Rational Use Of Medicines Research Articles

Racinality of NSAID Use on Osteoathritis Patients in the Army Hospital of Pematang Siantar

Rational Use Of Medicine (RUM) or known as Rational Use of Medicine (POR) is a campaign that is spread throughout the world, also in Indonesia. The formulation of the problem in this study is how the rationality of the use of NSAIDs in osteoarthritis patients who seek treatment at the Pematangsiantar Army Hospital. This research was carried out on outpatients at the Pematangsiantar City Army Hospital for the April-June 2021 period . Research data collection was carried out in July-August 2021. Rationality in terms of 5 accuracy (right diagnosis, right indication, right drug, right dose and right patient) then we get the results of the analysis that some of the accuracy is 100% correct, while for the right drug parameter it is still worth 52%. So it can be concluded that treatment for Osteoarthritis patients when viewed from the right diagnosis, right indication, right dose, right patient, right drug, right method of administration at the Pematangsiantar City Army Hospital still cannot be fully said to be rational.

Knowledge, Attitude, and Perception of the Clinicians, Nurses, Pharmacists, Patients, and Public on Compounding, Dispensing, and Labeling services of Pharmacists in a hospital

Background: A pharmacist is a professional who dispenses medicines, counsels patients, and advises health care stakeholders on the rational use of medicines. The study is therefore an attempt to determine the awareness about the pharmacy profession among stakeholders. Material methods: This is an exploratory and descriptive study, designed to describe and explore the Knowledge, Attitude, and Perception (KAP) of the role of a pharmacist in the compounding, dispensing, and labeling of drugs. The statements included in the questionnaire were largely based on the guidelines issued by the Pharmacy Council of India (PCI). Questionnaires were randomly provided to clinicians, pharmacists, nurses, public, and patients. The questionnaire was then taken back and kept for analysis of response. 514 stakeholders participated in the study. The results are expressed as percentages and frequencies. Results: All stakeholders agreed that during compounding, dispensing, and labeling, pharmacists ensure that drug products should match the prescription and appropriately compounded, packed, and labeled. All stakeholders except nurse (99%) agreed that during compounding, dispensing and labeling pharmacist ensure that drug product is within the expiry date. 34.9% of patients agreed that while dispensing the drug to the patient/attendants, appropriate information on drugs is given by the pharmacist. Conclusion: The present study reveals that clinicians and nurses do not have sufficient confidence on the supportive role of a pharmacist in the health care team for better patient care. The pharmacist also needs to work proactively and through his knowledge, expertise and skills generate confidence amongst the patient and health workers that he can perform his expanded role effectively and thus promote patient health

Continuing professional development needs of pharmacy professionals in Zambia: Findings and future directions

Background: Despite continuing professional development (CPD) becoming a key strategy for improving health outcomes by enhancing the quality of pharmaceutical care services, the CPD needs of the pharmaceutical practitioners in Zambia remained unknown prior to this study. Aim: To determine the CPD needs and preferences among pharmaceutical practitioners in Zambia. Methods: This descriptive cross-sectional study involved administering a structured self-administered online questionnaire to collect data from 111 pharmaceutical practitioners registered in Zambia. Results: The majority of the participants (80%) were Pharmacists with less than 10-years post-registration experience. Several respondents (84.8%) indicated they were engaged in more than one sector of pharmaceutical practice, with hospital and community (retail) pharmacy sectors together having the highest proportion of practitioners. The highly preferred modes of undertaking CPD activities were conferences, seminars, symposia, and workshops (81.7%) followed by hands-on interactive skills activities (79.2%), and short courses (74.4%). CPD involving skills development (95.3%) was highly preferred followed by knowledge impartation (89.9%), behavioural enhancement (77.8%), and lastly attitude inculcation (74.1%). Specific high priority CPD programmes identified included: supply chain management, antimicrobial stewardship, medicine use review, rational use of medicines, and chronic care (non-communicable diseases) management, among several others. Conclusion: Pharmaceutical practitioners interviewed in this study seem to be in need of contextually relevant CPD programmes. Blended learning approaches involving face-to-face and online learning coupled with hands-on interactive sessions in knowledge impartation, behavioural enhancement, and skills development were preferred. These findings suggest an opportunity in Zambia to develop and upgrade relevant CPD for pharmaceutical practitioners.

Determinants of exit-knowledge of ambulatory patients on their dispensed medications: The case in the outpatient pharmacy of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.

Patient's knowledge about dispensed medications is one of the major factors that determine the rational use of medicines. This study aimed to assess exit-knowledge of ambulatory patients about their dispensed medications and associated factors at the outpatient pharmacy of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia. A hospital-based cross-sectional study design was conducted from August to October 2021. Study subjects were selected by random sampling technique and were interviewed using a structured interview questionnaire. Binary logistic regression was used to identify factors associated with exit knowledge. At a 95% confidence interval (CI), p≤0.05 was considered statistically significant. Of the total 400 participants, 116 (29.0%) participants had sufficient exit-knowledge about their dispensed medication. Patients with higher educational level had increased exit knowledge of dispensed medications than those with no formal education (AOR: 5.590; 95% CI 1.019-30.666). Also, the nature of illness as being chronic significantly enlarged the odds (AOR 5.807; 95% CI 2.965-11.372) of having sufficient exit-knowledge. Participants who reported, "I do not know" and "I did not get enough information from the pharmacist" had lower odds (AOR 0.374; 95% CI: 0.142-0.982) and (AOR 0.166; 95% CI 0.062-0.445) of sufficient exit-knowledge in comparison to those who responded "I got enough information from the pharmacist" respectively. Furthermore, the odd of sufficient exit-knowledge was 7.62 times higher in those who claimed prescribing doctor as the source of information. The majority of patients had insufficient exit-knowledge about their dispensed medications. Educational status, nature of the disease, perceived sufficiency of pharmacist knowledge, and source of information were significantly associated with exit knowledge.

Drug Prescription Pattern in a Primary Care Clinic, Southwest, Nigeria

Background: Rational drug use is of the utmost importance in a region such as West Africa, where the prevalence of drug resistance is increasing due to inappropriate use of medications. 
 Objective: This study aimed to assess the pattern of prescription drug use at the General Outpatient Clinic of the University College Hospital, Ibadan. This study also assessed the knowledge and attitude toward rational drug use among prescribing physicians in the Clinic. 
 Design: The study was a retrospective cross-sectional review of patients' records over three years. The medical records were selected by systematic random sampling and subjected to the WHO core drug use indicators. Prescribers at the study site had their knowledge, attitude, and practice (KAP) of rational drug use assessed with a self-administered questionnaire. 
 Results: A total of 795 medical records were analyzed for drug use indicators. The mean number of drugs per encounter was 2.64 ±1.23. The percentage of encounters in which an antibiotic was prescribed was 20.4%, while 71.6% of all drugs prescribed were in the generic form. From the KAP survey, 64% of physicians routinely prescribed both generic and brand names, and 68% admitted they needed further education on rational drug use. 
 Conclusion: Using the WHO core drug use indicators, this study identified some degree of polypharmacy and poor adherence to the generic prescription of drugs. Continuing Medical Education for health workers is encouraged to stem the irrational prescription of medications in the African sub-region. 
 Keywords: Prescription Drugs Use, Rational Use of Medicines, Physician's knowledge, Nigeria

Evaluation of Drug Use Pattern in Pediatric Outpatient Clinics in a Tertiary Teaching Hospital Using WHO Drug-Prescribing Indicators.

PurposeThe main aim of the study is to assess physicians’ prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan.MethodsThis is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators.ResultsA total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively.ConclusionThis study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.

Rational Use of Medicines and Medication Adherence in Chronic Kidney Disease on Maintenance Hemodialysis.

Chronic kidney disease is associated with abnormal structural and functional changes in the kidney and its main unit nephrons, which lead to abnormal urine output and impaired excretory function. CKD is also associated with hypertension, diabetes, obesity, and other renal disorders. So After crossing the stages, the renal failure reaches to end-stage renal disorder (ESRD) which is the fifth stage of CKD according to the NKF. Dialysis in the patient individual is done in the end stage, i.e., when the kidney loses its function by about 80 – 90% and when the GFR rate is 15 ml/min. In CKD the maintenance of hemodialysis is done by some medications like antiplatelet (heparin), erythropoietin-stimulating agents, and iron drugs and sometimes if the patient is hypertension, ACE inhibitors are used. A descriptive study, which was conducted on 120 dialysis patients. Data were collected by using a structured questionnaire from December 2020 to June 2021 and then analyzed using SPSS version 20.0 software. Out of the 120 patients who were undergoing dialysis, 83 patients were male and 37 patients were females. According to age group classification, the age group of 40 to 50 years old, or 38 (31.7%), was the most afflicted. CKD (80%) was the most common diagnosis, followed by AKI (10.3%). The most common type of dialysis was an AV fistula (70%) followed by a jugular (25%). The most common comorbidity was hypertension with diabetes mellitus (58.3%) The most common complications were anemia (35.4%) followed by edema (26.24%). Finally, medication adherence was 76.7%. This study indicated that patients who underwent and were undergoing dialysis procedures were majorly affected by CKD. Mostly followed, a type of dialysis was an AV fistula with comorbid condition HTN and diabetes mellitus. The results of the study, which was conducted has minor complications, no major drug interactions, and lower medication adherence, which was developed later by patient education by counseling the patient.

SOSIALISASI PENGGUNAAN LEAFLET DALAM PENINGKATAN PEMAHAMAN PENGGUNAAN OBAT HERBAL UNTUK PENYAKIT KRONIS DI KOTA DENPASAR

The instability between the success and failure of herbal treatment for chronic diseases illustrates the lack of understanding in society. For this reason, it is necessary to provide socialization of knowledge about herbal medicines through leaflets that are practical, simple, and easy to accept. This activity targets the people of Denpasar City who suffer from chronic diseases and use herbal medicines. The method used is in discussions with respondents who have or are currently undergoing degenerative disease therapy by utilizing herbal medicines as therapy and distributing leaflets containing information on herbal medicines to respondents who are less precise in understanding herbal medicines. The results of community service, giving handouts to the community, can increase knowledge about herbal treatments for chronic diseases. The use of leaflets can increase understanding of herbal medicines about the content, seek information from doctors/pharmacists as a complementary therapy, and different effects of conventional drugs. Thus, leaflets are essential to increase the rational use of medicines, especially herbal medicines.

Evaluation of the Patient Medication Counseling Services in the Philippine General Hospital Using the CIPP Model

Objectives. The patient medication counseling (PMC) services at Philippine General Hospital (PGH) started 21 years ago. While several changes have been incorporated into the program, no formal evaluation has been conducted to date. The objective of this evaluation was to assess the relevance, usefulness, responsiveness, acceptability, efficiency, impact, and sustainability of the service using the context, input, process (CIPP) model of Stufflebeam.
 Methods. The study utilized a mixed-methods study design. Interviews and surveys were conducted on pharmacist-counselors, a purposive sample of doctors, nurses, and other stakeholders. A review of records from the Department of Pharmacy of UP College of Pharmacy (UPCP) and PGH, such as patient and student satisfaction surveys and monthly reports of counseled patients served from 2015 to 2019, was conducted. The results were analyzed using descriptive statistics for quantitative data and content analysis for qualitative data.
 Results. Context evaluation revealed that the establishment of PMC resulted from informal interactions with hospitalized patients due to incorrect use of prescription medicines. Correct information was envisioned to address the irresponsible use of medicines. The input evaluation revealed that only 24% (N=75) of the pharmacists are involved in PMC, which comprise only 10% of their workload. There was also a lack of comprehensive training for counseling and insufficient physical facilities. The process evaluation identified lack of time (94%) as a significant limiting factor for the involvement of pharmacists in PMC. The interns became an additional workforce for the service, but scheduling and the consistent availability of both students and faculty-preceptors were experienced. The product evaluation revealed positive perceptions among the pharmacists, faculty, and student interns. From the patient satisfaction survey records of 5,071 patients counseled, 98 to 100% expressed high service satisfaction, and 100% were likely to recommend PMC to other patients. The pharmacists, interns, and faculty-preceptors suggested that PMC improved their confidence, communication skills, and decision-making.
 Conclusion. The PMC service is relevant and valuable to ensure patients' rational and quality use of medicines. As a value-added service to existing hospital pharmacy services, it serves as a venue for enhancing soft skills among pharmacists and students alike. However, physical and human resources and current processes need to be upgraded to improve efficiency, ensure sustainability, and expand service coverage to more patients.

Drug utilization pattern and adverse drug reactions of chemotherapy in pediatric patients at Muhimbili National Hospital, Tanzania.

Background: Cancer is a highly debilitating non-communicable disease and an essential contributor to the global burden of disease. Pediatric patients are highly exposed to multiple drugs for the management of cancer. Monitoring drug utilization patterns helps to provide feedback to healthcare providers to ensure the rational use of medicines; as a result, it increases the therapeutic efficacy and decreases the frequency and severity of adverse drug reactions (ADRs). Therefore, this study assessed the utilization pattern and ADRs of chemotherapy in pediatric patients at Muhimbili National Hospital (MNH). Methods: A descriptive cross-sectional study was conducted for three months from February to April 2021 in pediatric cancer patients undergoing chemotherapy at MNH. A total of 123 children diagnosed with cancer and on chemotherapy were enrolled in this study. Patients' socio-demographics, clinical information, chemotherapy status, prescribed medications, and prevalence of ADRs were collected. Descriptive statistics was used in data analysis, whereby frequency and proportions were used to summarize data. Results: Out of 123 patients, 62.6% were male. Most patients received an average of four anticancer drugs. Vincristine (55.3%) was the most used anticancer drug, followed by cytarabine (44.7%) and methotrexate (42.3%). The most used adjuvant drugs were ondansetron (30.9%), hydrocortisone (27.6%), and piperacillin/tazobactam (23.6%). The percentage of drugs prescribed from the Tanzania Essential Medicine List (TEML) and World Health Organization (WHO) list was 66.4% and 93%. Most (87%) of the patients reported having experienced ADRs whereby nausea and vomiting (45.8%), hair loss (33.6%), and neutropenia (32.7%) were more prevalent ADRs reported. Conclusions: This study found the drug prescribing pattern to be in line with the essential medicine list, but the average number of drugs prescribed was higher than recommended. ADRs were prevalent among pediatric cancer patients.

Mapping of New Pharmacological Alternatives in the Face of the Emergence of Antibiotic Resistance in COVID-19 Patents Treated for Opportunistic Respiratory Bacterial Pathogens.

The increase in bacterial resistance against antibiotics is thought to be another type of pandemic after COVID-19. Emergency treatment based on antibiotics is a major influence in increasing this resistance. Bacteria, such as Klebsiella pneumoniae, are the most affected by the indiscriminate use of antibiotics, since they are resistant to most antibiotics currently available on the market. This review aimed to evaluate patents of new drugs and formulations, for the treatment of infections caused by Klebsiella pneumoniae. The present patent review was carried out through a specialized search database Espacenet. The selection was based on the criteria of patents published from 2010 to May 2021, in any language, and containing the keywords in title or abstract. Also, a research was performed on the PubMed database, using the inclusion criteria. Twenty-two patents were selected for the analysis according to the aim of the study. The advance of new patents has been mostly observed in the World Intellectual Property Organization, China, and United States. The results showed that the main approach was the drug association, followed by drug carriers, new isolated products, and vaccines. It has been observed that few studies use new drug alternatives for the treatment, probably due to the higher cost of the development and lack of investments. The effectiveness and safety of these therapies depend on the acceptance, the correct prescription, and rational use of medicines. Therefore, this review can further develop new treatments as alternatives against Klebsiella pneumoniae and pneumonia caused by it.

Social and economic factors associated with antidepressant use: Results of a national survey in primary care

• The findings suggested inequity in access to drug treatment for depression in a middle-income country, especially for non-white individuals and those from lower social economic status brackets. • Public policies should be developed on primary health care services to optimize the detection and treatment of depression. • Polypharmacy was strongly associated to use of antidepressants. • Optimizing pharmacotherapy can minimize harm and undesired drug interactions. Background: Antidepressants are widely prescribed, and it is important to describe their use characteristics. We aimed to estimate the prevalence of antidepressant use and identify associated factors in a cross-sectional study from a middle-income country. Methods: Participants (n=8,803) from the National Survey on Access, Use, and Promotion of the Rational Use of Medicines in Brazil, a cross-sectional study with a representative sample, were asked about the use of any medicines in the past 30 days. Through the answers, we classified the antidepressants users and non-users. The association between antidepressant use, demographic and clinical characteristics was evaluated. Results: The prevalence of antidepressant use was 6.8% (95% CI 6.2 - 7.3). Most users whom self-reported a previous diagnosis of depression (70.6%) did not report antidepressant use, suggesting underuse. Fluoxetine and amitriptyline ranked first in use. White females, from higher economic status, self-reporting a previous diagnosis of depression, in polypharmacy and in use of psychotropics, with alcohol abstinence, were more likely to use the medicines. Limitations: The use of drugs was measured by self-report, which might have underestimated results. Indication for antidepressant use in depression or other conditions was not investigated. Conclusions: The prevalence of antidepressant use observed in Brazil is lower than in the USA and some European countries. Although patients have a universal right to health in Brazil, improved primary care actions are required to ensure access to treatment of depressive disorders, especially for non-white individuals and those from lower social-economic status brackets.

Assistência Farmacêutica e governança global da saúde em tempos de Covid-19

ABSTRACT This essay addresses how and at what levels Pharmaceutical Services is affected by the dynamics of global health governance, and how it correlates with geopolitical and socioeconomic aspects. It attempts to go beyond access to medicines and health products, as well as to address the rational use of medicines, the impact in antimicrobial resistance and in people’s health. Furthermore, it debates how Pharmaceutical Services can be seen in this context.

Evaluation of clinical pharmacy services in community health centres to support Indonesian health programme in West Java Indonesia

Background: The implementation of clinical pharmacy services is critical in Indonesia's community health centres (CHCs). However, there is a paucity of studies evaluating the implementation of such services. This study aimed to evaluate clinical pharmacy services by CHCs in West Java, Indonesia. Methods: This cross-sectional study used a self-completed questionnaire, including several indicators of the standard pharmacy services, to evaluate the implementation of clinical pharmacy services by CHCs in West Java, Indonesia. Results: In total, 39 CHCs participated in this study. The home visits, drug therapy and adverse monitoring, counselling services, and drug use evaluation were not well performed as determined. In contrast, drug information services, rational use of medicine, and prescription have been well performed. There was no app or IoT (internet of things) system to support the clinical pharmacy services in Indonesia’s CHCs. Conclusions: The performance of the clinical pharmacy services of accredited CHCs should be improved to support Community Health Centers in Indonesia.

Benzodiazepines utilization in Brazilian older adults: a population-based study.

ABSTRACTOBJECTIVETo evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines).METHODSThe PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview).RESULTSThe prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3–10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52–2.32), depression (PR = 5.31; 95%CI: 4.41–6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20–1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18–1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01–1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10–8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13–0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19–0.94).CONCLUSIONDespite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.

ANTIBACDUS-PAN: Antibacterial Utilization among Adult Patients Before and During COVID-19 Pandemic within 12-Months Period: A Tertiary Hospital Pharmacoepidemiology Study.

Irrational use of antibacterials is a concern during the COVID-19 pandemic. Hospital pharmacoepidemiology studies are important for evaluating the rational use of medicines, especially antibacterials, during pandemics. Defined daily doses (DDD) and drug utilization 90% (DU90%) are established methods for the evaluation of drug utilization. We aimed to evaluate antibacterial utilization in a tertiary hospital setting at Koç University Hospital (KUH). This cross-sectional, descriptive study was retrospectively conducted with data extracted from KUH Inpatient Electronic Order System (CP) and was carried out for a period of one year. Antibacterial utilization of adult (aged ≥ 18 years) inpatients, who were prescribed at least one type of systemic antibacterial (ATC code J01), was evaluated using the recommended parameter DDD/100 admission and compared between 6 months before COVID-19 and during COVID-19 periods. March 11, 2020, the very first COVID-19 diagnosed case in Turkey, was set as the cutoff date of the 6-month period for the selection of the compared antibacterials using the DU90% method. Finally, 3280 of 5942 and 2605 of 4942 prescriptions for pre-COVID-19 and COVID-19 periods were included, respectively. Antibacterial utilization according to DDD/100 admissions increased from 193.96 to 201.26 DDD/100 admissions after the initiation of COVID-19 pandemic. The most utilized antibacterials were piperacillin and enzyme inhibitors in pre-COVID-19 period, whereas meropenem was utilized the most during COVID-19 period. Azithromycin utilization increased by 656.24%, whereas clarithromycin utilization decreased by 52.12%. Antibacterials were utilized most in general surgery department, with an increase of 17.57%. There is an increase in antibacterial utilization in KUH during COVID-19 pandemic, especially reserved antibacterials, which is a concern for antibacterial resistance.

Self-medication in patients over 18 years of age in health centers in Honduras

Context: Inappropriate self-medication is seen as a global public health concern. Without appropriate professional healthcare guidance, a variety of issues can arise with potentially serious consequences to one’s personal health. Aims: To describe self-medication in outpatients aged 18 years or over who attended public health care centers in Honduras. Methods: A sample of 4573 people was chosen using a cluster sampling technique. A structured questionnaire was applied. Study variables included: sociodemographic factors, frequency and reasons for self-medicating, kind of medicine and sources of acquisition. Results: With a minimum age of 18 years and a maximum age of 94 years, women predominated with 3340 (73.0%), originated from the department of Francisco Morazán with 1186 (25.9%) persons, primary complete in 1042 (22.8%) persons, and with a monthly household income of less than $171.41 in 1462 (32.0%) persons, 3035 (66.4%) people reported knowing what self-medication is, but 2365 (51.7%) of them were unaware of the consequences of self-medication and 2385 (52.2%) people used medications in the last three months without a prescription. Conclusions: The frequency of self-medication in the studied population shows the need to implement national prevention and promotion initiatives in the rational use of medicines, emphasizing the consequences of self-medication, as well as the creation of stricter surveillance and regulation policies in the sale of medicines.

Prevalência de doenças respiratórias crônicas e uso de medicamentos entre crianças e adolescentes no Brasil - um estudo transversal de base populacional

Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.

Patients Access to Medicines - A Critical Review of the Healthcare System in Kenya.

Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

Prevalence and reasons for practicing self-medication among basic health staff: case of Monywa District, Myanmar: a cross-sectional study

Background: Self-medication is often associated with an incorrect diagnosis, wrong medication, delayed effective medical care, disease masking, prolonged-course therapy, and harmful effects following medication. This study aimed to demonstrate self-medication prevalence and detect the reasons for practicing self-medication among BHS.Methods: Researchers conducted this cross-sectional study within four township health departments of Monywa District. A total of 405 BHS was culled from each subpopulation of BHS through proportional sampling. SPSS version-25 was applied for data analysis.Results: This study demonstrated that the self-medication prevalence among BHS was 57.8%, of which self-medication of antibiotics was 61.5%. The most common reasons for self-medication were cold, cough, fever, ache and pain in the head, throat, teeth, muscles, and bones, gastrointestinal symptoms, and high blood pressure. Commonly practiced self-medication drug was pain relievers (86.8%) and the most preferred antibiotic self-prescribed was amoxicillin (26.5%). Other drug types used for self-medication were cold and cough medicines, gastro-intestinal medicines, vitamins and minerals, and anti-hypertensive, contraceptive, hypoglycemic, and herbal medicines. Mostly, self-medication practices were based on own experiences (83.3%), easy access and availability of medicines (82.5%), academic knowledge of the diseases (41%), and treatment options (47.4%), considering the symptoms as minor (29.5%).Conclusions: A high prevalence of self-medication occurred among BHS. This study points out that BHS needs to be more comprehensive about safety, regulations, and rational use of medicines. This study suggests that the Myanmar technical working groups should enforce the National medicines policy.