Daniel Asfaw Erku

Extent of dispensing prescription-only medications without a prescription in community drug retail outlets in Addis Ababa, Ethiopia: a simulated-patient study.

Purpose This study was aimed at assessing the extent of dispensing prescription-only medications without a prescription in community drug retail outlets (CDROs) of Addis Ababa, Ethiopia. Methods A descriptive cross-sectional observational study design was used to sample 31 pharmacies, 25 drug stores, and two rural drug vendors from August 11, 2015, to October 21, 2015, through a simple random sampling method. A simulated-patient method of visit was implemented to collect data. Requests of six tracer prescription-only medicines (amoxicillin + clavulanic acid capsule, amitriptyline, captopril, glibenclamide [also known as glyburide], omeprazole capsule, and sildenafil citrate) and upper respiratory tract infection were selected as the simulated clinical scenario. Results Amoxicillin–clavulanic acid capsule was dispensed when requested in 87.93% of the dispensaries. All of the CDROs dispensed omeprazole upon request. Sildenafil citrate (Viagra) was in stock in 96.55% of the CDROs, all of which issued the requested number of tablets without asking why or for whom the drug was needed. Amitriptyline, captopril, and glibenclamide (glyburide) were dispensed in 84.48%, 89.65%, and 87.93% of CDROs upon the provision of an empty container. Antibiotics were obtained from 75.86% of CDROs for presentation of upper respiratory tract infection symptoms. Among the dispensed antibiotics, the most common was amoxicillin (93.18%), followed by amoxicillin–clavulanic acid capsule (72.72%), and azithromycin (50%). Only 4.5% of the dispensaries asked about drug allergies, and 15.9% of the CDROs informed the simulated patient about the possible side effects of the drugs. Conclusion This study revealed a very high rate of dispensing of prescription-only medicines without a prescription. Antimicrobials and drugs for chronic diseases were obtained with ease from almost all of the randomly sampled CDROs. Putting good dispensing practice into effect and adhering to the existing national laws and regulations regarding the same are necessary. It is also necessary to adopt a strong and explicit line of action, especially toward the irrational use of antibiotics.

Complementary and Alternative Medicine Use and Its Association with Quality of Life among Cancer Patients Receiving Chemotherapy in Ethiopia: A Cross-Sectional Study

Background. Today, complementary and alternative medicine (CAM) use is being routinely practiced by cancer patients worldwide. This study aimed at examining the prevalence of CAM use in patients with cancer and comparing the quality of life (QoL) in CAM users and nonusers. Methods. A cross-sectional study was employed on 195 cancer patients receiving chemotherapy at Gondar University Referral Hospital (GURH) chemotherapy center. Interviewer-administered questionnaires were used and the collected data were analyzed by the Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows. Results. 154 (79%) patients were found to be users of CAM. Educational status, average monthly income, disease stage, and comorbidity were strong predictors of use of CAM. The most commonly utilized types of CAM were traditional herbal based medicine (72.1%) and only 20.8% of patients discuss with their doctors CAM use. No significant difference was found in QoL between CAM users and nonusers except in financial difficulties (p = 0.020). Conclusions. This study revealed a high rate of CAM use with very low disclosure rate to their health care providers. Health care providers should be open to discuss the use of CAM with their patients as it will lead to better health outcome.

Prevalence and Correlates of Complementary and Alternative Medicine Use among Hypertensive Patients in Gondar Town, Ethiopia

Background. Complementary and alternative medicine (CAM) therapies are being widely used by hypertensive patients worldwide. However, evidences regarding CAM use by hypertensive patients in Ethiopia are limited. This study aimed at assessing prevalence and correlates of CAM use among hypertensive patients attending ambulatory clinic at Gondar University Referral Hospital (GURH), Ethiopia. Methods. A cross-sectional study was employed on 423 patients visiting GURH. Descriptive statistics and bivariate and multivariate logistic regression tools were used to analyze/come up with the prevalence and correlates of CAM use. Results. The prevalence of CAM use in our study was found to be 67.8% and herbal based medicine was the most commonly utilized CAM therapies. Majority of CAM users (70.2%) did not disclose CAM use for their physician. However, nearly half of CAM users (48.4%) were satisfied with the result of CAM use. Conclusions. The higher prevalence of CAM use among hypertensive patients coupled with a very low disclosure rate to their health care providers can have a marked potential to cause ineffective hypertensive management and adverse effects due to CAM use. Health care providers should be open to discussing the use of CAM with their patients as it will lead to better health outcome.Background. Complementary and alternative medicine (CAM) therapies are being widely used by hypertensive patients worldwide. However, evidences regarding CAM use by hypertensive patients in Ethiopia are limited. This study aimed at assessing prevalence and correlates of CAM use among hypertensive patients attending ambulatory clinic at Gondar University Referral Hospital (GURH), Ethiopia. Methods. A cross-sectional study was employed on 423 patients visiting GURH. Descriptive statistics and bivariate and multivariate logistic regression tools were used to analyze/come up with the prevalence and correlates of CAM use. Results. The prevalence of CAM use in our study was found to be 67.8% and herbal based medicine was the most commonly utilized CAM therapies. Majority of CAM users (70.2%) did not disclose CAM use for their physician. However, nearly half of CAM users (48.4%) were satisfied with the result of CAM use. Conclusions. The higher prevalence of CAM use among hypertensive patients coupled with a very low disclosure rate to their health care providers can have a marked potential to cause ineffective hypertensive management and adverse effects due to CAM use. Health care providers should be open to discussing the use of CAM with their patients as it will lead to better health outcome.

Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital Ethiopia: a cross-sectional study.

BackgroundImproving maternal and child health is one of the public health priorities in several African countries including Ethiopia. However, research on herbal medicine use during pregnancy is scarce in Ethiopia. The present study aimed at assessing the prevalence and correlates of herbal medicine use among pregnant women on antenatal care (ANC) follow-up at Gondar university referral hospital, EthiopiaMethodsAn institutional-based cross sectional study was conducted on 364 pregnant women attending ANC clinic from March to May 2016 at University of Gondar referral and teaching hospital, northwest Ethiopia. Data on socio-demography, pregnancy related information as well as herbal medicine use was collected through an interviewer-administered questionnaire. Descriptive statistics, univariate and multivariate logistic regression analysis were performed to determine prevalence and associated factors of herbal medicine use.ResultsFrom 364 respondents, 48.6% used herbal medicine during current pregnancy. ginger (40.7%) and garlic (19%) were the two most commonly used herbs in pregnancy. Common cold (66%) and inflammation (31.6%) were the most common reasons for herbal use. Majority of herbal medicine users (89.8%) had not consulted their doctors about their herbal medicine use. Rural residency (Adjusted odds ratio (AOR): 3.15, Confidence interval (CI): 1.17–6.14), illiteracy (AOR: 4.05, CI: 2.47–6.62) and average monthly income less than 100 USD (AOR: 3.08CI: 1.221–7.77) were found to be strong predictors of herbal medicine use.ConclusionsThe use of herbal medicine during pregnancy is a common practice and associated with residency, level of education and average monthly income. From the stand point of high prevalence and low disclosure rate, the health care providers should often consult pregnant women regarding herbal medicine use.

Management of minor ailments in a community pharmacy setting: Findings from simulated visits and qualitative study in Gondar town, Ethiopia

Community pharmacy professionals are being widely accepted as sources of treatment and advice for managing minor ailments, largely owing to their location at the heart of the community. The aim of the present study was, therefore, to document the involvement of community pharmacy professionals in the management of minor ailments and perceived barriers that limit their provision of such services. Simulated patient (SP) visits combined with a qualitative study using in-depth interviews was conducted among community pharmacy professionals in Gondar town, Northwest Ethiopia. Scenarios of three different minor ailments (uncomplicated upper respiratory tract infection, back pain and acute diarrhea) were selected and results were reported as percentages. Pharmacy professionals were also interviewed about the barriers in the management of minor ailments. Out of 66 simulated visits, 61 cases (92.4%) provided one or more medications to the SPs. Pharmacy professionals in 16 visits asked SPs information on details of symptoms and past medical and medication history. Ibuprofen alone or in combination with paracetamol was the most commonly dispensed analgesics for back pain. Oral rehydration fluid (ORS) with zinc was the most frequently dispensed medication (33.3%) for the management of acute diarrhea followed by mebendazole (23.9%). Moreover, amoxicillin-clavulanic acid capsule (35%) followed by Amoxicillin (25%) were the most commonly dispensed antibiotics for uncomplicated upper respiratory tract infection. Lack of clinical training and poor community awareness towards the role of community pharmacists in the management of minor ailments were the main barriers for the provision of minor ailment management by community pharmacy professionals. Overall, community pharmacists provided inadequate therapy for the simulated minor ailments. Lack of access to clinical training and poor community awareness were the most commonly cited barriers for providing such services. So as to improve community pharmacists’ involvement in managing minor ailments and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia

Background: Community pharmacists play a crucial role in reducing medication related health problems and improving the patient’s overall wellbeing. Evidence suggests that community pharmacist led counseling services result in a better clinical and self-reported outcome, including a higher level of satisfaction and quality of life. Objective: This study aims to document self-reported and actual levels of community pharmacists’ involvement in the provision of patient counseling and barriers that limit their involvement in such services. Methods: Simulated patient visits and a cross-sectional survey of community pharmacists were employed in Gondar town, Ethiopia between March 15 and May 15, 2016 to observe actual counseling practices and to assess their reported counseling practices respectively. Four different scenarios were developed for the simulated patient visit. A well designed questionnaire and an assessment form were used for the survey and simulated patient visit. Results: In the cross-sectional survey, 84 pharmacists were approached and 78 agreed to participate (92.8 % response rate). Of the respondents, 96.1% agreed/strongly agreed that patient counseling is important and 69.3% strongly agreed that patient counseling should be a professional duty. The most frequent information provided to patients were dosing schedule of drugs, how to take medication, and drug-food interaction. Majority of community pharmacists either strongly agreed (42.1%) or agreed (51.3%) that patients are comfortable towards their counseling practice. A total of 48 simulated visits were conducted and a medicine was dispensed in all visits. In all four scenarios, dosage schedule (100%), how to take medication (97.6%) and drug-food interaction (69.1%) were the most common type of information provided while what to do when dose is missed (100%), contraindication (95.2%) and the importance of compliance or adherence (92.9%) were the most commonly ignored types of information. Conclusions: The present study emphasizes the existing gap in self-reported and actual counseling practices by community pharmacist in Gondar town, Ethiopia. Hence, the ministry of health, local health policy makers and other stakeholders should collaborate to design interventions to improve community pharmacists’ dispensing and counseling practice.

Involvement of community pharmacists in public health priorities: A multi-center descriptive survey in Ethiopia

Located in the heart of the community and widely distributed geographically, community pharmacies provide a platform for a more proactive involvement in public health services. So far, little information has been gathered in Ethiopia on community pharmacists’ level of involvement in public health services. The aim of the present study was, therefore, to document the level of involvement of community pharmacy professionals in the provision of public health services and the barriers to such involvement. This study employed a self-administered questionnaire based survey, which asked participants to indicate their frequency and level of involvement in providing public health services and their perceived barriers in providing such services. Surveys were undertaken from May to July, 2016 with 472 community pharmacy professionals working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya and Debre Birhan. Among 472 community pharmacy professionals approached, 412 (233 pharmacists and 179 pharmacy technicians) completed the survey with a response rate of 87.3%. Most respondents reported as being either “not at all involved” or “little involved” in counselling on smoking cessation (79.3%), and screening for hypertension (86.9%), diabetes (89.5%), and dyslipidemia (88.9%). On the other hand, they reported a higher level of involvement in the management and screening of infectious diseases (72.8%) and counseling with partners when initiating treatment for sexually transmitted diseases (68.9%). Lack of knowledge or clinical skills and lack of personnel or resources were the most commonly reported barrier for expanding such services. This survey revealed a low level of involvement of community pharmacists in public health services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of community pharmacy professionals, interventions should focus on overcoming the identified barriers.

Traditional herbal medicine use among people living with HIV/AIDS in Gondar, Ethiopia: Do their health care providers know?

BACKGROUND People living with HIV/AIDS (PLWHA) are increasingly using herbal remedies due to the chronic nature of the disease, the complexities of treatment modalities and the difficulty in adhering to the therapeutic regimens. Yet, research on herbal medicine use in this patient population is scarce in Ethiopia. The present study aimed at investigating the prevalence and factors associated with the use of traditional herbal medicine among PLWHA in Gondar, Ethiopia. METHODS A cross sectional survey was conducted on 360 PLWHA attending the outpatient clinic of University of Gondar referral and teaching hospital from September 1 to 30, 2016. A questionnaire about the socio-demographic, disease characteristics as well as traditional herbal medicine use was filled by the respondents. Descriptive statistics, univariate and multivariate logistic regression analyses were performed to determine prevalence and correlates of herbal medicine use. RESULTS Out of 360 respondents, 255 (70.8%) used traditional herbal medicine. The most common herbal preparations used by PLWHA were Ginger (Zingiber officinale) (47%), Garlic (Allium sativum L.) (40.8%) and Moringa (Moringa stenopetala) (31.4%). Majority of herbal medicine users rarely disclose their use of herbal medicines to their health care providers (61.2%). Only lower educational status was found to be strong predictors of herbal medicine use in the multivariate logistic regression. CONCLUSIONS The use of herbal medicine among PLWHA is a routine practice and associated with a lower educational status. Patients also rarely disclose their use of herbal medicines to their health care providers. From the stand point of high prevalence and low disclosure rate, health care providers should often consult patients regarding herbal medicine use.

Preferred information sources and needs of cancer patients on disease symptoms and management: a cross-sectional study

Purpose This study aimed at identifying the information needs of cancer patients, their preferences for the means of receiving health information, and the perceived level of satisfaction of existing possibilities for acquiring cancer-related information in Ethiopia. Materials and methods An institutional-based cross-sectional survey was employed on 556 cancer patients undergoing chemotherapy in the oncology wards of Gondar University Referral Hospital and Tikur Anbesa Specialized Hospital. Data were collected through interviewer-administered questionnaire. Results The principal information regarded as the most important by the majority of them (67.26%) concerned information on the specific type of cancer (name and stage of cancer), followed by the side effects of chemotherapy and their management (63.29%) and “prognosis (survival)” (51.8%). Doctors were the overwhelming information source about cancer (88.8%), followed by nurses (34%). The majority of respondents (70.3%) were not satisfied at all or satisfied a little, while 15.6% of respondents reported that they were “quite” or “very” satisfied with the existing possibilities for acquiring information regarding cancer. Conclusion Medical practitioners other than doctors and nurses such as clinical pharmacists should support and identify measures that can enhance patients’ satisfaction level regarding the existing possibilities for acquiring information regarding cancer. Periodic assessment of cancer patient’s information requirements is also crucial, considering the ever-changing dynamics of priorities of such information desires.

Knowledge and Self-Reported Practice of Insulin Injection Device Disposal among Diabetes Patients in Gondar Town, Ethiopia: A Cross-Sectional Study

Background. Incorrect sharp disposal practices may expose the public to needle-stick injuries. The present study aimed at assessing the knowledge and practice of diabetic patients towards insulin injection device disposal in Gondar town, Ethiopia. Methods. A cross-sectional study was employed on insulin requiring diabetes patients who visited the diabetes clinic at Gondar University Referral Hospital (GURH) from February 1 to March 28, 2016. Frequencies, percentages, and ANOVA (analysis of variance) and Students t-test were used to analyze variables. Results. About half of the participants (49.5%) had poor knowledge towards safe insulin injection waste disposal. More than two-thirds (80.7%) of respondents had poor practice and 64.3% of respondents did not put insulin needle and lancets into the household garbage. 31% of respondents threw sharps on street when they travel outside. Respondents living in urban areas had a higher mean of knowledge and practice score than those who live in rural area. Conclusions. This study revealed that knowledge and practice of diabetic patients were low towards safe insulin injection waste disposal in study area. Healthcare providers should also be aware of safe disposing system and counsel patients on appropriate disposal of used syringes.Background. Incorrect sharp disposal practices may expose the public to needle-stick injuries. The present study aimed at assessing the knowledge and practice of diabetic patients towards insulin injection device disposal in Gondar town, Ethiopia. Methods. A cross-sectional study was employed on insulin requiring diabetes patients who visited the diabetes clinic at Gondar University Referral Hospital (GURH) from February 1 to March 28, 2016. Frequencies, percentages, and ANOVA (analysis of variance) and Student’s t-test were used to analyze variables. Results. About half of the participants (49.5%) had poor knowledge towards safe insulin injection waste disposal. More than two-thirds (80.7%) of respondents had poor practice and 64.3% of respondents did not put insulin needle and lancets into the household garbage. 31% of respondents threw sharps on street when they travel outside. Respondents living in urban areas had a higher mean of knowledge and practice score than those who live in rural area. Conclusions. This study revealed that knowledge and practice of diabetic patients were low towards safe insulin injection waste disposal in study area. Healthcare providers should also be aware of safe disposing system and counsel patients on appropriate disposal of used syringes.