Knowledge, attitude, and practice toward antibiotic use among the general public in a resource-poor setting: A case of Aden-Yemen.

INTRODUCTION: Antibiotic overuse and misuse can cause serious health issues. These problems have contributed to a rise in bacterial resistance. Hence, our study aims to highlight the existing knowledge and attitudes toward antibiotic usage among the general public in Aden-Yemen. METHODOLOGY: A cross-sectional descriptive study of knowledge, attitude, and practice of the general public was conducted in different areas of Aden city-Yemen. The study conveniently selected a sample of 400 general public working in different areas in Aden. Descriptive statistics were used for data analysis. RESULTS: A total of 400 participants were involved in the study. Nearly 88.8% administered antibiotics in all cases of fever, 58.3% thought that antibiotics could cure infections caused by the virus, and 65.5% disagree that antibiotics should be stopped as soon as the complaint disappears. More than 77.5% thought that antibiotics in cases of the common cold are not necessary. However, 46.5% incorrectly thought that "early use of antibiotics in patients with cough, running nose, and sore throat would be cured quickly". Concerning knowledge of antibiotic resistance, 81.5% correctly answered that "overuse of antibiotics increases the risk of resistance. Most respondents reported that physicians were their primary source of information regarding antibiotic use. The most noted among respondents was that 62.7% had antibiotics for treatment without prescription in the last six months. CONCLUSIONS: Respondents have adequate knowledge and moderate attitude toward antibiotic use. However, self-medication was common practice among the general public of Aden. Therefore, they had a misunderstanding, misconception, and irrational use of antibiotics.

Detection of Short-Term Side Effects of ChAdOx1 nCoV-19 Vaccine: A Cross-Sectional Study in a War-Torn Country.

Purpose: The chAdOx1 nCoV-19 vaccine is the first COVID-19 vaccine available in Yemen. Hence, this local-based study was used to identify the type and frequency of short-term side effects following 48 hours of the first shot of the vaccine. Methods: A cross-section of vaccinated participants in Aden were surveyed by telephone. Descriptive statistics were used for statistical analysis. Results: A total of 500 participants were included through convenient sampling. 27% of them were health care providers. Nearly 70% of the respondent experienced side effects. The top three side effects reported were fever (n=276, 55.2%), myalgia (n=270, 54%) and fatigue (n=247, 49.4%). Generally, most participants stated that they experienced the side effects after the first 24 hours of vaccination. Conclusion: Side effects that participants experienced were not different from the literature, indicating a safe profile for the vaccine. Further studies are needed to identify the side effects after the second and third dose of the vaccine. In addition, more studies are required to assess the efficacy of the existing vaccines against new variants.

Teaching Pharmacovigilance to Undergraduate Students: Our Experience in Poor-Resource Setting.

Using medicines associated with adverse drug reactions (ADRs) might cause serious health complications. The pharmacist plays a unique role in monitoring ADRs, either by themselves or with the assistance of other health-care professionals, to diminish the hazards of ADRs by distinguishing, reporting, and evaluating any proposed ADRs. To train future pharmacists who have adequate knowledge of ADRs and related aspects, it is highly recommended to introduce the WHO-ISoP pharmacovigilance (PV) in the core curriculum. In this article, we shared the suggested curriculum in Aden University. It is based on comprehensive outlines and reference books that offer a broad view of all aspects related to PV. A brief student course evaluation was carried out. Fifty students participated in the survey. Students expressed the importance of the course and indicated that they wanted to know more about the types of ADRs and common medication errors. Some of them lacked an understanding of the causal relationship between ADRs and risk assessment and not familiar with the reporting forms. They suggested for PV awareness programs for health-care staff and public. The curriculum should be tailored according to the country's needs because each country has its own medication safety issues and PV program. To reach the ultimate objective, this article reports the initiative to develop PV proficiencies in a university setting.

An insight into the pharmaceutical sector in Yemen during conflict: challenges and recommendations.

In our world today, we need to understand, measure, and respond to inequality. The conflict and siege in Yemen have caused serious repercussions and consequences for the pharmaceutical sector and health of the people. Hospital, health centres and facilities, medicines warehouses and pharmaceutical factories have been destroyed. Further, the conflict has aggravated the health situation with shortages of medicines, an increase in chronic illnesses, and multiple epidemics and casualties. This article aims to highlight the challenges faced by the pharmaceutical sector in Yemen. It will address the overall state of health of the Yemeni people, as well as focus on the past, current status and future development of the pharmaceutical sector. Further, it will focus on possible remedial actions to solve some of these problems. These problems can be tackled if the responsible parties have the political will to do so. Acknowledging the different classes of problems is undeniably very important to provide clarity on the future of Yemen's supposedly promising pharmaceutical landscape.

Antimicrobial Resistance Profiles for Different Isolates in Aden, Yemen: A Cross-Sectional Study in a Resource-Poor Setting.

BACKGROUND: There is a rapid deterioration in the effectiveness of antibiotics due to the global prevalence of bacterial antimicrobial resistance (AMR). AMR can cause an increase in mortality and morbidity due to treatment failures and a lack of effective therapy. OBJECTIVE: The purpose of this study was to evaluate the AMR pattern of different bacterial isolates at hospitals and laboratories. MATERIALS AND METHODS: A cross-sectional study from March 2019 to June 2019 was conducted at different governmental and private hospitals and laboratories in Aden, Yemen. Age, sex, specimen type, bacterial isolates, and antibiotic susceptibility pattern were collected using a data extraction sheet. Descriptive statistics were used for data analysis. RESULT: Data were recorded for 412 patients from whom 20 clinical specimens were collected and analyzed. The most common bacteria isolated were Staphylococcus spp. (n = 172, 41.74%), E. coli (n = 164, 39.80%), Pseudomonas spp. (n = 37, 8.98%), and Klebsiella pneumoniae (n = 18, 4.36%); other bacteria were less common. The overall bacterial resistance was highest against the combination of sulfamethoxazole with trimethoprim (73.12%), followed by amoxicillin and clavulanate (65.19%). The cephalosporin antibiotics also showed high resistance rates. The study also showed moderate bacterial resistance to gentamycin (32.65%), azithromycin (29.92%), cefoxitin (62.65%), and ciprofloxacin (25.60%). Ertapenem (16.67%) and levofloxacin (15.56%) had the lowest resistance rates. CONCLUSION: There was a high percentage of bacteria resistant to several antibiotics. Antibiotic susceptibility testing is a prerequisite guide for the selection of appropriate antibiotic therapy for bacterial infections.

Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen.

BACKGROUND: Medicine and medical supplies are often in short supply in countries suffering from the scourge of conflict. Effective medicine supply policies are lacking in many low- and middle-income countries (LMICs), particularly during conflict. This study aimed to assess the availability of essential medicines in both the public and private healthcare sectors. METHODS: The study was conducted by administering a survey from November 2017 to February 2018 using the World Health Organization/Health Action International (WHO/HAI) guidelines and methodology. Thirty healthcare facilities in thirteen districts from three governorates in Yemen were included in the assessment of thirty essential medicines. The results were reported as frequencies and percentages of outlets with available medicines on the day of data collection. RESULTS: A set of 30 vital and essential medicines were selected from the list of essential medicines that are used in healthcare centers in Yemen to treat prevalent diseases. In general, only 52.8% of the selected medicines were available in public and private healthcare settings. The distribution and availability of medicines in the three governorates were approximately equal. The availability of medicines was better in the private healthcare settings, specifically 73.3% in private hospitals and approximately 79.7% in private pharmacies. CONCLUSIONS: The availability of essential medicines during this state of conflict in three governorates in Yemen is low, in both public and private hospitals and healthcare centers. Many of the medications that were not available are used to treat chronic illnesses.

Knowledge and Attitudes on Khat Use among Yemeni Health Sciences Students.

Background: Khat chewing has a negative impact on an individual's life. Objectives: The study was execute to assess health sciences students' knowledge and attitudes regarding khat use in Yemen. Methods: This survey involved health sciences students from Aden University. Approximately 500 participants were selected through convenience sampling. The data were collected using a structured and validated self-administered questionnaire. The data were tabulated and descriptively analyzed. Results: The total number of respondents was 500. Almost half of the students reported that they chewed khat (n = 239, 48%). Approximately 66% (n = 330) of the students spent 2000 Yemeni riyals or less (USD1 = YER249.9) per day on khat. The main reasons for chewing khat were 'it is a social habit' (n = 155, 31%), followed by 'it improves my concentration when studying or working' (n = 140, 28%). Students knew that the effects of khat are similar to those of amphetamines (n = 210, 42.0%) and that khat is addictive (n = 254, 50.8%). Additionally, they knew that cathinone is the dependence-producing constituent of khat leaves (n = 269, 53.8%). The students agreed with the following statements: 'I will advise people to cease khat use'; 'Khat chewing is harmful to health'; 'Children and adolescents should not chew khat'; 'Khat chewing helps people stay awake'; and 'Health professionals serve as role models for patients and the public'. Conclusions: Khat chewing is prevalent among Yemeni university health sciences students. Only about half of the students recognized health risks associated with khat use. Also, among those who used khat, students endorsed positive benefits such as improved concentration.

Attitudes and practices of community pharmacists and barriers to their participation in public health activities in Yemen: mind the gap.

BACKGROUND: Patients in Yemen commonly visit community pharmacies to obtain consultation or treatment for common ailments. Community pharmacists have an opportunity to optimize medication use and improve patient outcomes. This study aimed to evaluate the attitudes and practices of community pharmacists regarding their participation in public health activities and barriers to their participation in these activities. METHODS: This cross-sectional study was carried out among community pharmacists working in pharmacies located in urban areas of the Aden governorate of Yemen from March to June 2017 using a self-administered questionnaire. We selected pharmacies from a line list using proportional sampling according to the number of pharmacies in the urban areas of each district. The questionnaire contained four sections: demographic characteristics, attitudes, practices, and barriers encountered. Data were analyzed descriptively, and the Chi-square test was used for analyzing the association of variables (alpha = 0.05). RESULTS: The questionnaire was distributed to 200 community pharmacists working in community pharmacies. Of the 200 respondents, 62% (n = 124) were male. Overall, the mean age (sd) was 30.0 years (8.6) with the number of years of work experience between 2 and 9.9 years (n = 158, 79%). On average, 62.3% of the pharmacists had a positive attitude toward participation in public health activities. Providing education to stop tobacco chewing, smoking, alcohol drinking and improve oral hygiene was an important activity of the community pharmacists. Blood pressure measurements (86%, n = 172) and glucose tests (45%, n = 90) were commonly conducted for clients. Lack of time (71%, n = 142) and lack of teamwork (70%, n = 140) were mentioned as common barriers to participation in public health activities. CONCLUSIONS: Community pharmacists had a positive attitude toward public health activities. Health education and routine health tests were important practices of the community pharmacists. Barriers need to be overcome to enable more active participation by community pharmacists in public health activities by consulting with all stakeholders, assessing the situation, considering alternatives and taking action.

Knowledge and Perception about Pharmacovigilance among Pharmacy Students of Universities in Sana'a Yemen.

INTRODUCTION: Pharmacists in community or hospital setting play a key role in reporting Adverse Drug Reaction (ADRs) during practice. Under reporting is considered as a profession malpractice worldwide. AIM: To determine the level of knowledge and perception about phramacovigilance and ADRs reporting among final year pharmacy students of Universities in Sana'a Yemen. MATERIALS AND METHODS: A cross-sectional study design was conducted among 385 final year pharmacy students. One public and four private universities were selected randomly using a validated self-administered questionnaire. The questionnaire contained data about student demographic data, knowledge and perception about the ADRs. The data was analysed by SPSS program and Chi-square tests were used to assess the significance of association. RESULTS: The male students were more knowledgeable than female (p=0.035), as well as private university students had better ideas on how to report ADRs than public university students (p=0.009). Private university students reported that pharmacovigilance topic is well covered in their curriculum compared to public university students (p≤0.001). A significant difference was seen amongst the students of public and private universities when asked about reporting ADRs in future, former found more confident (p≤0.001). Furthermore, the private university students also had more command on the concept of post-marketing surveillance than public university students (p≤0.001). The private university students in Yemen were more known to causality assessment of ADRs as compared to the students of public universities (p≤0.001). The results of perception revealed regarding perception toward ADRs and pharmacovigilance. Female students (p≤0.018) and private universities students (p≤0.001) had positive perception than male and public university students respectively. CONCLUSION: The findings showed poor knowledge among students in Sana'a Universities and positive perception towards pharmacovigilance and ADRs reporting. A poor knowledge among the future pharmacists suggests need for educational interventions and improvement of strategies to ease the reporting mechanisms. Steps can be taken to improve pharmacovigilance tools and methods in Yemen as well as incorporating subjects of pharmacovigilance in the health faculty's curriculum in Yemen.

Pharmacovigilance system in Saudi Arabia.

Pharmacovigilance plays an important role in ensuring that patients are receiving safe drugs. In Saudi Arabia, Saudi Food and Drug Authority, health institutions, marketing authorization holders and healthcare professional are involved in pharmacovigilance activities regardless of the level of the involvement. Although pharmacovigilance is well established in developed nations and it is considered a new concept in Saudi Arabia. It is a collective effort from various stakeholders to make pharmacovigilance successful toward promoting safe and effective use of medicines among the population. However, the practice of pharmacovigilance still needs more attention especially from marketing authorization holders and healthcare professionals. The aim of this review was to describe the current situation of pharmacovigilance in Saudi Arabia and the activities that have been conducted by the stakeholders.

Perceived Stress among Malaysian Railway Workers.

BACKGROUND: Stress is a common work-related problem worldwide. Railway workers are predominantly stressed due to their rigid protocols and limited rest opportunities. This study aimed to determine the level of, and factors associated with, stress among railway workers in Malaysia. METHODS: A cross-sectional study was conducted among all 729 railway workers employed at Keretapi Tanah Melayu Berhad (KTMB) in eight states in Malaysia via a postal survey. The self-administered questionnaire consisted of socio-demographic characteristics and the validated Malay version of Perceived Stress Scale-10 (PSS-10). Response rate was 70.4% (513/729). RESULTS: Mean (SD) age of workers was 41.4 (10.7), with the majority aged 30 years or older (79.3%). Mean (SD) perceived stress was 18.8 (4.3). In multiple linear regression analysis, the significant predictors of high stress were high school versus tertiary education (ß = 0.10, 95% CI 0.11, 1.73, P = 0.027) and being a white collar worker versus blue collar (ß = 0.113, 95% CI 0.10, 1.74, P = 0.010). CONCLUSIONS: Education level and type of work were significantly associated with perceived stress among railway workers in this study.

Need for involving consumers in Nepal's pharmacovigilance system.

In Nepal, reporting of adverse drug reactions (ADRs) occurs on a voluntary basis by doctors, pharmacists, nurses, health assistants, and other healthcare professionals. The country's pharmacovigilance program is still in its infancy; it has limited coverage and underreporting is common. This major limitation could be reduced with consumer involvement. This report examines the necessity and benefits of consumer involvement in Nepal's existing pharmacovigilance program, reflecting on existing examples of consumer pharmacovigilance in different countries to highlight the necessity for such a framework in Nepal.

Do Health Professionals have Positive Perception Towards Consumer Reporting of Adverse Drug Reactions?

AIM: The aim of this study was to evaluate the perceptions of general practitioners (GPs) and community pharmacists (CPs) in Penang, Malaysia, towards consumer reporting of Adverse Drug Reactions (ADRs). METHODOLOGY: A cross-sectional mail survey was adopted for the performance of the study. Survey questionnaires were sent to 192 CPs and 400 GPs in the state of Penang, Malaysia. Reminders were sent to all the non-respondents after 3 weeks of the initial mailing. Data which were collected from the questionnaires were analyzed by using the Statistical Package for Social Science (SPSS), version 15. The Chi-square test was used to determine as to whether there was any significant difference between expected and observed frequencies at the alpha level of 0.05. RESULTS: Only 104 respondents (47 CPs and 57 GPs) returned the survey, with a response rate of 18.0%- a figure which could be considered to be low. This study indicated that GPs and CPs were aware about the importance and benefits of consumer reporting. A majority of them (88.0%) thought that consumer reporting would add more benefits to the existing pharmacovigilance program. Similarly, 97% of the respondents agreed that reporting of ADRs was necessary and 87.0% respondents had seen ADRs among their patients. However, 57 of them (6.0%), had not been aware that the national program in Malaysia allowed consumers to report ADRs. A majority of them (97.0%) agreed that consumers needed more education regarding ADR reporting. Most of them (84.0%) thought that consumers could not write valid reports which were similar to reports which were made by healthcare professionals (HCPs). A majority of the respondents (68.0%) had not heard about the consumer reporting program in Malaysia and half of them did not believe that consumer reporting could overcome under-reporting, which was the main problem of the national pharmacovigilance program in Malaysia. CONCLUSION: The GPs and CPs were aware about the importance and benefits of consumer reporting. Such reporting will add more benefits to the existing programmes in Malaysia, although the barrier that we are facing now is the doubt that they hold over patients' ability to write valid reports which are similar to reports which are made by healthcare professionals (HCPs). Therefore, the consumers need to be educated more about their medications, on how to validate any complaints that they had about the drug consumption and on how to file a proper report and channel it to the 'right' person or bodies. Equally importantly, the media and the non-governmental organizations (NGOs) should play an important role in determining the success of consumer reporting.

Developing a consumer reporting program in Malaysia: a novel initiative to improve pharmacovigilance.

The national pharmacovigilance program in Malaysia is limited to very few centers and under-reporting of adverse drug reactions (ADRs) is a major limitation. Studies from developed countries have documented the importance and usefulness of consumer reporting of ADRs. Involving consumers in ADR reporting can be very useful in improving the reporting rates in Malaysia. The present article highlights the proposed plan of initiating a consumer based pharmacovigilance program in University Wellness Center located inside the campus of the Universiti Sains Malaysia, Penang, Malaysia.