Eight-year epidemiological study for drug poisoning in Qassim, Saudi Arabia, 2008-2015.

Literature reported drug poisoning as a major cause for visiting emergency departments, with various rates of occurrences across countries, regions, socioeconomic status, and cultures. Therefore, this study was conducted in Qassim to describe the sociodemographic patterns of acute drug poisoning as well as the most common drugs involved. A retrospective method of data collection was used employing medical record review for drug poisoning cases that occurred in the Qassim region during the 8 years from January 2008 to December 2015. Data was collected using a standardized, validated data collection sheet. The study failed to reveal any pattern (either decreasing or increasing) in the number of poisoning cases over time. Most cases (56.2%) of drug poisoning were accidental, caused by analgesics (35%), affected children younger than 5 years of age (41.4%), and occurred via ingestion (99.2%). It can be concluded that as most poisoning cases affected children, this highlights the importance of increasing awareness and educating families about the safe handling and storage of drugs out of reach of children.

Evaluation of medication counseling practice at community pharmacies in Qassim region, Saudi Arabia.

INTRODUCTION: Pharmacists have a unique opportunity to promote good health through assuring the quality use of medicines. One of the most important tools to achieve this is medication counseling. Counseling plays an important role in enhancing medication adherence and optimizing medication therapy. Therefore, for improving the quality of services delivered by community pharmacists, it is essential to assess the current situation of counseling services delivered to patients. AIMS AND OBJECTIVES: To date, there is a paucity of data regarding the quality of counseling services delivered to patients in community pharmacies in Saudi Arabia. This study aims to fill this gap through evaluating the counseling skills and counseling content delivered by pharmacists in a sample of community pharmacies in Qassim region, Saudi Arabia. METHODS: The study was conducted at eleven community pharmacies in Qassim region. A convenient sample of community pharmacies was chosen based on their willingness to participate. To gather information, a form was prepared based on the core and complementary drug use indicators for evaluation of drug use in healthcare settings developed by the WHO. The study was conducted through observing the counseling services performed by the community pharmacists who participated in the study. RESULTS: Two hundred and thirty-five forms were completed in eleven community pharmacies. A total of 44.4% of the counseling skills was found to be performed adequately, while only 20.1% of the counseling contents were performed adequately. CONCLUSIONS: The overall standard of medication counseling services provided to patients to improve usage of their medications, and consequently, their well-being was poor.

Scale development on consumer behavior toward counterfeit drugs in a developing country: a quantitative study exploiting the tools of an evolving paradigm.

BACKGROUND: Although desperate need and drug counterfeiting are linked in developing countries, little research has been carried out to address this link, and there is a lack of proper tools and methodology. This study addresses the need for a new methodological approach by developing a scale to aid in understanding the demand side of drug counterfeiting in a developing country. METHODS: The study presents a quantitative, non-representative survey conducted in Sudan. A face-to-face structured interview survey methodology was employed to collect the data from the general population (people in the street) in two phases: pilot (n = 100) and final survey (n = 1003). Data were analyzed by examining means, variances, squared multiple correlations, item-to-total correlations, and the results of an exploratory factor analysis and a confirmatory factor analysis. RESULTS: As an approach to scale purification, internal consistency was examined and improved. The scale was reduced from 44 to 41 items and Cronbach's alpha improved from 0.818 to 0.862. Finally, scale items were assessed. The result was an eleven-factor solution. Convergent and discriminant validity were demonstrated. CONCLUSION: The results of this study indicate that the "Consumer Behavior Toward Counterfeit Drugs Scale" is a valid, reliable measure with a solid theoretical base. Ultimately, the study offers public health policymakers a valid measurement tool and, consequently, a new methodological approach with which to build a better understanding of the demand side of counterfeit drugs and to develop more effective strategies to combat the problem.

Evaluation of patients' knowledge about their medications: A cross-sectional study in Qassim region, Saudi Arabia.

Background: To authors' knowledge, in Saudi Arabia, information regarding patients' knowledge about their medications is lacking. Objectives: This study aimed to fill this literature gap by assessing patients' knowledge and perceptions about their medications. Design: To achieve the objective of the study, a cross-sectional survey was conducted outside community pharmacies in Qassim region through an exit interview with patients after getting their prescriptions filled or refilled. Methods: A convenient sample of patients was chosen based on acceptance to participate. A form was prepared based on the core and complementary medicines use indicators for evaluation of medicines use in healthcare settings developed by the World Health Organization (WHO). Results: Four hundred forty-three forms were completed. A total of 70% of the indicators of patients' knowledge about their medications were found to be satisfactory, and a total of 89% of the patients were found to have positive perceptions about safety and effectiveness of their medications. Conclusion: Overall, patients' knowledge about their medications was found to be reasonable with exception of the area "information about precautions and possible side effects" which had shown poor patients' knowledge.

Saudi pharmacy students' perceived knowledge and attitude on their role in public health services.

OBJECTIVES: This study aimed to explore the preparedness of pharmacy students to actively participate in public health services by examining their attitude towards and knowledge about the national public health programmes (NPHPs). METHODS: A cross-sectional study was conducted using an online questionnaire survey of the students in Unaizah College of Pharmacy (UCP) and College of Pharmacy Main Campus (CPMC), Qassim University, between October 2019 and February 2020. KEY FINDINGS: A total of 100 out of 125 students responded to the questionnaire at a response rate of 80%. While the majority (77%) of the participants agreed on the necessity for pharmacists to know about the NPHPs, 71% reported they did not learn about National Health Policy in their pharmacy curriculum. Also, a small number of pharmacy students, at 16%, believed that their current knowledge about the NPHPs was sufficient or very sufficient. Lastly, 81% of the participants felt that they had an important or very important role to play in the NPHPs. CONCLUSIONS: The majority of the participants expressed interest in more education on public health during their pharmacy education. Their interest supports the advancement of public health education to facilitate greater involvement of pharmacists in public health services.

Epidemiology of Chemical Poisoning among Adults in Qassim Region: An Eight-Year Study.

Chemical poisoning is considered a common medico-social problem that, in addition to causing extensive morbidity and mortality, dominates the valuable health care service resources. Therefore, this study was conducted to explore the extent and frequency of chemical poisoning events among adults in Qassim region as well as the most common poisoning agents involved. A retrospective method of data collection was used employing medical record review for chemical poisoning cases that occurred in Qassim region during the 8-year period from January 2008 to December 2015. Data were collected using a standardized, validated data collection sheet. The study revealed that there is no steady trend (either decreasing or increasing) of the number of poisoning cases through time. There is a statistically significant association between the type of poisoning agent and gender (χ2 = 14.3104, p < 0.05). Moreover, there is a statistically significant association between the type of poisoning agent and period in years (χ2 = 19.7565, p < 0.05). It can be concluded that poisoning cases are distributed, to some extent, evenly between males and females, with no pattern through time. Educational programs are needed to raise public awareness about poisoning, especially among women.

Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future.

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

Complementary medicine seeking behaviour among infertile women: A sudanese study.

INTRODUCTION: It is not surprising in developing countries with psychological, familial and community pressure to produce child, infertile women, in addition to conventional medicine, seek various traditional methods and religious practices.This study was conducted in Sudan to explore the perspectives of currently married infertile Sudanese women on complementary medicine seeking behaviour with more emphasis on traditional self-management strategies. METHODS: A cross-sectional survey involving 203 infertile women was conducted. Collection of data was performed by means of a specifically designed questionnaire using a convenient sampling method at the women's visits of infertility treatment clinics in Khartoum, Sudan. RESULTS: Findings of the study revealed that 43.3% of participated women had rich experience with infertility self-management strategies, and 65.0% of them used these strategies to treat infertility. Also 59.1% of the participants mentioned unaffordability of modern treatment as a main factor for trying self-management strategies. CONCLUSION: The study revealed women's rich experience and wide use of different types of self-management strategies together with formal infertility health care services either simultaneously or subsequently. Also, unaffordability of formal treatment services was reported as one of the most encouraging factors towards seeking traditional treatment options.

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries.

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs) such as India. Medicine costs are a key issue in LMICs, with typically high patient co-payments. In addition, pharmacists are underutilised in LMICs, including India. However, pharmacist-led educational interventions may improve the care of patients with COPD, as well as reduce medicine costs. Consequently, the objective of this study was to assess the effectiveness of a pharmacist-led intervention in reducing medicine costs. METHODOLOGY: We assessed the impact of a pharmacist intervention on direct medicine costs in COPD patients (medicine costs and pharmacist time) in a randomised controlled study involving an intervention and control group, conducted at a tertiary care teaching hospital in India. RESULTS: The 6-monthly cost of medicines at baseline increased with disease severity, from a maximum of US$29.46 for those with mild COPD to US$63.28 for those with very severe COPD. Substantial savings in medical costs were achieved with the pharmacist-led programme, to a maximum of US$20.49 over 6 months for very severe patients. This equates to a reduction of 30.6% in medicine costs (p < 0.001), reduced to 26.1% when pharmacists' time (US$3.00/patient) was included. CONCLUSION: There could be a key role for pharmacists as educators for COPD patients in LMICs, to improve care and reduce costs, including patient co-payments.

The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia.

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes.Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios.Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively.Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future.

BACKGROUND: There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. OBJECTIVE: Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. OUR APPROACH: Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. ONGOING ACTIVITIES: A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. CONCLUSION: There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future.

BACKGROUND: Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. METHODOLOGY: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. RESULTS: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. CONCLUSION: There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored.

Pharmaceutical Care in the Community Pharmacies of Saudi Arabia: Present Status and Possibilities for Improvement.

Pharmaceutical care can be given in all settings: The community, hospitals, long-term care, and the clinic. However, published literature indicates that there is a substantial barrier to implementing pharmaceutical care programs in community pharmacies. This review was conducted to discover gaps and limitations in pharmaceutical care services in community pharmacies in the Kingdom of Saudi Arabia (KSA). We searched PubMed and other available scientific website databases using the following key words to retrieve the relevant articles: Community Pharmacy, Healthcare System, Pharmaceutical Care, KSA. Two authors independently screened the titles and abstracts of promising articles. They discarded irrelevant studies and retained studies, and reviews that held the promise of relevant data or information. The review revealed that only one out of the four studies conducted in KSA retrieved by the authors reported pharmaceutical care service other than dispensing. The same results were reported in other studies conducted in some developing countries. All pharmaceutical care services were reported in studies conducted in Europe. The authors came to the conclusion that in KSA, dispensing of medicines is the dominant service provided by community pharmacists and that there was very limited if not a total absence of other pharmaceutical care services.

An Examination of Income Effect on Consumers' Ethical Evaluation of Counterfeit Drugs Buying Behaviour: A Cross-Sectional Study in Qatar and Sudan.

INTRODUCTION: There are limited studies on consumer behaviour toward counterfeit products and the determining factors that motivate willingness to purchase counterfeit items. AIM: This study aimed to fill this literature gap through studying differences in individual ethical evaluations of counterfeit drug purchase and whether that ethical evaluation affected by difference in income. It is hypothesized that individuals with lower/higher income make a more/less permissive evaluation of ethical responsibility regarding counterfeit drug purchase. MATERIALS AND METHODS: To empirically test the research assumption, a comparison was made between people who live in the low-income country Sudan and people who live in the high-income country Qatar. The study employed a face-to-face structured interview survey methodology to collect data from 1,170 subjects and the Sudanese and Qatari samples were compared using independent t-test at alpha level of 0.05 employing SPSS version 22.0. RESULTS: Sudanese and Qatari individuals were significantly different on all items. Sudanese individuals scored below 3 for all Awareness of Societal Consequences (ASC) items indicating that they make more permissive evaluation of ethical responsibility regarding counterfeit drug purchase. Both groups shared a basic positive moral agreement regarding subjective norm indicating that influence of income is not evident. CONCLUSION: Findings indicate that low-income individuals make more permissive evaluation of ethical responsibility regarding counterfeit drugs purchase when highlighting awareness of societal consequences used as a deterrent tool, while both low and high-income individuals share a basic positive moral agreement when subjective norm dimension is exploited to discourage unethical buying behaviour.

Counterfeit drug demand: perceptions of policy makers and community pharmacists in Sudan.

BACKGROUND: The counterfeit drug trade has become widespread and has developed into a substantial threat to both the public's health and the pharmaceutical industry. OBJECTIVES: The aim of this study was to seek insights into the determining factors of counterfeit drug purchases among health policy makers and community pharmacists in a developing country. METHODS: In-depth qualitative interviews with Sudanese policy makers and community pharmacists were undertaken in 2 Sudanese states, namely Khartoum and Gadaref. A semistructured interview guide was developed by incorporating information from existing literature. A purposive sample of knowledgeable policy makers and community pharmacists was interviewed. RESULTS: Thematic content analysis of the interviews identified 8 major themes: understanding the term "counterfeit drug," presence of counterfeit drugs in the Sudanese market, vulnerability to counterfeit drugs, price-quality inference, awareness of societal consequences of counterfeit drugs, subjective social norms, difference in vulnerability according to demographic characteristics, and education pertaining to counterfeit drugs. Unaffordability of medicines and desperate need were emphasized by both policy makers and community pharmacists as major influencing factors that increased consumers' vulnerability to counterfeit drugs. CONCLUSIONS: This study concluded that high prices and the unaffordability of medicines have a major role in increasing vulnerability to counterfeit drugs, in addition to lack of knowledge about counterfeiting and the implications of use of these products. Because very limited studies have been conducted in developing countries to explore perceptions about counterfeit drugs, the present study provides information from which policy makers and key stakeholders in the supply chain can benefit.

Newspapers' coverage of contaminated intravenous fluids from an Indian manufacturer distributed by Public Central Medical Supplies in Sudan: lessons to be learned.

OBJECTIVES: This study aims to answer the question whether or not newspapers have a role in decision-making process in non-democratic settings. METHOD: This cross-sectional study has reviewed newspapers' articles published in Sudan about the questioned quality of intravenous fluid imported by Sudan Central Medical Supplies Public Corporation. It covered the period from 17 January 1999 to 8 October 2007. A total number of 310 articles published in 18 newspapers about the topic was retrieved. RESULTS: Of the total number, 165 (53.2%) articles were against the selling of the suspiciously contaminated intravenous fluids from Core Parentral (the Indian manufacturer of the products). The remaining 143 (46.1%) articles are in favor of selling such fluids. CONCLUSION: Health authorities need to have good communication with media. The incident has proven that the lack of this communication is harmful both for the health authorities and for the population.