The effect of prescription patterns on the performance of the pharmacy department of a Regional Referral Hospital, Uganda.

Background: Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries. Objective: This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda. Methods: This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables. Results: The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers. Conclusion: Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized.

Prevalence and factors associated with sputum smear non-conversion after two months of tuberculosis treatment among smear-positive pulmonary tuberculosis patients in Rwanda: a cross-sectional study.

BACKGROUND: Non-conversion of sputum smear prolongs the infectivity of pulmonary tuberculosis patients and has been associated with unfavorable tuberculosis (TB) treatment outcomes. Nevertheless, there is a limited evidence on predictors of sputum smear non-conversion among smear-positive PTB (SPPTB) patients in Rwanda. Therefore, this study aimed to determine the factors associated with sputum smear non-conversion after two months of treatment among SPPTB patients in Rwanda. METHODS: A cross-sectional study was conducted among SPPTB patients registered in the national electronic TB reporting system by all health facilities countrywide (Rwanda) from July 2019 to June 2021. Eligible patients who had completed the first two months of anti-TB treatment and with smear results at the end of the second month of treatment were included in the study. Bivariate and multivariate logistic regression analyses were done using STATA version 16 to determine the factors associated with sputum smear non-conversion. Adjusted odds ratio (OR), 95% confidence interval (CI), and p-value < 0.05 was considered statistically significant. RESULTS: This study included 7,211 patients. Of them, 632 (9%) patients had sputum smear non-conversion at the end of the second month of treatment. In multivariate logistic regression analysis, age groups of 20-39 years (AOR = 1.7, 95% CI: 1.0-2.8) and 40-59 years (AOR:2, 95% CI: 1.1-3.3), history of first-line TB treatment failure (AOR = 2, 95% CI: 1.1-3.6), follow-up by community health workers(CHWs) (AOR = 1.2, 95% CI: 1.0-1.5), BMI < 18.5 at TB treatment initiation (AOR = 1.5, 95% CI: 1.2-1.8), and living in Northern Province of Rwanda (AOR = 1.4, 95% CI: 1.0-2.0), were found to be significantly associated with sputum smear non-conversion after two months of treatment. CONCLUSION: Sputum smear non-conversion among SPPTB patients remains low in Rwanda compared to countries of similar health care setting. Identified risk factors for sputum smear non-conversion among SPPTB patients in Rwanda were age (20-39 years, 40-59 years), history of first-line TB treatment failure, follow up by CHWs, BMI < 18.5 at TB treatment initiation and residence (Northern province).

Use of an online medical database for clinical decision-making processes: assessment of knowledge, attitude, and practice of oral health care providers.

Purpose: This study was conducted to determine the level of knowledge, attitude, and practice of oral health care providers toward the use of online medical databases for clinical decision-making processes. Subjects and methods: The study population included all the licensed oral health care providers living in Rwanda, registered either with the Rwanda Allied Health Professional Council (RAHPC) or Rwanda Medical and Dental Council (RMDC). A self-administered questionnaire was used to collect demographic data as well as data regarding knowledge, attitude, and practice of oral health care providers regarding the use of online medical databases for making clinical decisions. A pilot study with 12 oral health care providers was done before the main study to pretest the questionnaire. Results: The study results show that among the 201 respondents, 80% (N=160) reported using internet-based resources to support their clinical decisions, while 20% (N=41) of oral health care providers do not use online resources when making their clinical decisions. In general, there was a positive attitude towards internet-based resources among the participants, as 92% (N=184) respondents believe that internet-based resources are helpful in clinical decision-making processes. Of clinical importance, 68% respondents (N=136) believe that by using current internet-based information, better clinical care can be offered to their patients. Conclusion: Educating oral health care providers on the useful and appropriate online resources available for supporting clinical decision-making processes might increase the efficiency of patient care.

Seroprevalence of Brucellosis among Patients Attending a District Hospital in Rwanda.

Studies on human brucellosis in Rwanda are scarce, and the incidence is likely to be higher than official estimates. In a recent study using Rose Bengal Test (RBT) on women who had aborted or had still births in Huye district, 25% were Brucella seroprevalent. Thus, purpose of the present study was to investigate the Brucella seroprevalence in patients presenting with the key signs and symptoms of brucellosis. Cross-sectional study was done in Nyagatare District in the Eastern Province of Rwanda. A total of 198 patients were recruited from Nyagatare District Hospital, blood samples were collected, and sera analyzed with RBT. A questionnaire was used to explore the risk factors. A total of 12 patients (6.1%; 95% confidence interval [CI] = 0.662-7.820) were Brucella seropositive. Infection was significantly associated with drinking unboiled milk (odds ratio [OR] = 8.3; 95% CI = 2.4-29.2) and having had recurrent fever (OR = 5.6; 95% CI = 1.5-21.3). Drinking unboiled milk is a risk factor for Brucella infection. Provision of adequate resources and trainings to staff in brucellosis diagnosis is needed to reduce recurrence of fevers probably because of misdiagnosis. Public awareness creation on transmission routes of brucellosis is to be intensified.

Malaria and helminthic co-infection among HIV-positive pregnant women: prevalence and effects of antiretroviral therapy.

The impact of malaria on anemia and the interplay with helminths underline the importance of addressing the interactions between HIV/AIDS, malaria and intestinal helminth infections in pregnancy. The aim of this study was to determine the prevalence of malaria-helminth dual infections among HIV positive pregnant mothers after 12 months of ART. A cross sectional study was conducted on intestinal helminths and malaria dual infections among HIV-positive pregnant women attending antenatal health centers in Rwanda. Stool and malaria blood slide examinations were performed on 328 women residing in rural (n=166) and peri-urban locations (n=162). BMI, CD4 cell count, hemoglobin levels, type of ART and viral load of participants were assessed. Within the study group, 38% of individuals harbored helminths, 21% had malaria and 10% were infected with both. The most prevalent helminth species were Ascaris lumbricoides (20.7%), followed by Trichuris trichiura (9.2%), and Ancylostoma duodenale and Necator americanus (1.2%). Helminth infections were characterized by low hemoglobin and CD4 counts. Subjects treated with a d4T, 3TC, NVP regimen had a reduced risk of T. trichiura infection (OR, 0.27; 95% CIs, 0.10-0.76; p<0.05) and malaria-helminth dual infection (OR, 0.29; 95% CI, 0.11-0.75; p<0.05) compared to those receiving AZT, 3TC, NVP. This study shows a high prevalence of malaria and helminth infection among HIV-positive pregnant women in Rwanda. The differential effect of ARTs on the risk of helminth infection is of interest and should be examined prospectively in larger patient groups.

Is sickle cell disease sufficiently prioritized in policy and socio-economic research on diseases in Tanzania? Lessons for the past 50 years.

Catastrophic health consequences associated with chronic and genetic disorders, including those related to sickle cell disease (SCD) remain lowly measured and understood. Illnesses associated with SCD, especially the, sickle cell anaemia (SCA) pose significant tolls to individual patients and their families and contribute to poverty due to loss in production and retardation of economic development. This paper synthesises evidence from systematic literature reviews on policy priorities both in theory and practice and studies carried out on SCD. The review was systematically done by drawing evidence from published and unpublished literature searched through online search engines and other sources. The magnitude of SCA problem is yet to be adequately measured and documented in terms of the scale of its prevalence in many countries including Tanzania. However, a few reports available pinpoint Tanzania as one of the African countries with a large number of patients with SCD. Social stigma and discrimination against patients with SCD pose psychological affect to either the individual patients or their family members and this is partly due to low community knowledge on this disease on one hand and the perceived socio-economic disturbances associated with the disease that at times reduce the morale of caregivers/ takers in families to attend patients. A few studies so far seem to have much focused on the medical dimensions of the disease usually reported at health facilities therefore, failing to establish the actual magnitude and socio-economic consequences of the disease, thus limiting the room for more informed policy decisions. Unfortunately, the inadequate public policy and research attention to this disease indicates that there is need for revisiting research and policy agenda towards making a difference in its interventions, and this include creation of public awareness and prioritizing research. '

Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania

Background: Community particpation (CP) is a key concept under primary health care programmes and Health Sector Reform (HSR) in many countries. However, international literature with current empirical evidence on CP in health priority setting and HSR in Tazania is scanty. Objectives: To explore and describe community views on HSR and their participation in setting health priorities. Methods: A multistage sampling of wards and villages was done, involving group discussions with members of households, Village Development Committiees (VDCs) and Ward Development Committiees (WDCs). Results: Respondents at village and ward levels in both districts related HSR with a cost sharing system at public health facilities. Views on the advantages and disadvantages of HSR were mixed, most of the residents pointing out that user charges burden the poor, there is a shortage of drugs at peripheral health facilities, the performance of government health service staff and village health workers does not satisfy community needs, health insurance is promoted more than people actually benefit, VDC and WDC poorly function as compared to local community-participatory priority-setting structures. Conclusion: HSR may not meet the desired health needs unless more efforts are made to enhance the performance of the existing HSR structures and community knowledge and enhance trust and participation in the health sector programmes at all levels. (AU)

Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania.

BACKGROUND: Community participation (CP) is a key concept under 'primary health care' programmes and 'Health Sector Reform' (HSR) in many countries. However, international literature with current empirical evidence on CP in health priority setting and HSR in Tanzania is scanty. OBJECTIVES: To explore and describe community views on HSR and their participation in setting health priorities. METHODS: A multistage sampling of wards and villages was done, involving group discussions with members of households, Village Development Committees (VDCs) and Ward Development Committees (WDCs). RESULTS: Respondents at village and ward levels in both districts related HSR with a cost sharing system at public health facilities. Views on the advantages or disadvantages of HSR were mixed, most of the residents pointing out that user charges burden the poor, there is a shortage of drugs at peripheral health facilities, the performance of government health service staff and village health workers does not satisfy community needs, health insurance is promoted more than people actually benefit, VDC and WDC poorly function as compared to local community-participatory priority-setting structures. CONCLUSION: HSR may not meet the desired health needs unless more efforts are made to enhance the performance of the existing HSR structures and community knowledge and enhance trust and participation in the health sector programmes at all levels.