ABSTRACT
Healthcare systems in resource-limited nations have been challenged by the shortage of essential medicines. This study explores cefazolin access and uses history in the Ethiopian healthcare delivery system, for possible policy implications. An exploratory qualitative study was conducted from July to August 2021. Semi-structured questions and observation guides were used to extract necessary data from people, documents, and field visits to hospitals, government supply agencies, and pharmaceutical business firms. The data were transcribed, coded, organized into themes, and presented. Cefazoline is the recommended first-line surgical antibiotic prophylaxis (SAP) in the Ethiopian Standard Treatment Guideline (STG) and is included in the national Essential Medicine List (EML). However, it was not available for use in the Ethiopian pharmaceutical markets for years. While the shortage might stem from supply-demand mismatches, multiple unknown issues exist in the background of the shortage. This is evidenced by the removal of cefazolin from the recent government procurement list regardless of the recommendation set in the national EML and STG. This study found a historic shortage of cefazolin in Ethiopian healthcare settings. This implies that the antibiotic availability in the pull market may not reflect required usage at facilities for several reasons including the misalignment of national guidelines and national procurement processes, and miscommunication between pharmacies and clinicians at sites on drug availability. Changing the essential medicines list and/or procurement requests without active review of the supply chain system and prescribing practices at facilities can lead to the elimination of necessary antimicrobial agents from the national public health sector supply.
ABSTRACT
Hydatidosis is a parasitic disease caused by Echinococcus granulosus, which affects children in many different parts of the world. It commonly affects the lungs and the liver of the children. Brain hydatidosis is an extremely rare clinical condition in the pediatric population, presenting with non-specific symptoms and signs. The diagnosis of intracranial hydatid cysts can be established by brain magnetic resonance imaging and histopathological examination of the specimen. Here, we report an 8-year-old female child diagnosed with a temporoparietal brain hydatid cyst. Brain magnetic resonance imaging showed a thin-walled cystic lesion located in the right temporoparietal lobe with significant mass effect and midline shift, with no abnormal wall or solid enhancement, and no surrounding edema. The diagnosis of brain temporoparietal hydatid cyst was made radiologically. The patient was operated on and the cyst was completely removed without rupture. The removed cyst was sent for histopathological examination; the histological sections showed a laminated acellular cyst wall with a nucleated germinal layer and no protoscolices, and the diagnosis of temporoparietal brain hydatid cyst was confirmed. The patient had a smooth postoperative course, started albendazole therapy, and was discharged with improvement.
