The Need to Establish and Sustain Public Health Emergency Operation Centers for Managing Infectious Disease Outbreaks: Lesson From Response to Louse-Borne Relapsing Fever Outbreak in Jimma, Ethiopia.

The coronavirus disease 2019 (COVID-19) pandemic has provided a great lesson for the globe about the necessity and significance of pandemics-related preparedness in all settings. Public health emergency operation centers play critical roles in preparing for and responding to public health events and emergencies by coordinating and pooling resources. In this article, we aimed to share lessons learnt from the public health response to the louse-borne relapsing fever (LBRF) outbreak coordinated by the emergency operation center established to respond to the COVID-19 pandemic in Jimma, Ethiopia.After the major waves of COVID-19 outbreaks in Ethiopia were over, Jimma University Medical Center (JUMC) reported clusters of louse-borne relapsing fever cases from Jimma Main Prison. Accordingly, Jimma Emergency Operation Center (JEOC) established for the COVID-19 pandemic was immediately alerted and effectively coordinated the overall response.As a result, the outbreak was contained within the prison without spreading to the community and the outbreak ended within a shorter period compared to previous LBRF outbreaks in Ethiopia. This indicates the necessity of establishing and sustaining public health emergency operation centers to prepare for and combat potential future public health emergencies.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital.

BACKGROUND: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however. OBJECTIVE: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. METHODS: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs). RESULTS: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively. CONCLUSIONS: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital / Implantación de servicios de farmacia clínica en los departamentos de un hospital universitario etíope

Background: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however. Objective: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. Methods: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma niversity Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs). Results: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively. Conclusion: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes (AU)

Antecedentes: El ejercicio de la farmacia clínica se ha desarrollado internacionalmente para expandir el papel del farmacéutico más allá de los papeles tradicionales de formulación, dispensación y distribución de medicamentos a papeles más directamente relacionados con los cuidados de los pacientes. Sin embargo, son escasos los estudios de las actividades del farmacéutico clínico en los departamentos en establecimientos de recursos escasos. Objetivo: Evaluar los servicios de farmacia clínica en un departamento de medicina interna del hospital universitario especializado de Jimma. Métodos: El estudio fue realizado en el departamento de medicina interna desde marzo a abril de 2011 en el hospital Universitario especializado de Jimma. El diseño del estudio fue observacional prospectivo donde se documentaron los servicios de atención farmacéutica proporcionados por un farmacéutico clínico a pacientes internados durante un periodo de dos meses. Se documentaron intervenciones como la optimización del uso racional y la aceptación de los médicos de estas recomendaciones. Un equipo independiente (1 internista y 1 farmacólogo clínico) evaluó la significación clínica de estas intervenciones usando un método estandarizado de clasificar los problemas relacionados con medicamentos (PRM). Resultados: Se realizó un otal de 149 intervenciones para 48 pacientes.; de ellos, 133 (83,9%) fueron intervenciones iniciadas por el farmacéutico clínico y 16 (10,7%) fueron iniciadas por otros profesionales de la salud. Los PRM más frecuentes subyacentes a cada intervención fueron medicación innecesaria 36 (24,2%); necesidad de medicación adicional 34 (22,8%); e incumplimiento 29 (19,5%). El tipo de intervención más frecuente fue el cambio de dosis/instrucciones de uso 23(15.4%). La tasa de aceptación por médicos fue del 68,4%. Entre las intervenciones que fueron calificadas de clínicamente significativas, 46 (48,9%) y 25 (26,6%) tuvieron grande y moderada importancia clínica, respectivamente. Conclusión: Envolver a un farmacéutico clínico en el equipo de salud lleva a la optimización clínicamente relevante y aceptada del uso de medicamentos en un establecimiento de recursos limitados. Este abordaje puede, probablemente, generalizarse a otros establecimientos en el país para mejorar los resultados de la medicación (AU)

Pharmacists' journey to clinical pharmacy practice in Ethiopia: Key informants' perspective.

OBJECTIVE: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding and supplying drugs to roles more directly in caring for patients and providing medication consultation to staff. This area of practice is at the infant stage in Ethiopia. The aim of this study was to explore key informants' perspective in the implementation of clinical pharmacy practice in Jimma University Specialized Hospital, Ethiopia. METHOD: A qualitative study was conducted through in-depth interviews with the heads of departments (internal medicine, paediatrics, surgery, nurse, pharmacy, medical director, administration) and pharmacy student representatives. Qualitative data analysis was done after audiotapes were transcribed verbatim and notes were compiled. RESULTS: All of the respondents interviewed express diverse and conflicting perspectives on pharmacists' role, varying from a health-care professional to a business man. Despite this, the current pace of change worldwide takes the professions' mission to that of a provider of clinical pharmacy services. The data ascertained the change in pharmacy practice, and integrating clinical pharmacy services within the health-care system should be seen as a must. Pharmacists should delineate from a business perspective and focus on widening the scope of the profession of pharmacy and should come close to the patient to serve directly. CONCLUSIONS: Although the perception of people on traditional roles of pharmacists was weak, there were promising steps in developing clinical pharmacy practice within the health-care system. Moreover, the results of this study revealed a high demand for this service among health-care providers.

Adherence to medication for the treatment of psychosis: rates and risk factors in an Ethiopian population.

BACKGROUND: Medication-taking behavior, specifically non-adherence, is significantly associated with treatment outcome and is a major cause of relapse in the treatment of psychotic disorders. Non-adherence can be multifactorial; however, the rates and associated risk factors in an Ethiopian population have not yet been elucidated. The principal aim of this study was to evaluate adherence rates to antipsychotic medications, and secondarily to identify potential factors associated with non-adherence, among psychotic patients at tertiary care teaching hospital in Southwest Ethiopia. METHODS: A cross-sectional study was conducted over a 2-month period in 2009 (January 15th to March 20th) at the Jimma University Specialized Hospital. Adherence was computed using both a compliant fill rate method and self-reporting via a structured patient interview (focusing on how often regular medication doses were missed altogether, and whether they missed taking their doses on time). Data were analyzed using SPSS for windows version 16.0, and chi-square and Pearsons r tests were used to determine the statistical significance of the association of variables with adherence. RESULT: Three hundred thirty six patients were included in the study. A total of 75.6% were diagnosed with schizophrenia, while the others were diagnosed with other psychotic disorders. Most (88.1%) patients were taking only antipsychotics, while the remainder took more than one medication. Based upon the compliant fill rate, 57.5% of prescription fills were considered compliant, but only 19.6% of participants had compliant fills for all of their prescriptions. In contrast, on the basis of patients self-report, 52.1% of patients reported that they had never missed a medication dose, 32.0% sometimes missed their daily doses, 22.0% only missed taking their dose at the specific scheduled time, and 5.9% missed both taking their dose at the specific scheduled time and sometimes missed their daily doses. The most common reasons provided for missing medication doses were: forgetfulness (36.2%); being busy (21.0%); and a lack of sufficient information about the medication (10.0%). Pill burden, medication side-effects, social drug use, and duration of maintenance therapy each had a statistically significant association with medication adherence (P ≤ 0.05). CONCLUSION: The observed rate of antipsychotic medication adherence in this study was low, and depending upon the definition used to determine adherence, it is either consistent or low compared to previous reports, which highlights its pervasive and problematic nature. Adherence must therefore be considered when planning treatment strategies with antipsychotic medications, particularly in countries such as Ethiopia.