Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

PURPOSE: The purpose of this study was to assess drug-related problems (DRPs) among ambulatory heart failure (HF) patients attending at medical referral clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted among 344 HF patients. Drug-related problems were classified using modified Cipolle's DRP classification schemes and drug-drug interactions were assessed using Micromedex, up-to-date, and drug.com drug-drug interaction checkers. The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics were used to summarize patients' characteristics. Univariable and multivariable binary logistic regression analysis was performed to identify associated factors with dependent variables. P < 0.05 was considered statistically significant. RESULTS: The mean age of the study participants was 53.38 ± 18.84 years and nearly half (45%) were in the age group of 31-60 years. Drug-related problems were found in 80.8% of HF patients. A total of 416 DRPs were identified. Adverse drug reaction (35.58%) was the top DRPs identified followed by the need for additional drug therapy (30.53%) and ineffective drug therapy (26.9%), respectively. Diuretics (45%), beta-blockers (BBs) (12.42%), and angiotensin-converting enzyme inhibitors (ACEIs) (10%) were the commonly used drug classes by study participants. The presence of comorbidity (p ˂ 0.001) and level of education of study participants (p = 0.03) had a significant association with the occurrence of DRPs. CONCLUSION: The prevalence of DRPs among ambulatory HF patients was high. The presence of comorbidity and the educational level of study participants had a significant association with the occurrence of DRPs. Checking potential drug-drug interactions before starting a new therapy, monitoring adverse drug reactions, ensuring sustainable availability of medications, and regular education programs are recommended to minimize DRPs.

Medicinal Plant Extracts Evaluated In Vitro and In Vivo for Antidiabetic Activities in Ethiopia: Bases for Future Clinical Trials and Related Investigations.

BACKGROUND: Diabetes mellitus (DM) is a metabolic disorder characterized by a persistent rise in the blood glucose level resulting from defects in cellular insulin function, secretion, or both, which affects millions of people every year. Several drawbacks have been stated with the use of marketed antidiabetic medicines such as drug resistance, adverse effects, toxicities, and even costs. Due to these several limitations, searching for novel antidiabetic medicines from medicinal plants (MPs) is becoming an active area of research. Therefore, MPs are exemplary sources of medicines with many accessible agents being obtained from them because numerous active constituents are isolated from them for direct use as pharmacological medicines or act as lead compounds. This paper was aimed to synthesize a concluding remark using in vitro and in vivo evaluations of extracts and fractions for antidiabetic potentials in Ethiopia, which can be used to direct future clinical trials and related investigations. METHOD: So as to get data on the different investigations, publications related to experimental evaluations on animal diabetic models in Ethiopia were searched from databases, such as Google Scholar, Web of Science, Medline, PubMed, and Scopus using English key terms. RESULTS: In this paper, about 37 research findings based on data from various areas of Ethiopia published until the end of November 2020 were included. A total of 37 MP species extracts and fractions belonging to 19 families have been revealed in vitro or in vivo for potential antidiabetic activities. Crude extracts were carried out mostly by hydromethanolic whereas fractions were done mostly by chloroform. Leaves were the most commonly experimentally investigated plant part. Among the MP species experimentally studied, the most frequently used to treat DM in Ethiopia were Thymus schimperi Ronniger (Lamiaceae), Moringa stenopetala (Baker f.; Moringaceae), Ajuga remota Benth (Lamiaceae), and Datura stramonium Linn. (Solanaceae). CONCLUSION: This paper gives aggregate evidences on the potential antidiabetic activities of MPs in Ethiopia. Antidiabetic MPs used in Ethiopia represent crucial input for the future development of novel antidiabetic drugs. To this end, more pharmacological and toxicological investigations need to be considered to prove the safety of constituents obtained from these MPs. Finally, we recommend upcoming research to ensure future success in the clinical study and development of novel medicines for DM treatment from these frequently evaluated MPs.

Microbial Ecosystem in Diabetes Mellitus: Consideration of the Gastrointestinal System.

Intestinal microbiota is established to be a crucial element in the control of human health, and keeping the symbiotic relationship between the human body and intestinal microbes will have paramount importance. A number of investigations illustrated that many chronic diseases are associated with intestinal micro-ecological disorders implying intestinal floras as an important component among the environmental factors, and perturbations in their composition are correlated with metabolic disorders, including obesity and diabetes mellitus (DM). Increased evidence suggests that alterations in the gut microbial ecosystem have been involved in part in the pathogenesis of both type 1 and type 2 DM. Short chain fatty acids (SCFAs), derived from microbiota, have been studied for their potential action in modulating CNS, gut barrier axis, and the immune system as a promising mechanism for the observed protective effects on diabetes pathogenesis. Besides, the role of bile acid (BA) stimulated receptors to have a significant role in liver metabolism, and pathophysiology of liver-based metabolic diseases has also been investigated. In the current review, we will try to summarize the correlation between intestinal microbiota and diabetes considering the existing current evidence revealing the role of gut microbiota in onset and disease progression.

Anti-Tuberculosis Commodities Management Performance and Factors Affecting It at Public Health Facilities in Dire Dawa City Administration, Ethiopia.

BACKGROUND: Health facilities (HFs) need extensive ranges of anti-tuberculosis (TB) drugs and related TB laboratory commodities (LCs) for diagnosis, prevention, and treatment of TB and multi-drug-resistance (MDR)-TB. This study was aimed to assess anti-TB commodities management performance at public HFs of Dire Dawa city administration, Ethiopia. METHODS: A cross-sectional study design in 16 HFs providing TB and MDR-TB related service using quantitative and qualitative method was conducted. Semi-structured questionnaires and observation checklists with logistic indicators assessment tools were used to collect data. We used an in-depth interview and analyzed using a thematic approach. Quantitative data were entered into Epi-Data version 3.1 and transported to SPSS version 20 to analyze the results. Chi-square was used to test the association and a P-value<0.05 was statistically significant. RESULTS: The majority(13; 81.3%) of HFs used a health commodity management information system. Forty-two (40%) bin cards (BCs) for first line anti-TB drugs were not updated, while 62.5% of BCs were updated for second line drugs. On average, 43% of HFs accurately reported a report and requisition format (RRF) had significant association with the presence of a logistic management information system (LMIS) and standard operating procedure (P=0.019). Of the HFs, 50% had good storage conditions and guidelines (P=0.041). Regimen change (56.3%; P=0.035), receive near expiry (56.3%; P=0.035), and defective practice to first expired-first-out (50%; P=0.007) were reasons for wastages. About 50% and 66.6% of HFs were stocked out for isoniazid 300 mg, rifampicin, isoniazid, pyrazinamide (RHZ fixed dose), and ethambutol 400 mg with a mean stock out duration of 10.8, 18.9, and 70.5 days, respectively. Regimen change (68.8%; P=0.026), low demand (56.3%; P=0.041), and delay to resupply (37.5%; P=0.041) were reasons for stock out of anti-TB commodities. CONCLUSION: Anti-TB drugs and LCs management performance of the HFs were found to be defective, which was confirmed by unsatisfactory data records, inconstant reports, deprived stock record accuracy, long lead time, high stock out rate, wastages, defective storage conditions, lack of training, and management support. Hence, respective organizations should improve their responsible activities to secure an uninterrupted supply of anti-TB drugs and LCs.

Supply Chain Management Performance of HIV/AIDS Commodities and Factors Affecting It at Health Facilities of SNNPRS of Ethiopia; from the Perspective of Achieving 90-90-90 Strategies.

BACKGROUND: Health facilities (HFs) need an extensive range of antiretroviral (ARV) drugs and related HIV/AIDS commodities for diagnosis, prevention, and treatment of HIV/AIDS. This study was aimed to assess supply chain management performance from the perspective of achieving 90-90-90 treatment strategy at HFs of Southern Nations, Nationalities and People's Regional State (SNNPRS), Ethiopia. METHODS: Facilities based cross sectional study design in 30 HFs (9 hospitals and 21 health centers) and five pharmaceuticals fund and supply agencies (PFSAs) was conducted. The HFs were selected randomly. Semi-structured questionnaires and observation checklists with logistic indicators assessment tools (LIATs) were used to collect data for HIV/AIDS related services from November 2016 to May 2017. In addition, we used in-depth face to face interview and thematic approach. Quantitative data were entered into Epi-Data version 3.1 and transported to SPSS version 20 to analyze the result. Qualitative data were analyzed using thematic approach. RESULTS: Only 9 (30%) HFs had received their orders from PFSA on time from date of report. Average lead time for ARV drugs was 46.4 days in hospitals and 59.2 days in health centers (HCs). Sixteen (60.7%) HFs reported their completed report and requisition format (RRF). From this, 53.3% HFs order was refilled correctly in quantity from that they need. Inventory accuracy rate was 77%. Major HFs, 20 (66.7%) faced at least one-time emergency order for ARV drugs, HIV test kits and viral load (VL) supplies. Whereas, 9 (30%) hospitals and 5 (16.67%) HCs were out of stock two and three times respectively. Sixteen (53.3%) commodities stocked out at least once in six months. Nevirapine (NVP) 10 mg/5 mL in 240 mL was the most stocked out (13 times) for an average 22 days. Uni gold was stocked out (16 times) with average of 34.5 days. Wastage rate was 2.5%. Twenty-five (83.3%) facilities had good storage conditions (>80% to the standard). CONCLUSION: Unsatisfactory data records, stock-outs, interrupted reports, inaccurate inventory and wastage rates were indicators for defective supply chain management of HIV/AIDS commodities. Respective organizations should improve their responsible activities to secure commodities availability.