Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications.

Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261−7.094; p < 0.001) and age (OR = 0.524, CI = 0.327−0.842; p < 0.008) were among the key factors impacting students' training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.

Patients' Knowledge and Practice on Disposal of Medicines Kept in Households in South Africa: Findings and Implications.

Objective: The disposal of unwanted, unused, or expired medicines is a concern. Currently, there is little knowledge regarding their disposal among patients in South Africa. Consequently, there is a need to address this. Methods: This was a descriptive and quantitative study with patients conducted among 16 primary health-care clinics (PHCs) in South Africa. A structured questionnaire was administered to 171 conveniently selected patients. Data on ideal disposal methods were collected and compared to actual disposal practices. Findings: 74.9% of patients reported having unused medicines at home, of whom 34.4% wanted these medicines disposed of. However, 64.9% did not know how to dispose of them, with 95.3% reporting having never been informed by health-care professionals of disposal methods. While patients prefer to return medicines to their PHC, only 7.0% did so. Patients' ideal disposal practices included designated collection task teams (25.1%) and dissolving their unused medicines in water (38.6%). However, current practices indicated that patients flushed medicines down the sewer (31.6%) or disposed of them in municipal bins (23.9%). Conclusion: Patients disposed of their unwanted medicines using incorrect disposal techniques, which they thought were correct. This urgently needs to be addressed.

A National Survey of Dispensing Practice and Customer Knowledge on Antibiotic Use in Vietnam and the Implications.

Misconceptions and pressures have increased the sales of antibiotics without a prescription across countries. There are concerns with such practices in Vietnam given rising antimicrobial resistance rates. A national survey was conducted among 360 private drugstores located in nine provinces in Vietnam. Anonymous interviews were conducted with participants selected by convenience sampling. Subsequently, multivariable logistic regression analyses were undertaken evaluating the relationship between customer characteristics and antibiotic purchases. A total of 480 out of 1626 surveyed participants purchased antibiotics, 81.7% of which did not have a prescription, involving 29 different antibiotics. In 86.4% of these, participants were prescribed antibiotics by drug sellers. Most antibiotics were sold to treat respiratory tract infections (61.4%), with the 'Access' antibiotics (amoxicillin and cephalexin) being the most frequently sold. Only one-fifth of participants understood that they were breaking the law by purchasing antibiotics without a prescription. Participants purchasing antibiotics without a prescription had lower awareness concerning antibiotic laws and treatment duration (p < 0.05). Under 50% agreed to having a doctors' prescription in the future when purchasing antibiotics. Freelancer occupation (OR = 0.52, 95% CI = 0.83−0.96) and a lower educational level (OR = 0.49, 95% CI = 0.25−0.96) were factors related to purchasing antibiotics without a prescription. Overall, we recommend increasing fines and monitoring of drugs stores, greater promotion of the family doctor system as well as increasing media and educational campaigns to limit self-purchasing of antibiotics in Vietnam and reduce resistance.

Awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia.

Aim: This study aimed to assess the awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia. Materials and Methods: We conducted a cross-sectional study among 326 undergraduate pharmacy students in Lusaka, Zambia, from February to April 2021. Data were analysed using Stata version 16.1. Multivariable logistic regression was used to determine key factors influencing vaccine acceptance. Results: Of the 326 participants, 98.8% were aware of the COVID-19 vaccines, but only 24.5% would accept vaccination. Compared to other religions, being of Christian faith was associated with reduced odds of awareness of the COVID-19 vaccine (aOR=0.01, 95% CI: 0.01-0.20). Conversely, factors associated with vaccine acceptance were being male, single and unemployed. Compared to females, male respondents were 86% more likely to accept the vaccine if it was made available (aOR=1.86, 95% CI: 1.10-3.14). In addition, unmarried respondents were 2.65 times as likely to accept vaccination than married respondents (aOR=2.65, 95% CI: 1.06-6.63). Conversely, unemployed respondents were less likely to accept vaccination than their employed counterparts (aOR=0.32, 95% CI: 0.16-0.46). Barriers to the acceptability of the vaccine were possible side effects (78.5%) and scepticism about its effectiveness (10.2%). Conclusion: There was significant vaccine hesitancy toward COVID-19 vaccines among Zambian pharmacy students despite their awareness of the vaccines. Health authorities must work collaboratively with training institutions to mitigate vaccine hesitancy, especially with healthcare students being a key part of the future healthcare workforce overseeing disease prevention strategies.

Adverse events following immunization reporting and impact on immunization services in informal settlements in Nairobi, Kenya: a prospective mixed-methods study.

INTRODUCTION: adverse events following immunization (AEFIs) are thought to contribute to cases of vaccine hesitancy, yet little data exists describing the state of reporting and management of AEFIs. This study investigated the occurrence and influence of AEFIs on vaccine hesitancy in an informal settlement of Nairobi. METHODS: this was a prospective mixed-methods study involving 7 focus group discussions, 8 key informant interviews and 457 face-to-face interviews with caregivers. Caregivers were recruited at/or before the 6 week clinic visit and assessed for occurrence of AEFIs in their children at the subsequent 10- and 14-week visits and a follow-up two weeks following the 14 weeks visit via phone calls. RESULTS: in this study, 12.3% (56/457) of the infants experienced an AEFI. Of these, 19 did not report for the next scheduled vaccine. Fever was the most common AEFI, for which most caregivers (66.7%) used Paracetamol as antipyretic, while 20.8% sought help from a nearby health facility. Three of the 56 AEFIs (convulsions) that occurred in study participants could be classified as severe reactions. Diphtheria, pertussis and tetanus (DPT 3) completion rate was 75.3%. Most (96.4%) caregivers considered immunization an important strategy for child survival. Vaccine hesitancy occurred among 3.6% of participants, 30% of whom attributed their hesitancy to occurrence of AEFIs. The review of health records revealed that no AEFI had been reported from any of the study facilities. CONCLUSION: cases of adverse events following immunization are not reported in Mathare Valley and they do have implications for vaccine hesitancy by some caregivers.

Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction.

Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.

Increasing hepatitis B vaccination coverage of healthcare workers - global lessons for South Africa.

Healthcare workers (HCWs) are at high risk of contracting hepatitis B (HB), a severe blood-borne vaccine-preventable disease, caused by HB virus (HBV) infection. Low HB vaccine (HepB) coverage has resulted in suboptimal protection and high HBV infection rates in South African HCWs. Studies from Africa have identified cost; unavailability/lack of access to HepB; and lack of awareness/knowledge of HB and HepB, as barriers to HCW uptake. Studies from Europe show little difference in HepB coverage between countries mandating versus recommending HepB. Providing easy and sustained access to free HepB to student HCWs, together with education about HB and HepB, are recommended to create demand for HepB. Only if this fails should mandatory vaccination be considered.

Health-Care Professionals' Knowledge and Practice Regarding Disposal of Medicines in Primary Health-Care Facilities in South Africa: Impact and Implications.

Objective: Professional nurses, pharmacists, and medical practitioners are responsible for disposing of medicines within health-care facilities. South African regulations stipulate that medicines should not be disposed of through sewage systems because of the potential impact on patients and the environment. Consequently, our objective was to determine knowledge and practices among health-care professionals (HCPs) in South Africa and the information they provide to patients regarding the safe disposal of unused/expired/damaged medicines to provide future guidance with identified concerns. Methods: A descriptive study was conducted among 165 HCPs at 16 primary health-care clinics in two subdistricts of the city of Tshwane in Gauteng Province through self-administered questionnaires. Findings: Only 23.5% of HCPs stated that they participated in destroying medicines within their facilities. More than half (65.1%) also reported that they always counsel patients regarding the safe storage of their medicines in their homes, with 27.9% indicating they counsel patients on the safe disposal of their medicines during consultations. More than half (65.1%) also reported that patients never asked about the disposal of medicines. Of concern is that incineration (31.9%), flushing down the toilet (20.6%), and flushing down the sink (9.9%) were regarded by HCPs as correct disposal methods, while 9.6% stated that they did not know the correct methods. In addition, 71.1% reported never receiving training regarding the safe disposal of medicine. Conclusion: There is an urgent need to educate HCPs regarding appropriate medicine waste disposal in South Africa. This can start with including this topic in the curriculum of HCPs, including pharmacists, and continuing post qualification.

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications.

BACKGROUND: Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. METHOD: Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. RESULTS: The 'Procurement process' emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. CONCLUSIONS: Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.

A comparison of five international clinical trial registers with the South African register for access to information and usability.

INTRODUCTION: in November, 2005, the South African (SA) National Department of Health (NDoH) mandated that, as from the 1st December, 2005, all new clinical trials to be conducted in the country must be registered on the South African National Clinical Trials Register (SANCTR). The objective was to compare access to the information contained in and the usability of the SANCTR with five other international on-line clinical trials registers. METHODS: Access to SANCTR was determined through the use of three search engines using the keywords "South African Clinical Trials." Five high-profile international registers were identified and accessed for comparative purposes. Each register was investigated for information on trials conducted in South Africa using a standardised data extraction form which listed 24 data items. The usability of the various on-line registers was determined through a self-administered questionnaire adapted from the five key usability factors previously defined in literature. Heuristic evaluation was carried out with 10 'experts' (Pharmacy staff and postgraduate students at Sefako Makgatho Health Sciences University (SMU)). Data generated from the heuristic evaluation were analysed using descriptive statistics, univariate and multivariate analyses. RESULTS: The SANCTR website had the highest ranking for access amongst the registers in all three selected search-engines after an internet search using the keywords "South African Clinical Trials". The total number of clinical trials registered varied among the registers. The WHO's International Clinical Trials Registry Platform (ICTRP) recorded 2 599 trials carried out in South Africa, with 2 260 registered in the ClinicalTrials.gov register, 2 196 in the SANCTR and 978, 149 and 174 in the European Union (EU), International Standard Randomised Controlled Trial Number (ISRCTN) and Pan African Clinical Trials (PACTR) registers respectively. The websites ClinicalTrials.gov and ISRCTN provided greater overall information per clinical trial registered and provided information on all 24 clinical trials data items. The PACTR had information on 23 of the 24 data items. The WHO and EU registers each contained 19 data items. The SANCTR provided the least information, only 11 data items. The heuristic evaluation identified ClinicalTrials.gov as the 'best' site, while the PACTR had the lowest rating for layout and design. The EU register and SANCTR were the least easily navigable. The respondents had the least satisfaction while using the 'Search' option in the SANCTR. Users also reported the SANCTR and the PACTR had the lowest overall user-friendliness. CONCLUSION: The fact that the SANCTR contains less information on SA clinical trials than other registers and is the least user-friendly warrants utmost attention. The study puts forward a case to the regulatory authority (currently the Medicines Control Council) as it takes on a new structure and working arrangements as the South African Health Products Regulatory Authority to optimise the SANCTR to be more user-friendly and contain more complete information on clinical trials conducted in SA.

Impact of a pharmacist-driven pharmacovigilance system in a secondary hospital in the Gauteng Province of South Africa.

BACKGROUND AND AIMS: Under-reporting of adverse drug reactions (ADRs) by health-care professionals (HCPs) is a worldwide problem. Spontaneous reporting in hospitals is scarce and several obstacles have been identified for this. Improved hospital-based reports could make important contributions to future care. Consequently, the objective of this study was to develop, implement and evaluate a structured pharmacist-driven pharmacovigilance (PV) system for in-patient ADR reporting in a leading public hospital in South Africa for future use in South Africa and wider. METHOD: Descriptive, operational intervention study with a pre-post design. Pharmacist-driven interventions targeted at ADR reporting were implemented. Convenience sampling was used to recruit HCPs [medical practitioners, pharmacists, pharmacist assistants, and nurses] to complete a self-administered questionnaire. The principal outcome measures were the number of the ADRs reported for inpatients, 18 months prior to and 18 months during the intervention period, as well as an evaluation of the intervention program in terms of continuous information and training. RESULTS: There was a significant increase in the number of HCPs reporting an ADR post-intervention (33.8% up from 12.1%; p < 0.0001). Reasons for non-reporting decreased significantly, e.g. 'How, where and when to report' an ADR (p = 0.0027) and 'Concern that the report may be wrong' (p = 0.0041). HCPs' knowledge of the ADR reporting system also improved appreciably. This was apart from pharmacists who were already knowledgeable. CONCLUSION: The results showed the benefits of pharmacist-driven interventions on HCPs' knowledge and awareness of PV and the number of the ADRs reported. Hospital management and policy makers should consider the important role pharmacists can play in improving rational and safe use of medicines among inpatients, based on appropriate training of HCPs and proper systems. As a result, help achieve the standards established by the Department of Health in South Africa.

Knowledge, attitudes and perspective on adverse drug reaction reporting in a public sector hospital in South Africa: baseline analysis.

OBJECTIVE: Adverse drug reactions (ADRs) can cause significant harm in patients; however, ADRs are under-reported in many countries, including South Africa, where evidence of a pharmacovigilance (PV) system to monitor and manage ADRs is a requirement for compliance with norms and standards for quality healthcare delivery. We conducted an analysis amongst health care professionals (HCPs) at Sebokeng Hospital to assess the situation there and make recommendations. METHODS: Data were collected using a structured self-administered questionnaire, targeting all medical practitioners, nurses, pharmacists and pharmacist assistants in the hospital. Current procedures for reporting of ADRs were documented. Records were reviewed to determine the number of ADR reports submitted for the 18-month period prior to the study. Data were analysed with SAS. Ethical clearance was obtained. RESULTS: The questionnaire was completed by 132 HCPs (nurses: 58.3%; medical practitioners: 23.5%; pharmacist assistants: 11.4%; pharmacists: 6.8%). The vast majority indicated ADR reporting is necessary (96.2%) and their professional obligation (89.4%). Only 18.9% were aware of an existing PV system in the hospital, 15.2% had an ADR form available and 18.9% knew to whom the form should be submitted. The vast majority had never reported an ADR, had never received training in PV, but wanted training on ADR reporting. Factors discouraging ADR reporting included not knowing how to report them (53.8%), lack of time (37.1%), additional work load (22.0%), uncertainty about the outcome of reporting (32.6%), and lack of confidence to discuss ADRs with colleagues (22.0%). Only 2.3% knew how many ADRs were reported, that ADRs are discussed by a committee (6.1%) and that internal feedback is received on reported ADRs (6.1%). CONCLUSION: There is an extensive need in Sebokeng Hospital for training on ADR reporting and implementation of systems to facilitate relevant processes; a need which may also exist in other public hospitals in South Africa.