Aid conditionalities, international Good Manufacturing Practice standards and local production rights: a case study of local production in Nepal

© 2015 Brhlikova et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This work was supported by the Economic and Social Research Council and the Department for International Development [RES-167-25-0110] through the collaborative research project Tracing Pharmaceuticals in South Asia (2006 – 2009). In addition to the authors of this paper, the project team included: Soumita Basu, Gitanjali Priti Bhatia, Erin Court, Abhijit Das, Stefan Ecks, Patricia Jeffery, Roger Jeffery, Rachel Manners, and Liz Richardson. Martin Chautari (Kathmandu) and the Centre for Health and Social Justice (New Delhi) provided resources drawn upon in writing this paper but are not responsible for the views expressed, nor are ESRC or DFID. Ethical review was provided by the School of Social and Political Science at the University of Edinburgh, and ethical approval in Nepal for the study granted by the Nepal Health Research Council (NHRC)

Drug utilization patterns in the global context: A systematic review

Objectives Standard drug use indicators have been developed by the World Health Organization/International Network for Rational Use of Drugs (WHO/INRUD). The purpose of this systematic review was to examine and report the current status of health facilities in different regions of the world in terms of drug use based on WHO/INRUD core drug use indicators. Design Systematic review of the literature following PRISMA guidelines. Methods The INRUD bibliography, WHO archives, Google Scholar, Medline, PubMed, SpringerLink, ScienceDirect and Management Sciences for Health (MSH) resource databases were searched between 1985 and 2015 for studies -containing 12 WHO/INRUD core drug use indicators. Secondary data sources were also searched. Results Four hundred and sixty three studies were retrieved and 398 were excluded as they did not provide relevant information or fulfill the selection criteria. Sixty articles met the criteria and were selected for final review. With respect to prescribing indicators, studies of “drug use” showed mixed patterns across geographic regions. Overall trends in “patient-care” and “facility-specific” indicators were similar across most of the World Bank regions. However, based on the Index of Rational Drug Use (IRDU) values, East Asia and the Pacific region demonstrated relatively better drug use practices compared with other regions. Conclusions This systematic review revealed that the drug use practices in all regions of the world are suboptimal. A regulated, multi-disciplinary, national body with adequate funding provided by governments throughout the world are a basic requirement for coordination of activities and services, to improve the rational use of drugs at a local level

Evaluation of the quality of prescriptions with antibiotics in the government hospitals of Yemen

Introduction: Irrational prescribing is a habit which is difficult to counteract and this may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasting resources and needless expenditure. Objective: The aims of this study were to investigate the prescribing of antibiotics in Yemen and provide a baseline picture of prescribing habits. It presented an overview on the quality of prescribing and the resulting patterns coming from the prescriptions. Methods: The scope of the study was limited to four public quaternary health care facilities in Sana’a, Yemen. A prospective drug utilization review method was used in this study. Results: Results showed that the total number of brand name antibiotics prescribed was 76.8%, and 27.5% of the antibiotics were not on the Yemen Essential Drug List (YEDL). Out of all prescriptions, it was found that 51.0% contained antibiotics. Antibiotic prescriptions were lacking in many areas of important information: the diagnosis, patient’s name, gender and age as well as for the prescribed antibiotics information (strength, dosage form, dose, frequency and duration). The average number of antibiotics per each patient received was 1.2 ± 0.4(median = 1) and the percentage of antibiotics prescribed as injections was 27.8%. Conclusion: The patterns which emerged in prescribing showed that there were various potential problems in antibiotic usage in the government quaternary hospitals in Yemen. Advocacy, education and awareness initiatives are required to alleviate these problems

The Use of Medicines in Oman : Public Knowledge, Attitudes and Practices

Objectives: The objective of this study was to identify the common problems of medicine use in Oman in order to improve the appropriate use of medicines. Methods: A cross-sectional, pilot-tested questionnaire was administered to 6,675 Omani patients or their carers on exit from primary health care centres. Results: 66% of respondents visited multiple facilities on the same date for the same complaint and 51% failed to go for follow up to the same facility. 39% did not accept non-drug therapy and 30% preferred prescription of 3 or more medicines per visit. Many failed to ask how or when to take the medicines, where to store them at home and did not mention any current therapies they were taking. A total of 70% stopped taking their medicines when symptoms disappeared; 26% were unaware that most medicines have side-effects and 61% did not realise that injections are the riskiest dosage form. A total of 54% had definite colour and taste preferences; 43% practised self-medication and 68% never consulted the dispenser; 36% chose medicines based on previous experience and 33% exchanged medicines with others; 55% stored all their medicines in a fridge and 17% did not check the expiry date; 45% threw unused medicines away; 41% kept them for future use and only 12% returned them to a pharmacy or health facility. Conclusions:There is a widespread lack of knowledge about the appropriate use of medicines in Oman. Certain attitudes and beliefs can contribute to health risks and unnecessary expenditure. Many of these results could be improved by a well-targeted public education campaign