Quality of Antimalarial Drugs in East Africa: A Systematic Review.

Background: The use of poor quality drugs will have multiple consequences with an extended hazard of growing drug-resistant strains. Purpose: The review aimed to provide the quality status of antimalarial drugs in East Africa. Data Source: PubMed, Scopus, Web of Science, and Google Scholar were searched from September 5 to September 12, 2021. Study Selection: The review included articles available as original research targeted at evaluating the quality of antimalarial drugs. For inclusion, data on at least one of the following quality control parameters were required: packaging and labeling, hardness, friability, weight variation/uniformity of weight, disintegration, dissolution, and assay/percentage purity. Mendeley citation manager version 1.19.4 was used to avoid duplication and organize references, and titles and abstracts were primarily used for screening. Data Extraction: The sample collection site, drug name, and the quality control parameters tested were retrieved from the selected studies. Data synthesis:  Totally, 300 antimalarial drug samples from Ethiopia, Kenya and Tanzania were included in this review. No antimalarial drug tested failed the identification and disintegration test. However, 15.93% (36/226), 5.00% (15/300), and 1.90% (3/158) of antimalarial samples failed the dissolution, assay and mass uniformity test, respectively. Moreover, amodiaquine and sulfadoxine/pyrimethamine samples failed dissolution and assay tests. In addition, amodiaquine samples failed the mass uniformity test. However, artemether/lumefantrine and quinine passed all quality control parameters tested. Overall, 19.67% (59/300) of antimalarial drug samples did not meet at least one quality control parameter. And the higher faller rate was reported for sulfadoxine/pyrimethamine accounting for 52.86% (37/70). Conclusions: An unneglected amount of antimalarial drug failed to meet at least one quality control parameter. Strengthening pharmaceutical management systems, including post-marketing surveillance, and providing the resources required for medication quality assurance, are recommended.

Development of constructs to measure client satisfaction with pharmacy services in resource-limited settings. A multicenter cross-sectional study.

BACKGROUND: Satisfaction with pharmacy services has many implications, including the degree of interaction with health care providers, the type and quality of service provided, and the extent to which needs and desires are met. This study aimed to identify the dimensions of pharmacy services and quantify client satisfaction with them. METHODS: A quantitative cross-sectional study was employed to guide this study. Data were entered into Epi Data, exported to SPSS 26.0, and analyzed using exploratory factor analysis to identify the underlying dimensions of pharmacy service. The study was conducted between 14th August 2020 and 28th December 2020. For standardization and comparison purposes, items loaded onto each dimension were computed and rescaled, and descriptive statistics were used to summarize the results. Stepwise linear regression was performed to quantify the contribution of each dimension to overall satisfaction and to identify determinant variables for overall satisfaction. A 95% CI, and a P-value of < 0.05 were used for the declaration of statistical significance. RESULTS: The mean overall satisfaction with pharmacy service was found to be (21.62±6.74)/30. There were eight dimensions of pharmacy service identified, and poor customer satisfaction was recorded for the premises and supply dimensions, with mean satisfaction of (12.08±8.49)/30 and (13.66±10.06)/30, respectively. The highest mean satisfaction was recorded with waiting time (24.24±6.54). Of the emergent dimensions, only four (supply, compassion and care, privacy, and premises) were predictors of overall satisfaction (P<0.05). The supply component was the strongest predictor of overall satisfaction, accounting for 20% of the variance in overall satisfaction. The number of prescribed and dispensed pharmaceuticals, marital status, and gender of participants also predicted overall satisfaction (P<0.05). CONCLUSION: The survey uncovered eight underlying aspects of pharmacy services that influence client satisfaction. A significant gap was recorded with premises and supply chain-related components. These dimensions' contributions to total satisfaction were substantial in terms of practical relevance. As a result, improving the availability of pharmaceuticals and the infrastructure surrounding pharmacy services may enhance consumer satisfaction considerably. Stakeholders must work on addressing supply related and premises difficulties to increase client satisfaction.

An analysis of COVID-19 information sources.

BACKGROUND: The COVID-19 pandemic has brought new situations that require the effective delivery of health information across the world and it's important to offer clear, consistent, and credible information on the pandemic to mitigate and control the outbreak. AIM: To assess COVID-19 information source, need and trust among the rural community of southwest Ethiopia. METHODS: A community-based cross-sectional study design was conducted among 634 rural communities of southwest Ethiopia. The data were collected by interviewing individuals from selected households and analyzed by SPSS version 26. A multivariable logistic regression model was used to assess factors affecting information needs. RESULTS: Radio 484 (76.3%) was mostly used as a source of information for COVID-19, and government 404 (63.7%) and health professionals 345 (57.7%) were trusted. However, only 10 (1.6%) of the participants acquired information from health professionals. Around 395 (62.3%) of the participants needed additional information on COVID-19. Around 230 (58.2%) and 186 (47.1%) of the participants required additional information on cause and sign and symptoms, respectively. Age of < 45 years old (AOR: 2.11, 95% CI: 1.43, 3.12, P < 0.001), and absence of formal education (AOR: 2.00, 95% CI: 1.35, 2.95, P: 0.001) were factors positively affecting the information needs of the participants on COVID-19. Church goers (AOR: 3.24; 95% CI: 2.03, 5.19; P < 0.001), television (AOR: 2.39; 95% CI: 1.63, 3.49; P < 0.001) and social media users (AOR: 4.52; 95% CI: 2.26, 9.04; P < 0.001) as source of information required additional information on COVID-19, and the participants that trusted social media (AOR: 2.52; 95% CI: 1.64, 3.87; P < 0.001) and friends/relatives (AOR: 2.95: 95% CI: 1.51, 5.76; P < 0.001) were also required additional information on COVID-19. CONCLUSIONS: The popular sources of COVID-19-related information were radio and television. The participants trusted the government and health professionals on COVID-19. However, less than 2% of the participants had information from health professionals. The majority of the participants wanted to learn more about COVID-19. The areas the participants required additional information include cause and signs and symptoms. Age, educational status, trust in social media, trust in friends, using the church, television and social media as a source were factors associated with information needs.

COVID-19 vaccines: awareness, attitude and acceptance among undergraduate University students.

BACKGROUND: The myths and conspiracy theories on the COVID-19 vaccine cause people to be hesitant and maleficent towards the vaccine. OBJECTIVES: To assess COVID-19 vaccine-related awareness, attitude and acceptance and to assess reasons for refusing the vaccine among undergraduate Jimma University Institute of Health students. METHODS: A cross-sectional study was conducted among 387 undergraduate students of Jimma University Institute of Health. Self-administered questionnaires were used to collect the data and summarized by descriptive statistics. A multivariable regression model was used to assess predictable variables for good awareness and positive attitude. A p value of < 0.05 was used to declare the statistical association. RESULTS: Only 41% of the students had a good awareness of the COVID-19 vaccine, and more than half, 224 (57.9%) of them had a positive attitude towards the COVID-19 vaccine. Age [(AOR: 95% CI) 1.18 (1.03, 1.35)] and having good awareness [(AOR: 95% CI) 2.39 (1.55, 3.68)] were associated with positive attitude of students towards the COVID-19 vaccine. However, only 27.1% of the students were willing to take the vaccine for COVID-19. Afraid of long term effects (49.1%), not being convinced of the safety standards (38.8%), lack of information about the vaccine (37.2%), and too short time for development (39.9%) was common reasons for refusing the COVID-19 vaccine. CONCLUSIONS: According to the present study, the majority of the participants had a positive attitude towards COVID-19 vaccine. However, only less than half of the participants had a good awareness of the vaccine. In addition, the acceptability of the vaccine is low. Afraid of long term effects, not being convinced of the safety profile, lack of information about the vaccine, and the time used for the development were the common reasons for refusing the vaccine. Therefore, all stakeholders are advised to increase awareness, positive attitude, and acceptance of the vaccine.

Active TB infection and its associated factors among HIV-1 infected patients at Jimma medical center, Southwest Ethiopia.

BACKGROUND: Human immune deficiency virus (HIV) increases the susceptibility to primary infection or reinfection and the risk of tuberculosis (TB) reactivation for patients with latent TB. There was no current report on the rate of active TB infection among HIV-1 infected patients in our teaching and referral hospital. Therefore, this study was aimed to determine the prevalence and factors associated with active TB infection among HIV-1 infected patients. METHODS: Hospital-based retrospective cross-sectional study was conducted at the Anti-Retroviral Therapy (ART) chronic follow-up clinic. Systematic random sampling was used to include the patients. A structured questionnaire was used to collect data. Data were analyzed using SPSS version 25. Descriptive statistics were used to describe the findings and multivariate logistic regression was performed to identify factors associated with active TB infection. RESULT: 150 HIV-1 infected patients (female 54.7%) were included. The median (interquartile range, IQR) age of the patients was 33.5 (25.7, 40.0) years. Twenty-six (17.3%) of the patients had developed active TB infection, which was independently associated with the WHO clinical stage III and IV (AOR: 9.67, 95% confidence interval (CI); 2.21-42.37), p = 0.003). The use of isoniazid preventive therapy (IPT) (AOR: 0.123, 95CI; 0.034-0.44, p = 0.001) and having good adherence to ART medications (AOR: 0.076, 95CI; 0.007-0.80, p = 0.032) was associated with the reduced risk of active TB infection among HIV-1 infected patients. CONCLUSIONS: Advanced WHO clinical stages increased the risk of active TB infection, while the use of IPT and good adherence to ART medications reduced the risk of active TB infection. Therefore, patients with advanced WHO clinical stage should be screened for TB infection, and starting IPT for the candidate patients should be strengthened to reduce the burden of active TB incidence. ART medication adherence should also be supported.

Health Extension Workers Knowledge and Associated Factors on Child Immunization in Bako Tibe, West Shewa, Oromia, Ethiopia: A Cross-Sectional Study.

PURPOSE: To assess health extension workers knowledge of child immunization schedules and associated factors. METHODS: A cross-sectional study design was conducted among health extension workers working in Bako Tibe Woreda. The data were collected by using semi-structured questionnaires, and descriptive statistics were used to summarize the data. Chi-square (χ 2) was used to identify factors associated with the knowledge of health extension workers on the immunization schedules. RESULTS: The response rate of the study was 92.1% (58/63). All of the health extension workers included in the study were females. The majority of health extension workers 45 (77.59%) had satisfactory knowledge of the child immunization schedule. Educational status (χ 2 = 11.05; P= 0.001), work experience of as health extension workers (χ 2 = 6.22; P= 0.045), on job training on immunization (χ 2 = 11.12; P= 0.002), marital status (χ 2 = 6.30; P= 0.019) were factors associated with health extension workers knowledge. CONCLUSION: The majority of health extension workers had satisfactory knowledge of the child immunization schedule. Educational status, work experience as health extension worker, on job training on immunization, and marital status were factors associated with the knowledge of health extension workers on the child immunization schedule.

Quality Evaluation of Ethambutol Hydrochloride Tablet Batches Available in Governmental Health Facilities of Jimma Town, Southwest Ethiopia.

BACKGROUND: The availability of poor-quality drugs on the drug market might favor the ineffectiveness of the drug and/antimicrobial resistance. AIM: To evaluate the quality of similar batches of ethambutol hydrochloride tablets available in different governmental health facilities of Jimma town, southwest Ethiopia. METHODS: The World Health Organization checklist was used to inspect the storage area of health facilities and check medicines for the sign of counterfeit. The test was conducted as per the United States Pharmacopeia on six similar batches of ethambutol hydrochloride sampled from different governmental health facilities. Data were analyzed using SPSS version 20, and one-way ANOVA was used for comparing the dissolution profile and weight variation of batches. RESULTS: Three health facilities did not comply with the storage area specifications for pharmaceuticals. No batches have shown any sign of counterfeit. All of the tablet batches tested complied with USP specifications for weight variation, percentage purity, and dissolution test. Conclusions and Recommendation. The entire tablet batches complied with the World Health Organization specification for packaging and labelling of pharmaceuticals. All tablet batches complied with the test for weight variation, purity of drug substance, and dissolution. Since some health facilities did not comply with at least one specification for storage of pharmaceuticals, regulatory agencies and stack holders are advised to inspect the health facilities to ensure appropriate storage of pharmaceuticals in health facilities.

Dissolution Profile Evaluation of Eight Brands of Metformin Hydrochloride Tablets Available in Jimma, Southwest Ethiopia.

BACKGROUND: Dissolution is the critical quality control parameter and used to predict an in vivo oral bioavailability, and it is used to support bio-waiver. AIM: To evaluate and compare the dissolution profile of eight brands of metformin HCL 500 mg tablets available in Jimma town, Southwest Ethiopia. METHODS: The study was conducted in Jimma town, Ethiopia. Eight (seven brands and one comparator) metformin HCL 500 mg tablets were included. The dissolution study was conducted as per United States Pharmacopeia, and the dissolution profile was compared by one-way ANOVA, model-dependent and model-independent approaches. RESULTS: All of the included tablet brands complied with single-point dissolution study specification. Statistical comparisons of the dissolution profile by one-way ANOVA revealed that all brands had similar dissolution profiles (p=0.89). All of the brands had a similarity factor (f2) >50% and the difference factor (f1) <15. The entire brands followed the Weibull curve approach (the highest coefficient of determination and lowest Akaike Information Criteria) for the release of an active pharmaceutical ingredient. CONCLUSION: All of the brands complied with single point dissolution study and all of them could be used interchangeably with the innovator drug. All brands followed the Weibull method for the release of the drug substance.