Prevalence of medication adherence among adult asthmatic patients in four African countries: A systematic review and meta-analysis.

Non-adherence to medications has many deleterious effects including poor treatment outcomes, increased economic burden, increased morbidity, hospitalization rate, health care utilization, productivity loss, and mortality. Therefore, this review aimed to estimate the pooled prevalence of medication adherence among asthmatic adults in 4 African countries. Primary studies were extensively searched from databases such as PubMed, HINARI, Cochrane Library, CINHALand, Google Scholar, and Google search engines. After screening and assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of medication adherence among adult asthmatic patients in Africa. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test. A sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The review was performed among 16 studies of which 14 were cross-sectional with a total of 4019 participants. The pooled random effects prevalence of adherence to medications among adult patients with asthma in Africa was 39% (95% CI: 32, 47; p < 0.001) with a heterogeneity (I2 = 94.82, p < 0.001). The pooled prevalence of medication adherence among adult asthmatic patients in Africa is low. Researchers should conduct further multicenter longitudinal studies by using objective methods of adherence measurement.

Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis.

BACKGROUND: Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. METHODS: A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. RESULTS: Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. CONCLUSIONS: Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.

Assessment of Drug Use Pattern Using WHO Core Prescribing Indicators at Outpatient Settings of Governmental Hospitals in Dessie Town.

BACKGROUND: Enhancing the standards of medical treatment at all levels of the healthcare delivery system can improve the quality of life in developing countries. One method to promote rational drug use is an assessment of drug use pattern based on drug use indicators. OBJECTIVE: To evaluate prescription patterns at the outpatient pharmacy of Dessie Referral Hospital and Boru Meda Hospital at Dessie town. METHODS: An institution-based retrospective cross-sectional study was conducted to assess the prescribing patterns in governmental hospitals of Dessie town from April 1 to May 30, 2019. Six hundred eligible prescriptions were selected from each hospital through a systematic random sampling technique. RESULTS: The result of this study showed that both hospitals used standard prescriptions (100%). Age (99.0%) and name (94.7%) of patients were the most commonly recorded patient information while weight, address of patients and diagnosis were recorded only in 1.1%, 39.2% and 61.3% of the studied prescription papers, respectively. A total 2409 drugs were prescribed in the 1200 prescription papers and the percentage of encounters with injection(s) and antibacterial(s) was 9.0% and 42.6%, respectively. At each hospital, all drugs were prescribed from the Ethiopian essential drug list. CONCLUSION: The present study revealed the use of standard presecription papers at both hospitals. None of the patient-related information was completely written in all prescrptions. For drug-related information, only the name of the drug was written in all prescription papers. There is also a significant deviation from the acceptable WHO standard for prescribing antibiotics.

In vitro Antioxidant and in vivo Wound Healing Activities of the 80% Methanol Extract and Solvent Fractions of Seeds of Brassica carinata A. Braun (Brassicaceae) in Mice.

BACKGROUND: Brassica carinata is one of the traditional medicinal plants used in Ethiopia for the treatment of wounds and other diseases. However, the plant has not been scientifically validated, and thus the present study evaluated the in vitro anti-oxidant and the in vivo wound healing activity of the crude extract and solvent fractions of B. carinata seeds in mice. MATERIALS AND METHODS: The crude extract was prepared by maceration using 80% methanol and formulated as 5% and 10% w/w ointments for topical application. The acute dermal toxicity was performed in female albino rats based on Organization for Economic Cooperation and Development (OECD) guideline number 434. Excision and incision wound healing models were used to evaluate the wound healing activities of crude extract and solvent fractions ointments in mice. Wound healing parameters such as wound area contraction and the period of epithelialization were determined in an excision model, whereas tensile strength was determined in an incision model. Moreover, the crude extract and solvent fractions were evaluated for the free radical scavenging activities in DPPH assay. RESULTS: The acute dermal toxicity test showed that a limit dose of 2,000 mg/kg of 10% w/w crude extract ointment did not cause dermal toxicity in mice. In the excision wound model, the data revealed that 10% w/w ointment exhibited a significant wound contraction (from day 6 to 16, P<0.001) effect with a significant decrease in epithelization period (at day 14, P<0.001). In addition, 5% ointment of the crude extract showed a significant effect in wound contraction (from day 8 onwards, P<0.01) and epithelization period (at day 16, P<0.01). Despite all fractions being shown to promote wound healing, 10% w/w aqueous and ethyl acetate fractions showed a significant wound contraction (P<0.001) effect starting from the 4th day onwards. Besides, the maximum antioxidant activity was seen in the aqueous fraction with an IC50 value of 3.45±0.12 mg/mL. CONCLUSION: The present study demonstrated that the 80% methanol extract and solvent fractions of the seeds of B.carinata possess potential wound healing and anti-oxidant effects, supporting the traditional use of the plant for wound management.

Rational Drug-Use Evaluation Based on World Health Organization Core Drug-Use Indicators in a Tertiary Referral Hospital, Northeast Ethiopia: A Cross-Sectional Study.

BACKGROUND: Irrational use of drugs is often observed in health-care systems throughout the world, particularly in developing countries. The World Health Organization estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately and that half of all patients fail to take them correctly. Therefore, the study was aimed at investigating the practice of rational drug use in a referral and teaching hospital in Northeast Ethiopia. METHODS: A hospital-based cross-sectional design was employed to conduct the study from February 2019 to May 2019. Systematic random sampling was used to select prescriptions dispensed in outpatient pharmacies. Convenient sampling was employed to select patient attendants and their prescriptions in outpatient departments during the study period. Data were collected using a structured and technical observational checklist for prescribing, patient care, and health-facility indicators. Face-to-face interviews were also employed to assess patient knowledge of correct dosage among patient-care indicators. Data were analyzed using SPSS version 20. Descriptive statistics are given using frequency, proportions, and summary measures. RESULTS: An average of 2.5 drugs per encounter were prescribed, with 34.64% and 13.80% of prescriptions being antibiotics and injections, respectively. Generics were used in 90.53% of prescription, and nearly 83% of drugs were prescribed from an essential-drug list. Average consultation and dispensing times were 1.57 minutes and 47 seconds, respectively. A total of 362 drugs were prescribed, with 82.6% actually dispensed and only 22.7% adequately labeled. The hospital had its own drug formulary and essential drug list, but no standard treatment guidelines. Moreover, except propyl thiouracil, all key essential drugs included in the study were available. CONCLUSION: The majority of World Health Organization-stated core drug-use indicators were not met by the referral hospital in this study, which is especially problematic regarding patient-care indicators.

Wound Healing Effect of Acokanthera schimperi Schweinf (Apocynaceae) Methanol Leaf Extract Ointment in Mice and Its in-vitro Antioxidant Activity.

BACKGROUND: Acokanthera schimperi is traditionally used for the treatment of wounds and various bacterial infections. Due to the ongoing escalation of antimicrobial resistance, there is an increasing demand for the appropriate wound care and hence, the present study was initiated to investigate the wound healing effects of the leaf extract ointments of A. schimperi in mice and its in-vitro antioxidant activity. METHODS: The crude extract was prepared as 5% and 10% w/w ointments for topical use in mice. Wound contraction and epithelialization period were determined in excision and infected models, whereas tensile strength was determined in an incision model. Besides, its antioxidant activity was evaluated using the DPPH method. RESULTS: In this study, the 10% w/w extract ointment did not cause toxicity at the 2000 mg/kg limit dose. In the excision model, the 10% w/w ointment exhibited a significant wound contraction effect starting from day 6 to 14 with a complete epithelization shown on day 13. Besides, the 5%w/w ointment showed a significant wound contraction effect starting from day 6 onwards, and a significant decrease in the epithelization period observed on day 16. Conversely, both the 10% w/w and 5% w/w ointments showed significant wound contraction effects starting from day 4 and onwards in the infected model. However, a complete epithelization period was observed on days 14 and 18 in the 10%w/w and 5% w/w/extract ointment treated groups, respectively. In the incision model, the 10% (w/w) and 5% (w/w) extract ointments showed a significant increase in tensile strength by 36.80 and 32.23%, respectively. Moreover, the antioxidant activity of the extract was concentration-dependent with an IC50 value of 5.49± 0.38 µg/µL. CONCLUSION: The potential wound healing effects of this plant may provide a candidate source in the discovery of new drugs for the treatment of wounds.

Antimalarial Activity of Fagaropsis angolensis (Rutaceae) Crude Extracts and Solvent Fractions of Its Stem Bark Against Plasmodium berghei in Mice.

BACKGROUND: A current challenge in malaria control and elimination is the progressive resistance to most antimalarial drugs which necessitates the discovery of new options. Hence, the current study was initiated to investigate the antimalarial activity of the stem bark of Fagaropsis angolensis in mice. METHODS: The test material was extracted using 80% methanol in a cold maceration technique and further fractionated in solvents of varied polarity. Acute oral toxicity was assessed following the OECD guideline no. 425 protocol. Then, the antimalarial activities of the crude extract and the fractions were evaluated in a 4-day suppression test. Rane's test was also used to evaluate the curative potential of the n-butanol fraction that showed the highest effect during the 4-day suppressive test. Parameters such as parasitemia suppression, mean survival time, packed cell volume, rectal temperature, and body weight were determined to establish the activity. RESULTS: The acute oral toxicity test indicated that the plant did not cause any signs of behavioral changes or mortality at 200 mg/kg limit dose. In a 4-day suppression test, a significant dose-dependent reduction in the parasitemia level and prolongation of survival time were observed (p<0.001) in all three doses of the crude extract compared with the negative control. The crude extract also exhibited a significant (p<0.001) protective effect in packed cell volume and rectal temperature decline in all three doses in a dose-dependent fashion compared with the negative control. Among all fractions, the n-butanol fraction displayed the highest effects in all parameters in the 4-day suppression test. In addition, the n-butanol fraction also showed a significant percentage of parasitemia suppression effects at all doses in Rane's test. Furthermore, higher free radical scavenging activity was observed in the n-butanol fraction and the 80% methanol extract. CONCLUSION: This study established that Fagaropsis angolensis had shown potential antimalarial activity as evidenced by the significant effects in the different parameters, upholding its traditional use for the treatment of malaria and laying the foundation for further investigations.

Prescription drug use and potential teratogenicity risk among pregnant women attending maternal and child health clinic of Kemisse General Hospital, Northeast, Ethiopia.

OBJECTIVE: To investigate medications prescribed for pregnant women and their potential teratogenicity risk in Kemisse General Hospital. RESULT: A total of 263 medical records of pregnant women were reviewed, of which 234 pregnant women were prescribed with a total of 430 prescription drugs. The average numbers of drugs per pregnant women was found to be 1.84. Most pregnant women 166 (63.2%) were in the third trimester and more than half of them (51.3%) were multigravida. The maximum number of drugs were prescribed in the second trimester 162 (37.67%) followed by third trimester 143 (33.26%). Supplemental drugs were the most widely used medications 297 (69.07%) and followed by 82 (19.1%) drugs from category B; 54 (12.6%) drugs from category C; and the rest 7 (1.6%) drugs from category D. There was no any drug from category X. Moreover, approximately one third of the pregnant women encountered with drugs from category B, C and D. However, there were no FDA category C and D drugs prescribed in first trimester.