Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia.

BACKGROUND: Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters. METHODS: A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. RESULTS: Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. CONCLUSIONS: There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Access to Essential Medicines for Diabetes Care: Availability, Price, and Affordability in Central Ethiopia.

Background: Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. Methods: A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. Results: Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5mg, metformin 500mg) and two blood pressure-lowering medications (nifedipine 20mg and hydrochlorothiazide 25mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets, respectively. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. Conclusion: There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Relevant stakeholders should work to improve access to EMs.

Self-Care Practice and Associated Factors Among Patients with Type 2 Diabetes Mellitus at a Referral Hospital in Northern Ethiopia - A Mixed Methods Study.

Introduction: Diabetes self-care is important to maintain optimal glycemic control and prevent debilitating and costly complications. Diabetes self-care may be improved through the identification of individual and group barriers to regimen adherence and subsequent development of specific plans to overcome these barriers. This study assessed the self-care practice and associated factors among type 2 diabetes patients attending their treatment at Dessie Referral Hospital, Dessie, North-Eastern Ethiopia. Methods: The study employed parallel mixed methods design which followed a cross-sectional interview and in-depth interview methods, respectively, from September to October 2019. The collected data were subjected to descriptive and inferential analysis for the quantitative part and a thematic analysis for the qualitative part. Results: A total of 328 type 2 diabetes patients participated in the study of which 50.3% reported good self-care practice. Being in the age category of 60-69 years old (AOR = 0.334, 95% CI (0.135, 0.951)), being ≥70 years old (AOR = 0.359, 95% CI (0.135, 0.951)), having complications (AOR = 1.956, 95% CI (1.172, 3.262)), having co-morbidity (AOR = 0.443, 95% CI (0.262, 0.749)) and diabetes education (AOR = 2.684, 95% CI (1.633, 4.412)) were significantly associated with good diabetes self-care. Accessibility, social support, knowledge and beliefs and diabetes-related morbidities were identified as barriers to diabetes self-care by the patients. Conclusion: The findings from this study revealed that only half of the type 2 diabetes patients who participated in this study reported good self-care practice. Different factors, including diabetes education, were significantly associated with good diabetes self-care according to the quantitative study. This was supported by the findings from the qualitative part and thus the recommendation to strengthen diabetes health education to patients and their families.

Assessment of compliance to packaging and labeling regulatory requirements of locally manufactured alcohol-based hand sanitizers marketed in Addis Ababa, Ethiopia.

BACKGROUND: Following the emergence of the global Coronavirus Disease-2019 (COVID-19) pandemic, alcohol-based hand sanitizers (ABHS) have been extensively used as one of the effective methods of preventing its transmission. The products are dispensed over the counter and used by the general population. Growing concerns have been reported, however, regarding the quality, efficacy and compliance to regulatory requirements calling for objective evidence that can facilitate proactive regulatory measures. OBJECTIVES: The study aimed at assessing the level of compliance to packaging and labeling regulatory requirements of selected locally manufactured ABHS products marketed in Addis Ababa, Ethiopia. METHODS: A cross-sectional study design was employed to randomly collect 25 locally manufactured ABHS products from retail outlets located in Addis Ababa. The manufacturers were grouped under four categories considering their experience in manufacturing, resources and technical capacities. The collected samples were evaluated for compliance to packaging and labeling information regulatory requirements and the results subjected to descriptive analysis. RESULTS: Majority of the products were found to meet most of the packaging, general product description and manufacturer-related information requirements. However, concerning gaps were observed in storage, precaution and warning-related labeling information requirements. The overall compliance of the selected products (to a total of 29 requirements under 5 categories) was 56.9%. The highest level of compliance was for general product information requirements (80.2%) followed by packaging and manufacturer-related requirements accounting for 76.8% and 75.0%, respectively. Low level of compliance was observed for storage condition and precautions (10.2% and 42.4%, respectively). Better overall compliance to packaging and labeling requirements (62.9%) were observed by large pharmaceutical and cosmetics manufacturers, while the lowest compliance level was recorded for medium level pharmaceuticals and cosmetics manufacturers. CONCLUSIONS: Even though most of the selected products were able to comply with the majority of packaging, product description and manufacturer-related requirements, gaps were observed in essential labeling information requirements. Considering the extensive use of ABHS products among diverse population groups and the potential risks associated with inappropriate use of the products, improving regulatory law enforcement practices, strengthening continuing education of manufacturing personnel and raising public awareness is very timely.

Evaluation of quality and antimicrobial efficacy of locally manufactured alcohol-based hand sanitizers marketed in Addis Ababa, Ethiopia in the era of COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been rapidly spreading across the globe since the World Health Organization (WHO) has declared the disease outbreak as a global pandemic on March 11, 2020. Hand hygiene, via either regular handwashing with soap and water or using hand sanitizers, is among the various measures that need to be followed to control the outbreak of the disease. Alcohol-based hand sanitizers (ABHS) are the "gold standard" for hand disinfection because of their broad antimicrobial spectrum of activity, easy availability, better safety profile, and general acceptability to users. This study aimed at evaluating the physicochemical quality and antimicrobial efficacy of the locally manufactured ABHS marketed in Addis Ababa, Ethiopia. METHODS: A cross-sectional survey was used to collect ABHS from Addis Ababa marketplaces. A total of 25 sample products were randomly selected from different categories of hand sanitizer manufacturers. The physicochemical evaluation of the products was carried out as per the United States Pharmacopoeia and WHO standards. Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella spp., and Shigella spp clinical isolates were used for the antimicrobial efficacy test. RESULTS: The Fourier Transform Infrared result confirmed that all the test products met the identification test for ethanol. The majority (68%) of ABHS complied with the test for ethanol content (75-85% v/v). However, only 3 products fulfilled the hydrogen peroxide content (0.112-0.137% v/v). LPC307 showed the maximum zone of inhibition of 12 mm against Escherichia coli whereas MPC204 exhibited only 3 mm. LPC101 was found to be more sensitive to Shigella and Klebsiella Spp with minimum inhibitory concentration values of 20% and 10%, respectively. The sample product LPC101 showed a minimum bactericidal concentration of 20% against Escherichia coli, Pseudomonas aeruginosa, and Klebsiella spp. CONCLUSION: One-third of the tested ABHS did not comply with the WHO ethanol content limit and the majority of the products failed to meet the label claim for hydrogen peroxide content. Besides, nearly all products proved that they have activity against all the tested pathogenic microorganisms at a minimum concentration from 10 to 80%; though, they did not show 99.9% bacteriostatic or bactericidal activities as claimed. The study findings suggested regular monitoring of the quality of marketed ABHS considering the current wide use of these products.

Asthma Treatment Outcome and Factors Associated with Uncontrolled Asthma Among Adult Patients with Asthma in Addis Ababa, Ethiopia.

Background: Asthma is a major public health challenge in the world resulting in significant health and economic burden. The modifiable and non-modifiable risk factors could have considerable impact on asthma control and medical care. Objective: This study is intended to evaluate the treatment outcome and identify risk factors for poor asthma control among patients with asthma in Addis Ababa, Ethiopia. Methods: A multicentre cross-sectional study using interview and chart review was conducted among patients with asthma attending ambulatory care of two large public hospitals in Addis Ababa, Ethiopia, between March and June 2018. The Global Initiative for Asthma Guideline was used to determine treatment outcomes. The variables of interest were described using descriptive statistics such as frequencies, percentages, mean, and standard deviations. Multivariable logistic regression was used to determine factors associated with uncontrolled asthma. All statistical significance level was determined at p < 0.05. Results: A total of 230 patients with asthma were interviewed. More than half (65.2%) of patients were females, and their mean age was 54 ± 15.1 years. Overall, 50.4% of the patients had uncontrolled asthma status. More than two number of trigger factors (AOR = 1.88; 95% CI: 1.09-2.01), cold weather (AOR = 2.11; 95% CI: 1.51-2.42), exacerbations of asthma in the last 12 months (AOR = 2.01; 95% CI: 1.39-2.32), moderate persistent asthma (AOR = 3.47; 95% CI: 1.75-5.13), severe persistent asthma (AOR = 2.90; 95% CI: 2.56-3.98), patients on Salbutamol puff with Beclomethasone (AOR = 2.92; 95% CI: 2.50-3.45) and patients on Salbutamol puff with Beclomethasone and Prednisolone (AOR = 5.76; 95% CI: 4.02-6.02) use were significantly associated with uncontrolled asthma. Conclusion: More than half of patients with asthma had uncontrolled asthma treatment outcome. This indicates the need to give due attention to asthma patients with uncontrolled status, particularly to those with identified risk factors. Health care providers should work in creating patient awareness on appropriate use of their prescribed medications, avoidance of asthma triggering factors for decreasing the progression of the disease and better asthma control.

Perceptions towards childhood asthma and barriers to its management among patients, caregivers and healthcare providers: a qualitative study from Ethiopia.

BACKGROUND: The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia. METHODS: A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach. RESULTS: The study findings revealed that the children's reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability. CONCLUSIONS: Low awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients' and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients' medication access issues.

COVID-19 vaccine hesitancy among Ethiopian healthcare workers.

INTRODUCTION: COVID-19 poses significant health and economic threat prompting international firms to rapidly develop vaccines and secure quick regulatory approval. Although COVID-19 vaccination priority is given for high-risk individuals including healthcare workers (HCWs), the success of the immunization efforts hinges on peoples' willingness to embrace these vaccines. OBJECTIVE: This study aimed to assess HCWs intention to be vaccinated against COVID-19 and the reasons underlying vaccine hesitancy. METHODS: A cross-sectional survey was conducted among HCWs in Addis Ababa, Ethiopia from March to July 2021. Data were collected from eligible participants from 18 health facilities using a pre-tested semi-structured questionnaire. Data were summarized using descriptive statistics and multivariable logistic regression was performed to explore factors associated with COVID-19 vaccine hesitancy. A p<0.05 was considered statistically significant. RESULTS: A total of 614 HCWs participated in the study, with a mean age of 30.57±6.87 years. Nearly two-thirds (60.3%) of HCWs were hesitant to use the COVID-19 vaccine. Participants under the age of 30 years were approximately five times more likely to be hesitant to be vaccinated compared to those over the age of 40 years. HCWs other than medical doctors and/or nurses (AOR = 2.1; 95%CI; 1.1, 3.8) were more likely to be hesitant for COVID-19 vaccine. Lack of believe in COVID-19 vaccine benefits (AOR = 2.5; 95%CI; 1.3, 4.6), lack of trust in the government (AOR = 1.9; 95%CI; 1.3, 3.1), lack of trust science to produce safe and effective vaccines (AOR = 2.6; 95%CI; 1.6, 4.2); and concern about vaccine safety (AOR = 3.2; 95%CI; 1.9, 5.4) were also found to be predictors of COVID-19 vaccine hesitancy. CONCLUSION: COVID-19 vaccine hesitancy showed to be high among HCWs. All concerned bodies including the ministry, regional health authorities, health institutions, and HCWs themselves should work together to increase COVID-19 vaccine uptake and overcome the pandemic.

Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up.

BACKGROUND: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. OBJECTIVE: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men's sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. METHODS: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. RESULTS: We enrolled 71 young unmarried men-35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were "YES." In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were "YES" (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were "YES." In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. CONCLUSIONS: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions.

Ethiopian patients' perceptions of anti-diabetic medications: implications for diabetes education.

BACKGROUND: The purpose of this study is to explore medication-related perceptions of adult patients with type 2 diabetes attending treatment in public hospitals of urban centers in central Ethiopia. METHODS: Qualitative in-depth interviews were held with 39 participants selected to represent a range of treatment experiences and socio-demographic characteristics who were attending their treatment in 3 public hospitals. Interviews continued until key themes were saturated. The interview and analysis was guided by Horne's necessity-concerns model. RESULTS: The findings revealed medication-related perceptions some of which were similar to those of Western patients and others that seem to be informed by local socio-cultural contexts. Participants' perceptions focused on the necessity of and concerns about their anti-diabetic medications, giving more emphasis to the latter. Concerns were expressed about both perceived and experienced adverse effects, inconveniences in handling the medications and access. It was evident that some of these concerns were exaggerated but could nevertheless negatively affect adherence to prescribed medications including resistance to initiate insulin with potential impact on health outcomes. CONCLUSIONS: Understanding patients' perceptions of their medications is critical for developing a diabetes education program that considers local contexts and beliefs to enhance adherence. Education programs should consider patients' concerns about medication adverse effects and reasons for use so as to improve their adherence and health outcomes.