Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators.

Rational use of medicine (RUM) for all medical conditions is crucial in attaining quality of healthcare and medical care for patients and the community as a whole. However, the actual medicine use pattern is not consistent with that of the World Health Organization (WHO) guideline and is often irrational in many healthcare setting, particularly in developing countries. Thus, the aim of the study was to evaluate rational medicine use based on WHO/International Network of Rational Use of Drugs (INRUD) core drug use indicators in Eritrean National and Regional Referral hospitals. A descriptive and cross-sectional approach was used to conduct the study. A sample of 4800 (600 from each hospital) outpatient prescriptions from all disciplines were systematically reviewed to assess the prescribing indicators. A total of 1600 (200 from each hospital) randomly selected patients were observed for patient indicators and all pharmacy personnel were interviewed to obtain the required information for facility-specific indicators. Data were collected using retrospective and prospective structured observational checklist between September and January, 2018. Descriptive statistics, Welch's robust test of means and Duncan's post hoc test were performed using IBM SPSS (version 22). The average number of medicines per prescription was 1.78 (SD = 0.79). Prescriptions that contained antibiotic and injectable were 54.50% and 6.60%, respectively. Besides, the percentage of medicines prescribed by generic name and from an essential medicine list (EML) was 98.86% and 94.73%, respectively. The overall average consultation and dispensing time were 5.46 minutes (SD = 3.86) and 36.49 seconds (SD = 46.83), respectively. Moreover, 87.32% of the prescribed medicines were actually dispensed. Only 68.24% of prescriptions were adequately labelled and 78.85% patients knew about the dosage of the medicine(s) in their prescriptions. More than half (66.7%) of the key medicines were available in stock. All the hospitals used the national medicine list but none of them had their own medicine list or guideline. In conclusion, majority of WHO stated core drug use indicators were not fulfilled by the eight hospitals. The results of this study suggest that a mix of policies needs to be implemented to make medicines more accessible and used in a more rational way.

Neurobehavioral effects of alcohol in overcrowded male adolescent rats.

Being a critical neurodevelopmental stage that is affected by social conditions, the period of adolescence was chosen as the age of examining possible modification of alcohol neurobehavioral effects by overcrowding. Adolescent male rats (postnatal day 35±1) were subjected to overcrowding and/or injected with ethanol, 2 g/kg, 20% w/v, (i.p.) for one week. 24 h after the last dose, motor, exploratory behavior, sociability and fear responses were assessed using open field, social interaction and defensive probe burying tests, respectively. Wet brain tissue nitric oxide and reduced glutathione contents as well as monoamine levels, namely dopamine, norepinephrine and serotonin, in addition to 5-HIAA were estimated. Overcrowding increased social play and freezing time. Alcohol administration under overcrowding condition impaired sociability and interfered with active fear response. Alcohol in normal or in under overcrowding condition, impaired motor and exploratory behavior and increased anxiety. These results indicate that concomitant exposure of male adolescent rats to overcrowding and alcohol induced adverse behavioral changes.

Influence of protein malnutrition on induction and treatment of inflammation in mice.

Considerable evidence suggests that protein malnutrition (PM) impairs immune function especially cytokine and interferes with the toxicopharmacology of some non-steroidal anti-inflammatory drugs. The present study tries to assess whether PM will affect induction and treatment of inflammation. The study was performed on adult male Swiss mice using the carrageenan-air pouch model. Animals were fed either protein sufficient 20% or protein deficient 8% casein diet starting 3wks before induction of air pouch, 6-days after which the pouch was administered with 1ml carrageenan (2%). Treatment with aspirin (200 mg/kg, p.o.) or diclofenac (20 mg/kg im.) was conducted one hour before the challenge with carrageenan. Six hours after the challenge, the local exudates were collected and subjected for total leukocyte infiltration count and IL-12 assessment. IL-1 beta and nitrate content were estimated in both plasma and air pouch infiltrate. The obtained results showed a reduction in leukocytes and decrease in IL-1 beta level in PM mice. In conclusion, PM slows the inflammatory reaction, and influences the inflammatory process differently especially in the presence of another stimulus.