while cauterization as the most harmful. Attitude toward CAM was positive, with 176 (79.7%) believing that CAM includes ideas and methods from which conventional medicine could benefit. Lack of trained professionals and lack of scientific evidence were the most perceived barriers for CAM implementation. 198 (89.6%) admitted the importance of knowledge about CAM for them as future healthcare practitioners. Conclusion: The students acknowledged the need to be well educated about CAM to better advise their patients in the future.

Improving rational drug use in Africa: the example of Sudan.

The aim of this review is to determine the extent of irrational drug use and contributing factors in Sudan and to identify the interventions that need to be strengthened to promote the rational use of drugs in the country and to evaluate the impact of different types of intervention. We present an overview of studies describing patterns of drug prescribing, dispensing and self-medication. Rates for inappropriate prescribing and dispensing practices and prevalence of self-medication with antimicrobials and herbal products were alarmingly high. Indicators of rational drug use have worsened over the past decade despite the implementation of managerial, regulatory and training interventions. Multifaceted interventions have proved effective in changing suboptimal prescribing practices. Educational interventions are needed to address self-medication and adherence.