Prevalence and determinants of serious spontaneously reported adverse drug events among three outpatient care settings in Ghana : findings and implication

Objective Most evidence of adverse drug events (ADEs) come from hospitals as the risks associated with hospital care are higher. However, under-reporting of ADEs is a critical problem in all health care settings. This is important in Sub-Saharan African countries like Ghana with limited resources and high prevalence of both infectious and non-infectious diseases. Consequently, this study sought to determine the annual prevalence of spontaneously reported ADEs using six years reports and factors associated with the occurrence of serious ADE among outpatient care settings in Ghana to provide future guidance. Method A cross-sectional study was conducted using duplicates of Ghana Food and Drugs Authority adverse event forms retrieved from 3 outpatient care setting who had submitted their reports to the National Pharmacovigilance Centre in Ghana between 2013 and 2018. The raw data were entered into Microsoft excel and analyzed using stata version 14. Bivariate analyses were performed using Pearson chi square and all variables that were statistically significant were used for a multivariate analysis. Results Overall, 93 spontaneously reported cases of ADEs were identified during the study period. The mean age of the patients with a reported ADE was 42 ± 17 years, the annual prevalence rate was 192 reports per 1,000,000 population among our study population and the rate of serious ADE was 35.48% (95% CI: 25.83%-46.09%). Serious ADEs were associated with the type of indication for which the drug was prescribed (p=0.048), the duration of ADEs (p=0.047) and the decision to administer treatment at the reporting facility (p=0.017) and was independently predicted by duration of ADEs (aOR =7.63, 1.37-42.65) and decision to administer treatment for ADEs (aOR=20.28, 2.38-172.57). Conclusion Early reporting of ADEs at outpatient settings is essential. Patient education and awareness of potential ADE must be intensified for early identification and we will be following this u

Adherence to pneumonia guidelines in Ghana

Background Adherence to standard treatment guidelines (STGs) is seen as a pragmatic way to measure and improve the quality of future prescribing in ambulatory care to reduce morbidity, mortality and healthcare costs. The objectives of this study were to evaluate adherence to the Ghana STGs for the empiric antibiotic treatment of ambulatory community acquired pneumonia (CAP) in a region in Ghana and factors associated with it. Method A retrospective cross-sectional survey was conducted using a checklist to collect data from the hospital electronic database of all ambulatory patients managed for CAP from September 2018 to January 2019 who attended Keta Municipal Hospital, a primary healthcare facility. The data included socio-demographic details, payment type and clinical information. Prescriptions were assessed for adherence to the Ghana STG based on choice of antibiotics. A chi square test, Fisher exact test and multiple logistic regression were subsequently conducted. Results A total of 1929 CAP patients were identified. The overall rate of adherence to the Ghana STG was 32.50% (n=627). Among our study participants, 62.50% were female, 41.84% were children (0 – 12 years), and 97.15% had a valid national health insurance status. Adherence was associated with the duration of antibiotic, number of antibiotics prescribed, and some patients’ clinical characteristics documented. Conclusion The rate of adherence to Ghana STG on ambulatory pneumonia management concerning the choice of antibiotics among the study population was sub-optimal. Efforts must be made to train and encourage prescribers to follow empiric guidelines to reduce inappropriate selection of antibiotics in resource-poor settings

Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a Public Hospital in Ghana : a clinical audit study

Background: One in ten of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate making it a potential driver of antimicrobial resistance. The study aimed to evaluate the appropriateness of antibiotic use among ambulatory patients seeking dental care services in a public hospital in Ghana. Methods: A retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected. Results: Overall, 1433 patient medical records were extracted from the database within the study period. The mean age of the patients identified was 39.9 years with almost two thirds being female. Majority (91.1%, n=1306) of them were attended to by a dental nurse. 88.6% (n=1269) of the patients received antibiotics and 87.5% (n=1254) of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Three-quarters of the dental conditions were managed with dual antibiotics comprising of amoxicillin and metronidazole. Antibiotic prescription was associated with the age, gender, the type of prescriber and the type of dental condition diagnosed. Conclusion: There is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital and most are inappropriate. Development of local guidelines supported by education of dental clinicians on empiric use of antibiotics is a suitable target for the antimicrobial stewardship (AMS) team to address in KMH

Assessment of adherence to pneumonia guidelines and its determinants in an ambulatory care clinic in Ghana : findings and implications for the future

Background: Adherence to local standard guidelines is seen as a pragmatic way to measure and improve the quality of future prescribing in ambulatory care to reduce morbidity, mortality and healthcare costs. The objectives of this study were to evaluate adherence to the Ghana Standard Treatment Guidelines (STGs) for the empiric antibiotic treatment of ambulatory care patients with community acquired pneumonia (CAP) in a region in Ghana and factors associated with it. Method: A cross-sectional survey was conducted using a checklist to collected data from the hospital electronic database, which included socio-demographic details, payment type and clinical information of all ambulatory patients attending Keta Municipal Hospital, diagnosed and managed for CAP from September 2018 to January 2019. Prescriptions were assessed for adherence to the Ghana STG based on choice of antibiotics. A chi square test and multiple logistic regression were subsequently conducted. Results: A total of 1929 patient records with a diagnosis of CAP within the study period at the ambulatory clinic were identified. The overall rate of adherence to the Ghana STG was 32.50% (n=627). From the patient records collected, 62.50% were female, 41.84% were children (0 – 12 years), and 97.15% had a valid national health insurance status. Adherence was associated with the duration of antibiotic prescribing, number of additional antibiotics prescribed, and some patients’ clinical characteristics. Conclusion: The rate of adherence to Ghana STG among the study population was low. Efforts must be made to train and encourage prescribers to follow empiric guidelines to reduce inappropriate selection of antibiotics in the ambulatory care settings

Practical Pharmacist-Led Interventions to Improve Antimicrobial Stewardship in Ghana, Tanzania, Uganda and Zambia.

The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR

Prevalence rate of spontaneously reported adverse events and determinants of serious adverse events among three outpatient care settings in Ghana : findings and implications

Introduction and objectives: Most evidence of adverse drug events (ADEs) comes from hospitals as the risks associated with hospital care are higher. However, under-reporting of ADEs is a critical problem in all health care settings. This is important in sub-Saharan African countries including Ghana with limited resources and high prevalence of both infectious and non-infectious diseases. Consequently, this study sought to determine the annual prevalence of spontaneously reported ADEs using six years reports and factors associated with the occurrence of serious ADEs among outpatient care settings in hospitals in Ghana to provide future guidance. Method: Cross-sectional study using duplicates of the Ghana Food and Drugs Authority adverse event forms retrieved from 3 outpatient care settings submitting their reports to the National Pharmacovigilance Centre in Ghana between 2013 and 2018. Descriptive and bivariate analysis were performed. Results: Overall, 93 spontaneously reported cases of ADEs were identified during the study period. The annual prevalence rate was 192 reports per 1,000,000 population among our study population and the rate of serious ADE was 35.48% (95% CI: 25.83%-46.09%). Serious ADEs were associated with the type of indication for which the drug was prescribed (p=0.048), the duration of the ADE (p=0.047) and the need to administer treatment for the ADE at the reporting facility (p=0.017). Conclusion: Early spontaneous reporting of ADEs at outpatient settings is essential. Patient and provider education and awareness of potential ADEs must be intensified for early identification and reportin

Covid-19, healthcare and self-medication issues in resource limited-settings : findings and implications based on experiences in Ghana

Introduction and objectives: There have been concerns with the level of misinformation regarding COVID-19 and its treatment, drug shortages, as well as increased use and prices of antimalarials, antibiotics and hygiene products during the recent pandemic. Community pharmacists can play a significant role in disease prevention and treatment in the fight against COVID-19 including providing hygiene information and medicine availability across Africa and generally. Consequently, there is a need to review the role of community pharmacists in preventing unintended consequences during any pandemic as well as the impact of COVID-19 on the demand, availability and prices of suggested medicines for its management. Method: Multiple approach involving a qualitative review of the management of COVID-19 across countries coupled with a pilot study in Ghana among six purposely selected community pharmacists during the early stages of the pandemic assessing patterns of demand, availability and prices of medicines suggested for the management of COVID-19. Alongside this, pharmacists’ future role enhancing appropriate medicine use in Ghana and wider combined with the help of senior level co-authors. Results: The majority (five out of six) of pharmacists in Ghana reported increased demand for hydroxychloroquine, antibiotics and vitamins as immune boosters resulting in shortages with price increases particularly for antimalarials. Conclusion: The global lockdown had impacted on the supply and prices of medicines in Ghana similar to other countries. Community pharmacists can play a key role with encouraging safe medicine use, reducing self-purchasing of medicines and planning workflows during future pandemics including vaccinations. They can also help address potential misinformation and its consequences as well as the unintended consequences of pandemics including better management of non-communicable diseases

Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries With a Particular Focus on Africa and the Implications

Background: Countries across Africa and Asia have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE). However, there has been considerable controversy surrounding some treatments including hydroxychloroquine where the initial hype and misinformation led to shortages, price rises and suicides. Price rises and shortages were also seen for PPE. Such activities can have catastrophic consequences especially in countries with high co-payment levels. Consequently, there is a need to investigate this further. Objective: Assess changes in utilisation, prices, and shortages of pertinent medicines and PPE among African and Asian countries since the start of pandemic. Our approach: Data gathering among community pharmacists to assess changes in patterns from the beginning of March until principally the end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: One hundred and thirty one pharmacists took part building on the earlier studies across Asia. There were increases in the utilisation of principally antimalarials (hydroxychloroquine) and antibiotics (azithromycin) especially in Nigeria and Ghana. There were limited changes in Namibia and Vietnam reflecting current initiatives to reduce inappropriate prescribing and dispensing of antimicrobials. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries where documented. In addition, generally limited change in the utilisation of herbal medicines. However, shortages have resulted in appreciable price increases in some countries although moderated in others through government initiatives. Suggestions in Namibia going forward included better planning and educating patients. Conclusion: Encouraging to see increases in the utilisation of vitamins/immune boosters and PPE. However, concerns with increased utilisation of antimicrobials needs addressing alongside misinformation, unintended consequences from the pandemic and any appreciable price rises. Community pharmacists and patient organisations can play key roles in providing evidence-based advice, helping moderate prices through improved stock management, and helping address unintended consequences of the pandemic