Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income countries: a Ugandan perspective.

In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. In low-income countries like Uganda, many such stockpiles are the result of donations. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. Many low- and middle-income countries need to: (i) strengthen public systems for medicines' management, to improve inventory control and the reliability of procurement forecasts; (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes; (iii) strengthen the regulation of drug donations; (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension; (v) strengthen the enforcement of regulations on safe drug disposal; (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators; and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector.

Dans certains pays à revenu faible et intermédiaire, les pharmacies nationales et les centres publics de santé détiennent d'énormes stocks de produits pharmaceutiques périmés. Dans les pays à revenu faible comme l'Ouganda, nombre de ces stocks proviennent de dons. Or, s'ils ne sont pas correctement contrôlés et réglementés, les produits pharmaceutiques périmés peuvent être reconditionnés et revendus en tant que contrefaçons ou bien jetés sans considération du danger pour l'environnement. Dans la chaîne d'approvisionnement, le pourcentage des produits pharmaceutiques périmés doit diminuer, et les produits périmés doivent être éliminés au bon moment et de façon sûre. De nombreux pays à revenu faible et intermédiaire doivent: (i) renforcer les systèmes publics pour la gestion des médicaments, afin d'améliorer le contrôle des stocks et la fiabilité des prévisions d'approvisionnement; (ii) réduire la pression à laquelle les pharmacies centrales sont soumises, grâce à des programmes de libéralisation et de remboursement; (iii) renforcer la régulation des dons de médicaments; (iv) étudier les options envisageables pour réemployer les produits pharmaceutiques officiellement périmés mais dont la durée de conservation pourrait éventuellement être prolongée après la réalisation de nouveaux tests; (v) renforcer l'application des réglementations pour une élimination sans risques des médicaments; (vi) investir dans des infrastructures d'élimination sans risques des médicaments, éventuellement au moyen d'incinérateurs à ultra-haute température; et (vii) responsabiliser les utilisateurs, en intégrant dans les programmes d'encadrement du secteur de la santé publique une obligation de rendre compte pour les produits périmés.

En algunos países con ingresos bajos y medios, los almacenes nacionales y las instalaciones del sector sanitario público contienen grandes cantidades de existencias de medicamentos que han superado su fecha de caducidad. En países con ingresos bajos como Uganda, muchas de estas existencias son el resultado de donaciones. Si no se controlan o regulan adecuadamente, puede ser que los medicamentos caducados sean empaquetados de nuevo y vendidos como falsificaciones o que se depositen sin tener conciencia del potencial daño medioambiental. Deben reducirse las tasas de caducidad de los medicamentos en la cadena de suministro y los medicamentos caducados deben depositarse a tiempo y de forma segura. Muchos países con ingresos bajos y medios necesitan: (i) fortalecer los sistemas públicos para la gestión de medicamentos para mejorar el control del inventario y la fiabilidad de la adquisición de provisiones; (ii) reducir el estrés en los almacenes médicos centrales a través de sistemas de reembolso y liberación; (iii) aumentar la regulación de las donaciones de medicamentos; (iv) investigar la recuperación de medicamentos oficialmente caducados a través de análisis y una posible extensión de la vida útil; (v) fortalecer la aplicación de regulaciones sobre la eliminación segura de medicamentos; (vi) invertir en una infraestructura para dicha eliminación, tal vez basada en incineradores de alta temperatura; e (vii) incluir la responsabilidad por parte de los usuarios en relación con los medicamentos caducados en los regímenes de responsabilidad rutinaria seguidos por el sector sanitario público.

Predictors of controlled prescription drug non-medical and lifetime use among patients accessing public mental health services in Uganda: a cross-sectional study.

OBJECTIVES: We determined the prevalence of controlled prescription drug (CPD) non-medical and lifetime use and their predictors among patients at three public psychiatric clinics in Uganda to identify missed care opportunities, enhanced screening priorities, and drug control needs. METHODS: A cross-sectional survey of 1275 patients was performed from November to December 2018. Interviewer-administered semi-structured questionnaires, desk review guide and urine drug assays were employed. Questionnaire recorded CPD non-medical and illicit drug use history from patients' files, CPD lifetime use and risk factors. Desk review guide recorded recently prescribed drugs in patients' files to corroborate with urine assays. Predictors were analysed by multivariate logistic regression. RESULTS: From desk review, 145 (11.4%) patients had history of CPD non-medical use and 36 (2.8%) had used illicit drugs. Of 988 patients who provided urine, 166 (16.8%) self-medicated CPDs, particularly benzodiazepines while 12 (1.2%) used illicit drugs. Of those with drug-positive urine, 123 (69.1%) had no documented history of CPD non-medical and illicit drug use. Being an inpatient (OR=10.90, p<0.001) was independently associated with CPD non-medical use. Additionally, being an inpatient (OR=8.29, p<0.001) and tobacco consumption (OR=1.85, p=0.041) were associated with CPD non-medical and illicit drug use combined. Among participants, 119 (9.3%) reported CPD lifetime use, and this was independently associated with education level (OR=2.71, p<0.001) and history of treatment for substance abuse (OR=2.08, p=0.018). CONCLUSIONS: CPD non-medical use is common among Uganda's psychiatric patients, and more prevalent than illicit drug use. Rapid diagnostic assays may be needed in psychiatric care in resource limited settings. It is necessary to assess how CPD non-medical use impacts mental care outcomes and patient safety. High risk groups like inpatients and tobacco consumers should be prioritised in psychiatric screening.

Evaluation of the Clinical Use of Ceftriaxone among In-Patients in Selected Health Facilities in Uganda.

Ceftriaxone has a high propensity for misuse because of its high rate of utilization. In this study, we aimed at assessing the appropriateness of the clinical utilization of ceftriaxone in nine health facilities in Uganda. Using the World Health Organization (WHO) Drug Use Evaluation indicators, we reviewed a systematic sample of 885 patients' treatment records selected over a three (3)-month period. Our results showed that prescriptions were written mostly by medical officers at 53.3% (470/882). Ceftriaxone was prescribed mainly for surgical prophylaxis at 25.3% (154/609), respiratory tract infections at 17% (104/609), and sepsis at 11% (67/609), as well as for non-recommended indications such as malaria at 7% (43/609) and anemia at 8% (49/609). Ceftriaxone was mostly prescribed once daily (92.3%; 817/885), as a 2 g dose (50.1%; 443/885), and for 5 days (41%; 363/885). The average score of inappropriate use of ceftriaxone in the eight indicators was 32.1%. Only 58.3% (516/885) of the ceftriaxone doses prescribed were administered to completion. Complete blood count and culture and sensitivity testing rates were 38.8% (343/885) and 1.13% (10/885), respectively. Over 85.4% (756/885) of the patients improved and were discharged. Factors associated with appropriate ceftriaxone use were gender, pregnancy status, days of hospitalization, health facility level of care, health facility type, and type of prescriber.