Prices and availability of locally produced and imported medicines in Ethiopia and Tanzania.

BACKGROUND: To assess the effect of policies supporting local medicine production to improve access to medicines. METHODS: We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR). RESULTS: The Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively. The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively. CONCLUSIONS: Our results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.

Factors contributing to non-adherence to diabetes treatment among diabetic patients attending clinic in Mwanza city.

BACKGROUND: Non-adherence to the diabetes treatment regimen is possibly the most common reason for poor health outcomes among people with diabetes. The rates of non-adherence to diabetes regimen tasks are highly variable, but have significant consequences on diabetes outcomes and the effectiveness of treatments. OBJECTIVE: The aim of this study was to determine the proportion (magnitude) of non-adherence and its contributing factors among diabetic patients attending clinics in Mwanza city. Specifically the study determined the relationship between non-adherence and various variables which are; alcohol use, knowledge on diabetes, its treatment and complication, travel distance to reach the clinic by patients and medication side effects. RESULTS: A total of 272 diabetic patients attending two diabetes clinics in Mwanza city were interviewed. Of the respondents, 118 (43.4%) were males. Their mean age was 51.22 (14.97 standard deviation). Among all respondents, 255 (93.8%) scored High level of knowledge on Diabetes and its treatment as compared with those with low knowledge making it not a significant contributor to non-adherence. Of the 272 patients, 77 (28.3%) reported non-adherent. Alcohol use, medication side effects and distance travelled to reach the clinic were the significant contributors to non-adherence (p = 0.001). CONCLUSION: Factors which were found contributing to non-adherence to diabetes treatment include: alcohol use, medication side effects and few clinics located far from most of patient. For improving adherence, availability of information with patients' perspectives about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent should be maintained.

Public knowledge, attitude and perception of over the counter medicines: case study in Dar es Salaam region, Tanzania.

OBJECTIVES: The purpose of this study was to investigate on misuse, abuse and the general public opinion as well as perception of OTC medicines. METHODS: Data were collected, by face-to-face interview guided with a semi-structured questionnaire. The key questions focused on community attitude towards retail pharmacy, use of OTC medicines, views on OTC in terms of safety and effectiveness and knowledge and opinion on misuse and abuse of OTC medicines. The collected data were coded and statistically analyzed using EPI-Info version 6 database. RESULTS: Out of 270 interviewees, 50% admitted to have had visited retail pharmacies at least once per month. More than half of the participants (64.1%) reported to having been buying OTC medicines at least once in a month and 55.7% used the medicines as per containers label or leaflets' instructions The public demonstrated high awareness on the potential misuse of OTC medicines. CONCLUSION: The study revealed a high level of awareness on the potential abuse of OTC medicines and positive perception with regard to safety and effectiveness of OTC medicines. From these findings, it shows those pharmacists need to be more proactive in the management of inappropriate OTC drug use.

Anti-diabetic drugs in the private and public sector in Dar es Salaam, Tanzania.

OBJECTIVES: To compare availability, cost, affordability and sources of anti-diabetic drugs between private and public health facilities in Dar es Salaam, Tanzania. DESIGN: Cross sectional descriptive study. SETTING: Diabetic clinics in private and public health facilities in Dar es Salaam, Tanzania. SUBJECTS: Eighty patients randomly selected and 45 health facility personnel staff working in the diabetic clinics. Semi-structured questionnaires and a checklist were used to collect the information. RESULTS: Oral hypoglycaemic agents were available in all seven private and three public facilities that were studied. Private facilities stocked more types of oral hypoglycaemic agents than public facilities, which stocked only chlorpropamide and tolbutamide, based on the National Essential Drugs List. The cost of chlorpropamide was five times higher in private facilities compared to public facilities. Insulin was also available in all the facilities. The price of animal insulin in private health facilities was ten times that in public health facilities. Human insulin, which is generally more expensive than animal insulin, was only available in private facilities. Although prices were much lower in public facilities, affordability emerged as a common issue in both private and public facilities. CONCLUSIONS: Urban private health facilities offer a wider choice for the needs of diabetic patients but this advantage is compromised by higher prices as compared to public facilities as well as inconsistent supply across facilities. Public health facilities offer only a limited selection of essential oral hypoglycaemics and insulin but at a lower price and across all facilities. Twenty six per cent and 10% of patients in public and private facilities respectively are unable to afford anti-diabetic drugs. The need for intervention to increase affordability of anti-diabetic drugs is evident. Financing and cost of drugs needs to be addressed, either by means of health insurance or other mechanisms, in this era of increasing prevalence of diabetes mellitus among developing countries.

Incidence, knowledge and health seeking behaviour for perceived allergies at household level: a case study in Ilala district Dar es Salaam Tanzania.

OBJECTIVES: To determine incidence of perceived allergies, causes and management, of disorders associated with allergies at household level in Ilala district. METHOD: A cross sectional study was conducted in Ilala district involving a total of 400 households randomly selected 8 wards out of 22 wards in the district and head of the household interviewed using a structured questionnaire. RESULTS: Of the household members interviewed, 66.8% being females, about 60.0% reported to be allergic to different substances. Food 16.7%, animal dander and fur 15.4%, pollen 13.3%, house dust 11.7%, medicines 8.3%, cosmetics 5.8, and plants 6.3% were the most common causes of allergy within the households. Most individuals were not aware of the source of allergy. Only few (40.4%) respondents had some knowledge about allergy, and they acquired the information through different sources such as mass media, school, friends, other families etc. In terms of prevention, 39.2% knew how the allergies could be prevented, and 41.2% had knowledge on appropriate medicines for the control and treatment of different allergic symptoms. Skin allergies 35.9%, respiratory allergies 13.3%, and allergies of the eye 10.8% were observed to be the most common complains. CONCLUSION: The study shows high prevalence of perceived allergy disorders in the community associated with poor understanding on the possible causes and preventive measures. This highlights the need conduct public education to raise awareness on allergy with a focus on causes and avoidance of exposure to allergens to mitigate effects of allergy in the society.

Causes, magnitude and management of burns in under-fives in district hospitals in Dar es Salaam, Tanzania.

OBJECTIVES: To determine the causes, magnitude and management of burns in children under five years of age who were admitted in the district hospitals of Dar es Salaam City, Tanzania. METHODS: In this study, a total of 204 under fives were enrolled. Questionnaires were used to elicit if the parent/caretaker had the knowledge of the cause of the burns, what was done immediately after burn injury, first aid given immediately after burn, source of the knowledge of first aid and when the child was taken to the hospital. Also the questionnaire was cited with data on the management of burns in the hospitals through observation and checking the treatment files. RESULTS: Forty nine percent were males while 50.5% were females. Most of the children (54.9%) were aged between 1-2 years. 78.4% had scalds while 21.6% had flame burns. No children were found to have burns caused by chemicals or electricity. Most of the burns (97.5%) occurred accidentally, although some (2.5%) were intentional. 68.6% of these burn injuries occurred in the kitchen. Immediately after burn 87.3% of the children had first aid applied on their wounds while 12.7% didn't apply anything. Of the agents used, honey was the most used (32.8%) followed by cold water (16.7%). The source of knowledge on these agents was from relatives and friends (72.5%), schools (7%), media (6%) and medical personnel (14%). The study further revealed that analgesics, intravenous fluids, antiseptics and antibiotics were the drugs used for treatment of burns in the hospital and that there was no specialized unit for burns in the hospitals. CONCLUSIONS: Causes of childhood burns are largely preventable requiring active social/medical education and public enlighten campaigns on the various methods of prevention. The government to see to it that hospitals have specialized units for managing burn cases and also the socio-economic status of its people be improved.

Incidence; Knowledge and Healh Seeking Behaviour for Perceived allergies at Household Level: a Case Study in Ilala District Dar Es Salaam Tanzania

Objectives: To determine incidence of perceived allergies; causes and management; of disorders associated with allergies at household level in Ilala district. Method: A cross sectional study was conducted in Ilala district involving a total of 400 households randomly selected 8 wards out of 22 wards in the district and head of the household intervie- wed using a structured questionnaire. Results: Of the household members interviewed; 66.8being females; about 60.0reported to be allergic to different substances. Food 16.7; animal dander and fur 15.4; pollen 13.3; house dust 11.7; medicines 8.3; cosmetics 5.8; and plants 6.3were the most common causes of allergy within the households. Most individuals were not aware of the source of allergy. Only few (40.4) respondents had some knowledge about allergy; and they acquired the information through different sources such as mass media; school; friends; other families etc. In terms of prevention; 39.2knew how the allergies could be prevented; and 41.2had knowledge on appropriate medicines for the control and treatment of different allergic symptoms. Skin allergies 35.9; respiratory allergies 13.3; and allergies of the eye 10.8were observed to be the most common complains. Conclusion: The study shows high prevalence of perceived allergy disorders in the community associated with poor understanding on the possible causes and preventive measures. This highlights the need conduct public education to raise awareness on allergy with a focus on causes and avoidance of exposure to allergens to mitigate effects of allergy in the society

Dispening and quality of Amoxicillin Preparations in Retail Pharmacies on Tanzania Market

A study on dispensing practice and quality of amoxycillin capsules and syrups was conducted in retail pharmacies in 5 regions of Tanzania. Data on dispensing practice was collected by interviewing 75 dispensers through structured questionnaires. Quality of amoxycillin capsule formulations and dry powder for suspension preparations from six different manufacturers was evaluated for chemical content at the Tanzania Food and Drug Authority (TFDA) in Dar es Salaam. The study showed that of all the dispensers only 17.3were pharmacists; 21.3pharmaceutical technicians and 28were nurses of different ranks. Results indicated that the most dispensed amoxicyllin was the locally produced preparation which accounted for 41.3. Affordability determined the most dispensed and lowest priced generic brand; amoxycillin by 68. Results revealed that only 46.6dispensers refused to dispense amoxycillin without a prescription while 53.4dispensed. Out of the ones who dispensed; 42.5gave patients the most expensive preparations and 22.5just dispensed according to the patients' demands. Similarly patients with prescriptions written in a generic name; the dispensers (28) issued them with the most expensive brand while others were issued the brand they specifically demanded by 32of the dispensers. For patients who came to the pharmacy with less money; results revealed that 66.7of the dispensers dispensed incomplete doses and then requested them to come back for the remainder and 13.3just gave out incomplete doses without any further counseling. Responses regarding reconstitution of the dry powder for suspension showed that only 10.7dispensers reconstituted before giving it out to patients and the rest just instructed patients on how to reconstitute at home. Further; 74.7of dispensers instructed the patients to use teaspoons to measure 5ml of the suspension. The results from the assessment of chemical contents showed that all capsules and dry powder for suspensions complied with respect to pharmacopoeial limits. It is concluded that dispensers should continually undergo continuing education on good dispensing practices