Medication Reconciliation as a Medication Safety Initiative

Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services

Men’s Knowledge and Spousal Communication about Modern Family Planning Methods in Ethiopia

This study attempted to determine knowledge, approval and communication about family planning methods among married men in Ethiopia. A cross-sectional study was conducted among a representative sample of 738 married males in Amhara Region. All 738 (100%) of the respondents had heard of family planning. About 558 (75.6%) mentioned the importance of using contraceptives for birth spacing and 457 (61.9%) to limit birth. Four hundred and forty-five (60.3%) of participants had ever discussed family planning with their wives. Thirty-three (33.0%) of the respondents reported that they were the sole decision makers in their families. About 597 (80.9%) approved the use of contraceptives. However, some participants did not discuss and approve family planning with their partner. This recalled an intensive effort has been taken by the concerned body to reach the country’s targeted family planning coverage by involving men in reproductive health endeavor to enhance the discussion and agreement about family planning usage

Optimal Design of a Standalone Photovoltaic Power Supply System for Air Conditioning Application at Samara University as an Alternative to Diesel Generator Source

The aim of this paper is to optimally design a stand alone photovoltaic power supply system for air conditioning application at Samara University to be used as an alternative to diesel generator supply. Samara University is established in samara town, Afar region and has an average daily radiation of 6.10kwh/m2, sun shine duration of about 10 hours. This  condition invites the use of photovoltaic system as an alternative primary energy source to replace the existing diesel generator supply system. Therefore in order to use this energy source for air conditioning application, the cooling load of the building, 628 tons, is estimated using Newton’s thumb rule. The evaporative air conditioning system which is sometimes called desert cooler is selected to condition the estimated cooling load of the dwelling room. The sizing method (numerical method and HOMER software tools) is complementarily used to design a standalone photovoltaic power supply system. Finally, the metric value of the present worth is US $ 3,302,066 and its simple payback is 6.6 years, and this foreseen that the attractiveness of photovoltaic power system as one of renewable energy to be used as an alternative to diesel generator in the near future

Prevalence of mental distress and associated factors among Samara university students, Northeast Ethiopia

Background. Empirical findings have indicated that higher institution students experience a higher prevalence of mental distress compared to the general population. Understanding the magnitude and associated factors of mental distress in university students would be helpful to practitioners and policymakers in Ethiopia. The aim of the present study was to examine the prevalence and associated factors of mental distress among Samara university students, Northeast Ethiopia. Methods. Institution based cross-sectional study design was conducted in Samara university from December to June 2018. A simple random sampling technique was employed to select the study participants. Self-Reporting Questionnaire-20 (SRQ-20) was used to measure the mental distress of students. Multivariable logistic regression modeling was used to examine the association between sociodemographic and psychosocial factors with the mental distress of students. Results. The proportion of students with mental distress were found to be 53.2% (95% confidence interval [CI]: 48.0%, 58.0%). Female students were more likely to be mentally distressed compared to male students (adjusted odds ratio [AOR]: 4.66; 95% CI: 2.81, 7.71). Ever khat use (AOR: 3.09; 95% CI: 1.74, 5.50) and poor sleep quality (AOR: 2.23; 95% CI: 1.12, 3.66) were significantly associated with mental distress of students. Conclusion. Our study indicates that the proportion of mental distress was found to be higher among Samara university students as compared to previously published studies in Ethiopia. Female students, ever khat users and those with poor sleep quality were associated with mental distress. There is a need for evidence-based interventional strategies such as self-help measures, sleep hygiene and peer support, as well as professional mental health services as part of student health services that would be helpful to reduce the burden of mental distress of students

Consumer drivers and barriers of WASH products use in rural Ethiopia

In Ethiopia, the coverage of basic WASH facilities is very low. In response, government of Ethiopia and its development partners have been using sanitation marketing to promote and sell WASH products. Qualitative in-depth interview with households, supply chain actors, and stakeholders were conducted in four regions of Ethiopia to learn about current product use behaviours. The result showed presence of any latrine was related to greater awareness about importance to health. Financial constraints, unavailability of construction materials were major barriers to possession of latrines. Word of mouth was the dominant source of information on WASH products, with health extension workers being a respected source. The major challenges of supply chain actors at district level were finance, inadequate working space, and lack of business development skills. Lack of regular WASH products supply system at community level and lack of profound awareness about health benefit were the priority constrains to access latrines

Study on knowledge, attitude and dog ownership patterns related to rabies prevention and control in Addis Ababa, Ethiopia

The study was conducted from May 2003 to August 2003 in Addis Ababa with the objective of understanding the distribution of stray and owned dogs, dog ownership patterns and attitudes of people towards rabies and its prevention and control methods. A total of 2390 households were selected from 6 Sub Cities of Addis Ababa using stratified random sampling and were interviewed using structured questionnaires. From the total households interviewed, 969 (40.5%) of them were known to own one or more dogs, and the total number of owned dogs was estimated to be 225,078. Male dogs make up 1042 (78.4%) of the total owned dogs. Almost half of all the dogs 463 (47.8%) were tied only for some time during the day whereas 320 (33.1%) of the dogs were not tied at all and freely move from place to place and contribute to high dog bites in human beings and for the widespread occurrence of canine rabies in Addis Ababa. Six hundred fifty five (67.6%) of the interviewed households who owned dogs had a well fenced house. Most of the owned dogs 856 (88.4%) get their food from their owners and only 321 (33.3%) of the owners reported that they let their dogs to be vaccinated while the majority of the owners 644 (66.5%) do not let their dogs vaccinated regularly. A significant proportion of the interviewed households 2,323 (97.2%), (P < 0.05) indicated that they have the knowledge that dogs, cats and other animals can transmit rabies to humans and 1,752 (73.4%) of the households replied that rabies can be transmitted through bite, scratch and lick to open wounds. Analysis of the list of 2400 post exposure human antirabies treatments recorded at the EHNRI Zoonoses Laboratory from February 2002 to October 2003 showed that the most common animals involved in biting people were dogs. A total of 2198 (91.6%) people were bitten by dogs during the same period and most of them, 2053 (85.5%) were bitten on their hands and legs. All the above data indicated the need for a strong and coordinated rabies control activities to be conducted in the city

Prevention and treatment of suspected pneumonia in Ethiopian children less than five years from household to primary care.

AIM: Ethiopia has implemented the integrated community case management to reduce mortality in childhood diseases. We analysed prevention, care seeking and treatment of suspected pneumonia from household to health facility in Ethiopia. METHODS: Analyses were based on a survey in four regions that included modules covering 5714 households, 169 health posts with 276 health extension workers and 155 health centres with 175 staff. Caregivers of children aged 2-59 months responded to questions on awareness of services and care seeking for suspected pneumonia. Pneumonia-related knowledge of health workers was assessed. RESULTS: When a child had suspected pneumonia, 46% (95% CI: 25,68) sought care at health facilities, and 27% (95% CI: 12,51) received antibiotics. Forty-one per cent had received full immunisation. One-fifth (21%, 95%: 19,22) of the caregivers were aware of pneumonia treatment. Sixty-four per cent of the health extension workers correctly mentioned fast or difficult breathing as signs of suspected pneumonia, and 88% suggested antibiotics treatment. CONCLUSION: The caregivers' awareness of suspected pneumonia treatment and the utilisation of these services were low. Some of the health extension workers were not knowledgeable about suspected pneumonia. Strengthening primary health care, including immunisation, and enhancing the utilisation of services are critical for further reduction of pneumonia mortality