Medicinal use of cannabis: A qualitative study of the perspectives of doctors and pharmacists from six African countries.

We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.

Effect of a national antibiotic stewardship intervention in China targeting carbapenem overuse: An interrupted time-series analysis.

OBJECTIVES: To assess trends and patterns of carbapenem use and to evaluate the effects of a nationwide antibiotic stewardship policy to reduce carbapenem overuse. METHODS: In this quasi-experimental study, using longitudinal data from the national drug procurement database and interrupted time-series analyses with carbapenems as the intervention group and possible carbapenem substitutes as the comparison group, we evaluated the effects of a national stewardship policy on carbapenem consumption and expenditures, by region and types of healthcare institutions. RESULTS: The carbapenem procurement volume declined by -28.8% (95% CI -35.0 to -22.6) (-334.4 thousand defined daily doses [DDDs] per month), and carbapenem expenditures showed a relative reduction of -38.1% (-43.9 to -32.2). The gap between the use of carbapenems and each drug in the comparison group narrowed after the policy intervention, with an increase in tigecycline use (14.9 thousand DDDs [10.8-18.9]) and a slower decrease in use of certain third-generation cephalosporin combinations (-85.7 [-143.0 to -28.4]), penicillin combinations (-200.9 [-421.4-19.6]), and fourth-generation cephalosporins (-116.9 [-219.8 to -14.0]). Consumption was highest during the pre-policy period, and declines were largest following the intervention in the eastern region (-32.1%, -39.8 to -24.4) and among tertiary hospitals (-266.2 [-339.5 to -192.9] thousand DDDs per month). CONCLUSION: This population-level drug utilization research represents the first comprehensive evaluation of the effectiveness of China's nationwide carbapenem stewardship. The national policy targeting carbapenem prescribing has led to a sustained reduction in carbapenem use with limited substitution. Effects varied geographically and were concentrated in tertiary and secondary hospitals.

Regional and temporal trends of falls and injurious falls among Chinese older adults: results from China Health and Retirement Longitudinal Study, 2011-2018.

OBJECTIVE: This study aimed to investigate temporal trends and regional differences of both falls and injurious falls among Chinese older adults and identify the associated risk factors. METHODS: We conducted a retrospective analysis using the 2011, 2013, 2015 and 2018 waves of China Health and Retirement Longitudinal Study. Our sample included 35 613 people aged 60 years or above. We analysed two binary outcome variables that were collected at each wave, including whether a respondent had any falls in the last 2 or 3 years, and if so, whether a respondent experienced any injurious falls that warranted seeking medical treatment. The explanatory variables included individual-level sociodemographic characteristics, physical function and health status. We conducted both descriptive and multivariate logistic analyses. RESULTS: We found no significant trend for falls after adjusting for individual-level factors, while significant regional variations in falls existed with higher fall prevalence in the central and western areas, compared with the eastern area. We detected a significant descending trend of injurious falls between 2011 and 2018 and identified the northeastern region with the lowest rates of injurious falls during the study period. Our study also revealed significant risk factors for falls and injurious falls, such as chronic conditions and function limitations. CONCLUSIONS: Our results indicated no temporal trend of falls, a declined trend of injurious falls, and significant regional variations in the prevalence of falls and injurious falls in 2011-2018. These findings have important implications for prioritising areas and subpopulations to prevent falls and injuries among China's elderly population.

Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study.

AIMS: Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone. METHODS: A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis. RESULTS: A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building. CONCLUSION: DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.

Current situation and future development of the biopharmaceutical industry in China: A mixed-method study.

Introduction: The biomedical industry has grown significantly both globally and in China; however, there are still challenges. This study aimed at evaluating the biopharmaceutical sector of China, in terms of ability to innovate, current sales volume, investment, and R&D expenditure, as well as providing a case study detailing the progress and challenges of the industry in Shaanxi province. Method: A cross-sectional mixed-method study design was used to generate a comprehensive profile of the nature of biopharmaceutical innovation capacity and development in China by triangulating country-wide survey and interview data from Shaanxi province. Only biopharmaceutical companies that are currently marketing or conducting research and development were eligible for inclusion, and Shaanxi province was selected for conducting the interviews. Categorical and continuous variables were analyzed descriptively. Interviews were thematically analyzed by using NVivo version 12. Results: The analysis includes responses from 77 biopharmaceutical enterprises; the majority (36, 46.8%) are in Eastern China, followed by 26 (33.8%) in Central China. In 2018, the total sales of biological products amounted to 26.28 billion yuan, and in 2019, a slight increase was observed (30.34 billion); the amount doubled in 2020 to about 67.91 billion yuan. The top three biopharmaceutical products on sale in 2020 were Camrelizumab (5.14 billion yuan), human albumin (4.56 billion yuan), and human immunoglobulin for injection (3.78 billion yuan). Expenditure on R&D has also increased; it amounted to 1657.7 million yuan in 2018, which more than doubled in 2019 to 3572.1 million yuan and further increased to 5857.7 million yuan in 2020. Nonetheless, the progress is not uniform across all provinces, as shown from the results from Shaanxi province, because of lack of local government policies that will impact on the funding, incentives, and market share that motivate the producers. Conclusion: China's biopharmaceutical industry has expand significantly. The increase in sales indicates that there is an increase in demand for biologicals; moreover, R&D funding is increasing. These are key indicators that influence innovation and development. However, the sector's capacity to innovate and develop needs to be improved, particularly in the western region, where research and production are relatively weak.

Under-five mortality in Sierra Leone and possible associated factors: evidence from the 2019 Demographic and Health Survey.

High under-five mortality rate remains one of the public health challenges, especially in Sub-Saharan Africa, accounting for more than half of all global cases. Sierra Leone was and is still one of the countries with the highest under-five mortality rate. Using the latest 2019 Sierra Leone Demographic and Health Survey data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead = 1; alive = 0). A total of 871 (9%) children died before their fifth birthday. The maternal age of 20-24 years [adjusted odds ratios (AOR) = 0.46; 95% confidence interval (CI) = 0.33-0.64; P < 0.001] up to 40-44 years (AOR = 0.43; CI = 0.27-0.7; P = 0.001), currently breastfeeding (AOR = 0.20; CI = 0.17-0.24; P < 0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR = 0.48; CI = 0.28-0.85; P = 0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR = 0.68; CI = 0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR = 1.31; CI = 1.08-1.59; P = 0.007) watched television less than once a week (AOR = 1.48; CI = 1.16-1.90), had two (AOR = 3.4, CI = 2.78-4.16; P < 0.001) or three and above birth (AOR = 8.11; CI = 6.07-10.83; P < 0.001) in five years, had multiple birth children (AOR = 1.41; CI = 1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI = 1.41-2.70) were more likely to lose their children below the age of 5 years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child's sex, multiple birth type, very small-sized child and the total number of births in 5 years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.

Prevalence and correlates of current tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in 22 African countries: a secondary analysis of the 2013-2018 global youth tobacco surveys.

BACKGROUND: Our study examined the prevalence and associated factors of tobacco product use and non-users' susceptibility to using tobacco products among school-going adolescents in 22 African countries. METHODS: We analyzed the cross-sectional 2013-2018 Global Youth Tobacco Survey (GYTS) data from 22 African countries. We conducted complex sampling descriptive and logistic regression analyses. RESULTS: The overall prevalence of current use of any tobacco product among adolescents was 19.1%, with more males (23.7%) than females (13.7%) being current users. Zimbabwe and Morocco were the highest (47.1%) and least (12.6%) reported prevalence, respectively. Being male (AOR = 1.93;95%CI:1.61-2.32), being 16 and older(AOR = 1.37;95%CI:1.01-1.86), exposure to secondhand smoke within (AOR = 1.98;95%CI:1.69-2.32) and outside (AOR = 1.37;95%CI:1.13-1.65) the home, not knowledgeable about the harmful effect of secondhand smoke (AOR = 1.44;95%CI:1.20-1.74), exposure to tobacco industry promotion (AOR = 3.05;95%CI:2.68-3.47) and not in favour of banning smoking in enclosed places (AOR = 1.32;95%CI:1.08-1.60) were associated with current use of any tobacco product. The prevalence of the susceptibility to using tobacco products among never users of tobacco products was 12.2%, with no significant gender difference. Mozambique (24.6%) and Algeria (4.5%) had the highest and least prevalence of susceptibility to using tobacco products among never users, respectively. Exposure to tobacco industry promotion (AOR = 1.54;95%CI:1.31-1.82), those not in favour of banning smoking in enclosed places (AOR = 1.29;95%CI:1.14-1.45) and those not exposed to anti-smoking school education (AOR = 1.24;95%CI:1.06-1.46) were associated with susceptibility to using any tobacco product among never users of tobacco products. CONCLUSION: Our study reports that tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in the 22 African countries is high. As part of public health efforts, governments and other stakeholders need to fully implement anti-tobacco use campaigns, enforce a complete ban on tobacco promotion and advertising, institute educational programs for families, and anti-tobacco use education for the general public and in schools in line with WHO Framework Convention on Tobacco Control guidelines.

Tobacco Use among School-Going Adolescents in Comoros: A Secondary Analysis of the 2015 Comoros Global Youth Tobacco Survey.

Background: Tobacco use among adolescents has long-term adverse health consequences, especially during adulthood. Currently, little is known about tobacco use behaviour among adolescents in Comoros. Our study aims at estimating the prevalence and identifying key factors associated with tobacco use among adolescents in Comoros using the 2015 Comoros Global Youth Tobacco Survey data. Methods: A national cross-sectional survey secondary data of 2,810 eligible school-going adolescents aged between 11 and 17 years was analysed. Complex sample logistic regression analyses were used to determine the correlates of current cigarette smoking and current use of noncigarette tobacco products. Results: The overall prevalence of current cigarette smoking was 14.3% [males (18.5%) and females (9.9%)]. The prevalence of current use of noncigarette tobacco products was 5.8% [males (6.7%) and females (4.9%)]. Being male (AOR = 2.24; 95% CI:1.39-3.63), exposure to secondhand smoke inside (AOR =3.88; 95% CI:2.84-5.31) and outside (AOR =1.49; 95% CI: 1.08-2.03) their home, and exposure to tobacco industry promotion (AOR =2.90; 95% CI:2.21-3.80) were associated with current cigarette use among school-going adolescents. However, parental smoke (AOR = 1.20; 95% CI:0.78-1.87) and not exposed to antismoking education in schools (AOR = 0.97; 95% CI:0.76-1.22) were not associated with current cigarette use. On the other hand, being male (AOR = 1.24; 95% CI:0.82-1.86) was not associated with the current use of noncigarette tobacco products. Adolescents who were exposed to tobacco industry promotion (AOR = .2.58; 95% CI:1.54-4.32) and not exposed to antismoking education in school (AOR = 0.52; 95% CI:0.32-0.85) were more and less likely associated with noncigarette tobacco use. Conclusion: One in seven school-going adolescents smokes cigarettes, and approximately one in 20 school-going adolescents uses noncigarette tobacco products in Comoros. Exposure to secondhand smoke within and outside the home and exposure to tobacco industry promotion were associated with tobacco use in school-going adolescents in Comoros. Our findings suggest the need for adolescent-friendly gender-sensitive tobacco interventions, including strengthening existing tobacco control laws to prevent and reduce tobacco use among school-going adolescents in Comoros.

Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors.

BACKGROUND: Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. METHODS: We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. RESULTS: When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (ß = - 3.90, 95% CI - 6.47 to - 1.32, p = 0.003), had no formal education (ß = - 2.80, 95% CI - 5.16 to - 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (ß = - 1.08, 95% CI - 1.74 to - 0.43, p < 0.001) and experienced a unit increase in enacted stigma (ß = - 2.61, 95% CI - 4.02 to - 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (ß = - 0.60, 95% CI - 0.103 to - 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (ß = - 1.50, 95% CI - 2.67 to - 0.33, p = 0.012). CONCLUSION: Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.

Status and Impacts of Recreational and Medicinal Cannabis Policies in Africa: A Systematic Review and Thematic Analysis of Published and "Gray" Literature.

Background: Despite cannabis's societal ubiquity, several African states remain traditional prohibitionists. However, cannabis is becoming a more explored frontier from a health, human rights, and monetary perspective. A number of African countries have taken to tailoring their policies to better engage in emerging global dialogs. Nevertheless, the focus is majorly on the crop's financial appeal with less consideration on impacts of policies. This review aimed to specifically focus on the identification of existing or pending policies, indicating national positioning in terms of recreational and medicinal cannabis use and summarizing publications addressing related impacts in Africa. Methods: We systematically searched six academic research databases (including Google Scholar), Google, country specific websites, and websites of relevant organizations. Included publications were in English and published between January 1, 2000, and November 31, 2020 (with exception granted to official legislation not in English and/or published earlier than 2000, but still in effect). Reference lists of included publications were screened for potentially relevant publications. Results were synthesized thematically and descriptively. Results: Cannabis is Africa's most consumed illegal substance, its use entrenched in social, political, historical, economic, and medicinal ties. African users constitute a third of the worldly total and cultivation is a major activity. Policies have led to prison overcrowding, accelerated environmental damage, and sourced regional instability. South Africa, Seychelles, and Ghana have decriminalized personal use with Egypt and Mozambique exploring similar legislation. Eleven countries have existing or pending medicinal cannabis-specific provisions. South Africa and Seychelles stand out as having regulations for patients to access medicinal cannabis. Other countries have made provisions geared toward creating export markets and economic diversification. Conclusion: Cannabis policy is a composite and complex issue. Official stances taken are based on long withstanding narratives and characterized by a range of contributing factors. Policy changes based on modern trends should include larger studies of previous policy impacts and future-oriented analysis of country-level goals incorporated with a greater understanding of public opinion.

A Simulated Client Exploration of Nonprescription Dispensing of Antibiotics at Drugstores for Pediatric Acute Diarrhea and Upper Respiratory Infection in Lahore, Pakistan.

INTRODUCTION: The excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an "everyday routine". The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children. METHODS: Using pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics' ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (χ 2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing. RESULTS: Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value <0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones. CONCLUSION: Overall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.

Healthcare Workers' Knowledge, Attitude, Practice and Perceived Health Facility Preparedness Regarding COVID-19 in Sierra Leone.

BACKGROUND: Healthcare workers (HCWs) are known to spearhead the fight against the COVID-19 pandemic. As such, their knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are considered critical to the success of the current COVID-19 response efforts. This study aims to determine HCWs' KAP toward COVID-19 and assesses their perception of their healthcare facilities preparedness to respond appropriately to the ongoing COVID-19 pandemic in Sierra Leone. METHODS: We conducted an online cross-sectional study among HCWs (n=516) between 1st May 2020 and 30th June 2020. We collected our data using a self-administered structured questionnaire via email and online social media platforms. We analyzed our data using descriptive statistics and regression analysis (p<0.05). RESULTS: Close to three-fourth of HCWs (n=375, 72.7%) were knowledgeable regarding COVID-19. Doctors were more knowledgeable than community health workers and laboratory technicians (AOR= 2.48, 95% CI: 1.16-5.31, p=0.019) regarding COVID-19. Close to two-thirds of HCWs (n=301, 58.3%) HCWs show positive attitudes toward COVID-19. Being male (AOR=2.08, 95% CI: 1.36-3.20, p=0.001) and directly involved in COVID-19 patient care (AOR=3.21, 95% CI: 1.88-5.48, p<0.001) were identified as predictors of positive attitude towards COVID-19. HCWs are generally adhering to COVID-19 safe practices with majority indicating that they regularly wash or sanitize their hands (n=510, 98.8%) and used facemask at point of care (n=499, 96.7%). Majority of HCWs are of the view that their healthcare facilities are ill-prepared to adequately respond to COVID-19 with majority (n= 400, 77.5%) of them stating that their facilities lack enough personal protective equipment. CONCLUSION: HCWs in Sierra Leone showed good knowledge, positive attitude and practice regarding COVID-19. However, HCWs are of the view that their healthcare facilities are ill-prepared to respond adequately to the COVID-19 outbreak. Health authorities and policymakers need to provide the necessary resources to allow HCWs to work in a safe environment.

Patients satisfaction with free healthcare pharmaceutical services in Sierra Leone: a national cross-sectional study.

Background Patient satisfaction is a critical construct of quality of pharmaceutical care in that it reflects whether a given service is meeting patients' expectations and consistent with their values. The government of Sierra Leone in 2010 introduced a free healthcare policy, which includes free pharmaceutical services for under-five children, lactating mothers, and pregnant women at all governments hospitals nationawide. Objectives The main objective of this study is to evaluate patient's satisfaction with the pharmaceutical services received from public hospitals implementing the free healthcare policy. Setting Four randomly selected public hospitals in Sierra Leone, one from each of the four regions, providing free healthcare services. Methods A cross-sectional design, using an interview-administered questionnaire, was employed in this study. Data were analyzed in SPSS, continuous and categorical data were computed descriptively. Responses to the open question were quantified and analyzed thematically. Adjusted and crude logistical models were used to assess factors associated with satisfaction, and significance was taken at p < 0.05. Main outcome measure Patients satisfaction with pharmaceutical services provided in public hospitals in Sierra Leone. Results Overall, 797 questionnaires were analyzed. The majority of patients seeking free pharmaceutical services were satisfied (n = 470, 56%) or very satisfied (n = 229, 28.7%) with the services they received. Pharmacy staff which includes pharmacists and pharmacy techincians demonstrated good communication skills while delivering services, but lacked technical details like; how to handle (n = 187, 23.5%) and store (n = 135, 16.9%) drugs and their potential side effects (n = 253, 31.8%). Low satisfaction was observed with the lack of private area for patients counseling (n = 474, 60.1%), and a convenient waiting area (n = 229, 28.7%). Respondents also thought the pharmacy was too small (n = 191, 24.6%) and with less than optimal lighting system (n = 120, 15.0%). Dissatisfaction was associated with college/university students or graduates [AOR: 0.211 (0.083-0.537), p = 0.001] and those with household incomes less than SLL 1,000,000 [AOR: 0.391 (0.155-0.987) p = 0.047]. Conclusions Patients were generally satisfied with pharmaceutical services received; however, infrastructural upgrades of the pharmacy like a comfortable waiting area and private counselling area within the pharmacy scores low in their satisfaction level. Improvement on the pharmacy structure, and motivated pharmacy staff with the right technical training will enhance the effective delivery of quality pharmaceutical care within the free healthcare.

Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators.

PURPOSE: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone. MATERIALS AND METHODS: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis. RESULTS: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug. CONCLUSION: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.

Analysis of Antibiotic Use Patterns and Trends Based on Procurement Data of Healthcare Institutions in Shaanxi Province, Western China, 2015-2018.

Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization's "Access, Watch and Reserve" (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.

Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study.

: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.

Knowledge, attitude and antibiotic prescribing patterns of medical doctors providing free healthcare in the outpatient departments of public hospitals in Sierra Leone: a national cross-sectional study.

BACKGROUND: Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics. METHODS: The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor's knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone. RESULTS: Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3 weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children <5 y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p<0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin. CONCLUSIONS: Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.

Attitude of clinicians towards hospital-based antimicrobial stewardship programs: a multicenter cross-sectional study from Punjab, Pakistan.

Background: Antimicrobial resistance (AMR) is a major threat to global health and antimicrobial stewardship programs (ASPs) are useful to limit the momentum of AMR. This study was intended to determine the attitudes of clinicians about AMR, ASP strategies, and their readiness to participate in ASPs. Methods: A cross-sectional survey was carried out among clinicians working in teaching hospitals of Punjab between August and November 2018. A multistage sampling method was used. Descriptive statistics and Kruskal-Wallis tests were employed for data analysis. Results: A response rate of 77.9% (670 / 859) was achieved. Most of the physicians (n = 302, 71.7%) compared to surgeons (n = 134, 70.9%) and anesthetists (n = 25, 41.7%) considered AMR as a serious health problem in Pakistani hospitals (p < 0.001). Clinicians were agreed that hospital audit and feedback (n = 434, 64.8%), restriction of certain antibiotics (n = 424, 63.3%), readily accessible microbiological data (n = 453, 67.6%), and regular educational sessions (n = 496, 74.0%) are imperative approaches to implement ASPs. Median ASP and AMR scores were significantly associated with age, experience, and types of clinicians (p < 0.05). Conclusions: Despite poor previous knowledge of ASPs, all clinicians showed a positive attitude towards hospital ASPs. Several approaches suggested by clinicians will be helpful to implement hospital ASPs in Pakistan.

Prices, availability and affordability of insulin products: a cross-sectional survey in Shaanxi Province, western China.

OBJECTIVE: To evaluate price, availability and affordability of insulin products in Shaanxi Province, western China. METHODS: We used a simplified and adapted WHO/Health Action International method to obtain the availability and prices of insulin products and five oral anti-diabetic medicines as comparators in public general hospitals and private retail outlets. In addition, we investigated the price components of eight selected insulin products by tracing the supply chain. RESULTS: All three kinds of insulin products, prandial, basal and premixed insulin, are 100% available in public hospitals, and have fairly high availability in the private sector (62.5-68.8%). The prices of most insulin products were higher than international reference prices in both sectors (ranging from 0.95 times to 2.33 times). All insulin products were unaffordable as they would cost 3.5-17.1 days' wage of the lowest-paid government workers in Shaanxi. The manufacturer's markup (selling price), which comprised more than 60% of the final price of all insulin products surveyed, was the largest price component. CONCLUSIONS: Although availability of insulin products was high in public general hospitals and private retail pharmacies, their high price made them unaffordable to diabetes patients, especially low-income patients. The government should increase insurance compensation for those who need these life-saving medicines or decrease the cost of insulin products through negotiation with suppliers.

Exploring the Knowledge and Perception of Generic Medicines among Final Year Undergraduate Medical, Pharmacy, and Nursing Students in Sierra Leone: A Comparative Cross-Sectional Approach.

Most low-income nations have national medicine policy that emphasized the use of generic medicines in the public health sector. However, the use of generics is often debatable as there are concerns over its efficacy, quality, and safety compared to their branded counterparts. This study was conducted to compare the knowledge and perception of generic medicines among final year undergraduate medical, pharmacy, and nursing students in Sierra Leone. We conducted a questionnaire-based cross-sectional study among these students at the College of Medicine and Allied Health Sciences University of Sierra Leone. Out of the 62 students, only two (2/62, 3.2%) knew about the acceptable bioequivalence limit. At least half of respondents in all three groups agreed that all generics are therapeutically equivalent to their innovator brand. At least half of the medicine (21/42, 50%) and nursing (6/9, 66.6%) students, compared to pharmacy students (5/11, 45.5%), believed that higher safety standards are required for proprietary medicines than for generic medicines. Most of them agreed that they need more information on the safety, quality, and efficacy aspects of generics (59/62, 95.2%). All three groups of healthcare students, despite variations in their responses, demonstrated a deficiency in knowledge and misconception regarding generic medicines. Training on issues surrounding generic drugs in healthcare training institutions is highly needed among future healthcare providers in Sierra Leone.