Omer Qutaiba Al-lela

Community pharmacists' attitudes, perceptions, and barriers toward adverse drug reaction reporting in Malaysia: a quantitative insight.

Objectives This study was designed to explore awareness and attitudes of community pharmacists toward the national ADR reporting system activities in the northern states of Malaysia. Methods A cross-sectional survey using a validated self-administered questionnaire was used in this study. The questionnaire was delivered to all community pharmacists (N = 470) practicing in the four northern states of Malaysia (Perlis, Kedah, Pulau Pinang and Perak) during the study period. Results A total of 470 survey forms were sent with one wave of reminders. Only 116 pharmacists responded to the survey (response rate of 25.2%). The total number of usable responses was 104 (24.7%). The survey findings revealed that nearly three-quarters of pharmacists (n = 75; 72.1%) were not aware of the pharmacovigilance activities run by the drug regulatory authority in Malaysia. Although more than half (n = 65, 61.5%) of the surveyed pharmacists emphasized the importance of ADR reporting, only 13 pharmacists (12.9%) claimed that they submitted ADR reports to the Malaysia Adverse Drug Reaction Advisory Committee (MADRAC) before this survey. Barriers which prevent community pharmacists from ADR reporting were identified. These included lack of knowledge on how to report (n = 36; 34.7%), the unavailability of reporting forms (n = 44; 42.6%), and ignorance of where the report should be sent to (n = 46; 44.6%). Conclusions Despite the unfamiliarity and the common misconceptions, the study results show that community pharmacists in the northern states of Malaysia have a very positive attitude toward the ADR reporting system in the country. However, the study findings highlight the urgent need for special education programs to establish continuous efforts to promote ADR reporting among community pharmacists. Further studies at the national level aimed at identifying and removing barriers that prevent community pharmacists from performing ADR reporting are required.

Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing

BackgroundParents are the main decision makers for their children vaccinations. This fact makes parents’ immunization knowledge and practices as predictor factors for immunization uptake and timeliness. The aim of this pilot study was to develop a reliable and valid instrument in Malaysian language to measure immunization knowledge and practice (KP) of Malaysian parents.MethodsA cross-sectional prospective pilot survey was conducted among 88 Malaysian parents who attended public health facilities that provide vaccinations. Translated immunization KP questionnaires (Bahasa Melayu version) were used. Descriptive statistics were applied, face and content validity were assessed, and internal consistency, test-retest reliability, and construct validity were determined.ResultsThe mean ± standard deviation (SD) of the knowledge scores was 7.36 ± 2.29 and for practice scores was 7.13 ± 2.20. Good internal consistency was found for knowledge and practice items (Cronbach’s alpha = 0.757 and 0.743 respectively); the test-retest reliability value was 0.740 (p = 0.014). A panel of three specialist pharmacists who are experts in this field judged the face and content validity of the final questionnaire. Parents with up-to-date immunized children had significantly better knowledge and practice scores than parents who did not (p < 0.001 and p = 0.001 respectively), suggesting a good construct validity. A significant difference was found in knowledge and practice scores among parents’ age (p = 0.006 and p = 0.029 respectively) and place of living (p = 0.037 and p = 0.043). The parents’ knowledge level was positively associated with their practice toward immunization (Spearman’s rank correlation coefficient 0.310, p = 0.003).ConclusionsThe pilot study concluded that the Bahasa Melayu version of the immunization KP questionnaire has good reliability and validity for measuring the knowledge and practices of Malaysian parents and therefore this version can be used in future research.

The Teaching of Subjects Related to Pharmacovigilance in MalaysianPharmacy Undergraduate Programs

Objectives: To evaluate the extent to which subjects related to pharmacovigilance are taught in the pharmacy programs within Malaysian universities. Methods: Self-completed questionnaires were sent (via surface mail) to all heads of schools and faculties of pharmacy and medicine that offer pharmacy programs in Malaysia. The questionnaires were intended for department heads or the person responsible for the teaching of the subject in the respective institutions. Results: Thirteen out of fourteen (n=13, 92.8%) medical and pharmacy schools responded to the survey. The vast majority (n=11, N=13, 84.6%) of the pharmacy programs within the studied Malaysian universities feature pharmacovigilance-related topics in their undergraduate syllabi. About two-thirds (n=8, 72.7%) of the pharmacy programs taught issues related to pharmacovigilance within epidemiology and/or pharmacoepidemiology courses. Pharmacovigilance-related topics are core/required in almost all (n=9, 81.8%) of the pharmacy programs. None of the pharmacy programs had a specific stand-alone course on pharmacovigilance. Conclusion: Subjects related to pharmacovigilance were widely taught in the majority of the universities surveyed. As the field of pharmacovigilance is very important for future pharmacy practitioners, this course should be made a core course within the local pharmacy curriculum in order to enhance medication safety for the population. To ensure effective practice in the area of drug safety, there is an urgent and necessary need for Malaysian pharmacy students to be adequately educated and exposed to the contemporary issues and challenges of pharmacovigilance implementation.

Does an educational intervention improve parents’ knowledge about immunization? Experience from Malaysia

BackgroundParents’ knowledge about immunization is an important predictor factor for their children’s immunization status. The aims of this study were to assess parents’ knowledge and to evaluate the effect of a short educational intervention on improving parents’ knowledge of childhood immunization.MethodsA cross-sectional study using a pre- and post-test intervention survey of a single group was conducted among Malaysian parents. Changes in total knowledge score before and after the intervention were measured using a validated questionnaire. The intervention consisted of an animated movie and lecture using simple understandable language. Wilcoxon signed ranks test and the McNemar x2 test were applied to compare the differences in knowledge before and after the intervention.ResultsSeventy-three parents were enrolled in this study; the majority were mothers (n = 64, 87.7%). Parents’ knowledge about childhood immunization increased significantly after the intervention compared to the baseline results (p < 0.001). There were significant differences between parents’ knowledge and their educational level and monthly income (p < 0.001 and p = 0.005), respectively.ConclusionsA short educational intervention designed for parents had a positive effect on their knowledge about immunization. Educational interventions targeting parents with low levels of education and income are needed. Further studies investigating the actual effectiveness of such interventions on immunization rates and statuses are required.

Incorporating an Immunization Course in the Pharmacy Curriculum: Malaysian Experience

To the Editor. The immunization system is a successful systematic program, especially during the last century. However, the immunization system is still imperfect because many countries still have unvaccinated children. The most common reasons for parents not having their child vaccinated are concern about immunization adverse effects, disbelief that the vaccine works, lack of awareness that the immunization is necessary, and lack of healthcare provider recommendation for the immunization.1 Health-care providers play an important role in child immunization because they have positive effects on parental decisions related to immunization.2 As a health care provider, pharmacists have played a role in promoting, maintaining, and improving immunization rates among children because the pharmacist is one of the most accessible healthcare professionals. A pharmacist can be trained to screen children for immunizations and counsel parents on immunization decisions, including providing information on immunizations risks and immunization benefits. In addition, pharmacists are highly regarded by the parents and by most immunization providers as drug information specialists, and often sought by people for medical advice.1,3 In the United States, 49 states have granted authority to pharmacists to immunize people, and pharmacists can play an important role in disease prevention by advocating and administering immunizations.4-6 While pharmacists in Malaysia are not authorized to immunize people, they can promote immunization through several types of activities: history and screening, patient counseling, documentation, administrative measures, and public education and reminders. In Malaysia, there are about 17 pharmacy colleges and schools (public and private) and 10 schools are fully accredited.7 Most of the schools or colleges do not have enough education courses regarding immunization. These deficiencies in immunization education and training in colleges and schools of pharmacy may contribute to low immunization rates in the Malaysia. An immunization course was introduced in Kulliyyah of Pharmacy- International Islamic University Malaysia during the current academic year (2012-2013). The course was offered as a part of the Pharmacotherapeutics I module during the first semester for fourth-year students enrolled in the bachelor of pharmacy degree program. The immunization course consists of 3 hours presented in 3 lectures. The first lecture consists of: immunization and vaccine types in children and adults; schedule and timing; adverse reactions; and contraindications. The topics for the second lecture hour consist of: epidemiology and disease prevention, pharmacist’s role, documentation, record keeping, planning, storage, parents’ education, and reminder. Immunization errors types, pharmacovigilance, and recommendations are presented in the last lecture. At the end of the immunization course, questionnaires will be administered to students to assess their perceptions of the course. As academic pharmacists, we believe that it is time for Malaysian pharmacy schools to help reach the national goals for immunization compliance through educating future generations of pharmacists. Schools of pharmacy have the responsibility to improve immunization education and to develop the practice skills of undergraduate pharmacy students. It can be done by introducing immunization into the undergraduate pharmacy curriculum. Although the initiation of the new course in pharmacy school requires additional resources and takes time to develop and update the curriculum, we strongly advise others Malaysian schools of pharmacy to mandate immunization education course and training as part of their core curriculum. The authors thank Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed (Academic Deputy Dean) and Assistant Professor Dr.Siti Hadijah Shamsudin (Head of Department of Pharmacy Practice) for their support in establishing and approving this immunization course in Kulliyyah of Pharmacy- International Islamic University Malaysia.

Pharmacy Education in Iraq

To the Editor. We appreciated the letter entitled “Pharmacy Education and Practice in 13 Middle Eastern Countries.”1 The letter provided some information regarding pharmacy education in Iraq. Information was obtained by reviewing the available published literature and individual university Web sites, as well as contacting program or country representatives. In 2008, Iraq had 7 public schools of pharmacy, but no private schools of pharmacy. The bachelors degree remains the first professional degree required to enter pharmacy practice. All schools offer bachelors degree programs and some offer the master’s degree, but no colleges or schools in Iraq offer the PhD degree in pharmaceutical science. Pharmacy schools in Iraq have both male and female students, but there are more female than male students enrolled.1 In this letter, we would like to correct, clarify, and update some important information related to pharmacy education in Iraq. Iraq has 13 public colleges of pharmacy, 9 of which were established in different Iraqi universities before 2008, as follows: Baghdad University in 19362; Mosul University in 19643; Basrah University in 19994; Kufa University in 19995; Mustansiriyah Universityin 20006; Tikrit University in 20027; Sulaimani University in 20048; Kerbala University in 20069; Hawler Medical University in 200610; Duhok University in 200911; Babylon University in 201012; Anbar University in 201113; and Thiqar University in 2012.14 In addition, Iraq has 4 private colleges of pharmacy. Two private colleges were established before 2008 and 2 otherd were established after 2008, as follows: Baghdad Pharmacy College established in 2000 by the Iraqi pharmacists union,15 Al-Yarmouk University College in 2006,16 Al-Rasheed University College in 2010,17 and Al-Rafedin University College in 2011.18 All colleges of pharmacy offered bachelors degree programs, while 3 public colleges of pharmacy offered MSc degree program. In addition, the PhD program was offered in 1 public college of pharmacy. In 1972, Baghdad University offered MSc degree program in 4 areas of pharmaceutical sciences, while the PhD program was offered in 1975 in pharmaceutical chemistry.2 Mosul University and Mustansiriyah University offered MSc program in 1993 and 2011, respectively.3,6 From 1936 to 1994, there was a higher proportion of female students than male students, while from 1994 to 2004, there was a higher proportion of male students than female students due to some regulations related to competition between male and female students. Ministry of Higher Education and Scientific Research in Iraq canceled these competition rules in 2004. Now, the percentage of female students in Iraqi colleges of pharmacy is higher than the percentage of male students.19

Immunization Errors among Pediatrics Younger than 2 years

Objective: This study evaluated immunization compliance, immunization completeness, and vaccination errors frequency among Iraqi pediatric. Study design this study was restricted the analysis to types of vaccines administered before 2 years of age. A cohort study of 528 pediatrics born between 1st January 2003 and 31st Jun 2008 was selected. Immunization history of pediatric was collected retrospectively from pediatric immunization card. Immunization doses were classified to five types: Normal dose, early dose, missed dose, late dose, and extra dose. Pediatric who received all the immunization doses without any immunization dose errors was considered as complete immunization with full compliance. If the pediatric missed at least one immunization dose, this pediatric was considered partial immunization with noncompliance, and if this pediatric received at least one immunization dose error, this pediatric was considered complete immunization with noncompliance. Results: Less than half of pediatric were considered as partial immunization with noncompliance. 3696 immunization doses must receive by 528 pediatric, 25.3% of doses were normal doses, 8.3% as an early doses, 13.6% as a missed doses, 47.5% of doses were late doses, and 5.3% as an extra doses. Conclusions: Immunization errors occur frequently and leading to improper immunization compliance. This study recommended increasing effort to optimize childhood immunization. Key words: immunization, compliance, errors, pediatrics, two years.

Errors and Omissions in Private Clinics Prescriptions: A Survey of Prescription Writing In Duhok, Kurdistan Region- Iraq

Background and aim: Prescriptions errors are currently a worldwide public health issue and it is one of the most serious errors. The aim of this study was to screen drug prescriptions written by physicians in outpatient private clinics in Duhok city for the essential elements of prescriptions. Method: Cross-sectional study was carried out in private five outpatient clinics. Convenient samples of 516 prescriptions were collected from the selected private clinics and reviewed for the presence and accuracy of information contained. Results: Only 18.25% of the drug written in generic name and 40.74 % as trade name. 87.46% of the prescribed drugs have the drug frequency on and 12.54% do not have the frequency on. The majority (64.10%) of the drugs prescribed in Duhok city are found without any consideration to food intake 61.63% of the prescriptions have it is the physician registration number. 96.32% of the prescriptions collected include the name of the patient, 46.90% includes the age, and only 5.43% includes the sex. Conclusion: Many errors found in prescriptions reviewed and most of the physicians don’t follow the rules for standard prescribing pattern. Moreover, patients might be at risk of therapeutic failure due to errors happen during the prescription writing, dispensing and administration

Assessment of community pharmacists concerning pharmacovigilance in Iraq

Objectives: This study was designed to explore the awareness and attitude of the pharmacists working in the retail pharmacies toward the national adverse drug reactions (ADRs) system activities in Iraq. Methods: A cross-sectional survey using a validated self-administered questionnaire was used in this study. The questionnaire was delivered to retail pharmacists (RPs) practicing in Baghdad during the study period (4 months). Results: Of the 200, only 176 pharmacists responded to the survey (response rate of 88%). The total number of usable responses was 123 (61.5%). The survey findings revealed that 79 pharmacists (64.2%) were not aware of the Iraqi spontaneous reporting system (SRS). The restriction factors which dropping the ADRs reporting among RPs were identified. These include lack of knowledge in the way of reporting (n = 41; 33.3%), the unavailability of reporting forms (n = 88; 71.6%), and unawareness of where these reports should be sent to (n = 88; 71.6%). Conclusions: The study showed that the RPs in Baghdad have a very positive attitude toward ADRs but unfortunately; they are not familiar with the Iraqi SRS. The study findings emphasize the serious need for special education programs to promote ADRs reporting among RPs.

New pharmacovigilance course at the International Islamic University Malaysia-IIUM

To the Editor. The Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) was established under the Drug Control Authority (DCA) to perform the function of pharmacovigilance for drugs registered for use in Malaysia. It became a member of the World Health Organization (WHO) Program for International Drug Monitoring in 1990.1 Although MADRAC has invited healthcare professionals (physicians, pharmacists, dentists, etc) to submit adverse drug reaction (ADR) reports, the number of ADR reports submitted by healthcare professionals is considered low according to WHO recommendations for the optimal National Pharmacovigilance Centre.2 The most important reason for underreporting of ADR by healthcare professional is a lack of information3. .....