Knowledge, attitude, and practices on disposal methods of expired and unused medicines among students in public academic institutions in Lusaka, Zambia

Background: Unsafe disposal of unused and expired household medicines is a public health problem and mostly occur because of a lack of knowledge towards suitable medicine disposal methods. Thus, we aimed to assess the knowledge, attitude, and practices on the disposal methods of unused and expired medicines among students in public academic institutions in Lusaka, Zambia.Methods: This was a cross-sectional study in which 385 students from three higher learning academic institutions were interviewed face to face using a structured questionnaire from 10th May to 24th June 2019. The cleaned data was then transferred to statistical package for social science (SPSS) version 25.0 for analysis.Results: The mean age of the participants was 23 (SD±2.9). Out of the 385 participants, 215 (55.8%) did not know much about medical waste and 345 (89.6%) of them did not have any previous information regarding proper and safe disposal of unused and expired medicine. However, 351 (91.4%) of the participants appropriately responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. Throwing unused and expired medicine in household garbage/bin was the most frequently used disposal practice followed by flushing them in toilet/sink as responded by 231 (60.0%) and 128 (33.3%) of participants respectively. Only 17 (4.42%) reported returning unused and expired medicines to the nearest pharmacy.  Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities. 

Evaluation of pharmacological prophylaxis for deep venous thrombosis in hospitalized patients with risk factors at the university teaching hospitals, Lusaka, Zambia

Background: Deep venous thrombosis is a common clinical problem accounting for high rates of morbidity and mortality. The existence of risk factors, which include trauma, venous stasis, and hypercoagulability, is linked to the occurrence of the condition. Objective of current study was to evaluate DVT risk factors and prophylaxis pattern of use for patients who were admitted at the University Teaching Hospitals in Lusaka, Zambia.Methods: A cross-sectional study was conducted using medical files for patients who were hospitalized at the University Teaching Hospitals in Lusaka, Zambia from May 2020 to June 2021. Two hundred and ninety-six patient files were reviewed, and the Caprini risk assessment model was used to stratify patients into DVT risk categories. Multilinear regression analysis was used to identify factors associated with DVT prophylaxis.Results: Of the 296 patient files that were sampled from ICU, medical, and surgical wards, 198 (66.9%) (>2 caprini score) were eligible for DVT prophylaxis, but only 77 (38.9%) of these eligible patients received prophylaxis. The number of eligible patients for DVT prophylaxis per department was as follows; ICU 50 (100%), Medical 71 (57.7%) and Surgery 77 (62.6%) wards. However, DVT prophylaxis was given to 21 (42%), 33 (46.5%), and 23 (29.9%) patients from the ICU, medical, and surgery, respectively. Enoxaparin was the most commonly used anticoagulant for Venous thromboembolism (VTE) prophylaxis with a mean dose of 60mg (SD±5). Across all departments, the most common predisposing risk factors for DVT were bed confinement for >72 hours (167, 56.4%) and age of 41-60 years (118, 39.8%). In the adjusted model, swollen legs (AOR: 3.6, CI: 1.97, 6.57) and history of VTE (AOR: 21.3, CI: 9.87, 46.08) were significantly associated with a higher likelihood of DVT prophylaxis.Conclusions: Pharmacologic thromboprophylaxis is underutilized in patients in ICU, medical and surgical wards at the university teaching hospitals in Lusaka, Zambia. This study underscores the importance of implementing a DVT risk assessment technique for patients in ICU, medical and surgical wards and administering prophylaxis unless contraindicated

Effects of medication knowledge on medication adherence among hypertensive patients at Matero level one hospital, Lusaka city, Zambia: a cross sectional study

Background: Medication adherence is the mainstay to good treatment outcomes. Failure to adhere to medication in hypertensive patients may lead to considerable deterioration of the disease resulting in increased costs of healthcare and mortality. Knowledge about the name of the drug, indications and side effects may enhance medication adherence. Therefore, the aim of this study was to assess effects of medication knowledge on medication adherence among hypertensive patients.Methods: This was a cross-sectional study that involved 120 hypertensive patients. A structured questionnaire was used to collect data on demographic characteristics. Adherence was assessed using the 8-item Morisky medication adherence scale while patient’s medication knowledge was assessed using a 7-item scale. Multiple logistic regression was used to assess factors associated with medication adherence.Results: The mean age of participants was 59 years (SD±14.9) and 10 (8.3%), 42 (35%) and 68 (56.7%) had adequate, average and poor medication knowledge respectively. The prevalence of adherence in this study was 37.5%. In multivariable logistic regression analysis, uncontrolled blood pressure (BP) (AOR: 0.38, CI: 0.16-0.90) was associated with lower likelihood of adhering to medication.Conclusions: The adherence level to treatment was low and medication knowledge of hypertensive patients was generally poor. Uncontrolled BP was associated with non-adherence. Patients with uncontrolled hypertension should be given health education and counselling regarding their condition to improve medication adherence.

Medication omissions in the first 48 hours after admission: failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children’s Hospital in Lusaka, Zambia

Background: The first few days of in-patient care are possibly the most significant in a patient’s recovery and any omitted medications during this period may harm the patient or increase their hospital length of stay. Therefore, our study aimed at assessing the frequency of medication administration omission errors and their reasons for the omission in the paediatric wards after admission at University Teaching Children’s Hospital.Methods: This was a descriptive study in which 259 patient files and drug charts were reviewed. Admission prescription charts were studied in detail over a period of four weeks and all drugs prescribed but then not given in the first 48 hours were recorded as omitted medications, along with the reason given for their omission.Results: From the 259 drug charts, a total of 1598 doses of drugs were ordered within 48 hours of admission. However, from this, only a total of 1132 doses were administered with the remaining 466 doses omitted, which accounted for a frequency of 29.2%. When the frequency of medication omission errors was compared, parenteral drugs (70.8% vs. 25.3%, [p=0.0001]), afternoon shift (48.5% vs. 15.8%, [p=0.0001]), and anti-infective medications (69.1% vs. 39.4%, [p=0.0001]) were found to be the most frequently omitted medications. There were also considerably more medication omissions in patients prescribed with more medications (median number: 4, I QR [2, 6] vs. median number: 2, IQR [2, 4], [p=0. 0.001]). The most common reason for the omission was medication unavailability (89.3%), followed by work overload (71.4%), and the patient is off the ward (71.4%).Conclusions: This study revealed that medication omissions are a continuing problem and this may result in increased morbidity and mortality rates. There is a need to put in place specific strategies to reduce this problem.

Familiarity, Knowledge and Practices of Healthcare Professionals Regarding the Pharmacovigilance of Biological Medicines in Lusaka, Zambia: A Multi-Facility Cross-Sectional Study.

Background: Pharmacovigilance of biological medicines is crucial because it ensures that medicines meet the World Health Organization (WHO) standards. In Zambia, there is little information on healthcare professionals’ familiarity, knowledge and practices on the pharmacovigilance of biological and biosimilar medicines. Therefore, this study investigated the familiarity, knowledge, and practices related to the pharmacovigilance (PV) of biological and biosimilar medicines at selected hospitals in Lusaka, Zambia. Methods: The study was an analytical questionnaire-based cross-sectional study conducted among healthcare professionals (HCPs) at the Adult hospital, Cancer Diseases hospital, Paediatrics hospital and Women and New Born Hospital in Lusaka. Data were collected over four weeks in May and June 2021 and subsequently analysed using IBM SPSS version 21. The statistical significance was set at a 95% confidence interval. Results: Of 245 participants, only 115 (48.9%) of the HCPs were familiar with biological medicines to a basic understanding. Regarding the term biosimilars, most of the HCPs (40.9%) never heard of this word. The mean score for knowledge regarding the PV considerations of biological medicines was 4.1 out of 8 questions. Most HCPs used non-proprietary names (44.2%) when prescribing, dispensing, or administering biological medicines. Additionally, more than half (57.3%) of HCPs did not record batch numbers when dispensing or administering biological medicines. Conclusion: Healthcare professionals were more familiar with the term biological medicines than biosimilars. Healthcare professionals generally scored poorly when their knowledge regarding the PV considerations of biological medicines was assessed. Thus, there is a need to provide adequate training and continuous professional development among healthcare professionals on the pharmacovigilance of biological and biosimilar medicines

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia.

INTRODUCTION: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. MATERIALS AND METHODS: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely; Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. RESULTS: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. CONCLUSION: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future

Psychological Impact of COVID-19 on Healthcare Workers in Africa, Associated Factors and Coping Mechanisms: A Systematic Review.

Background: The coronavirus disease 2019 (COVID-19) is a public health problem that has caused harm to the mental health of healthcare workers. In Africa, the COVID-19 pandemic has led healthcare workers to experience mental health disorders such as anxiety, depression, stress, insomnia and burnout. This study aimed to review published studies on the effect of COVID-19 on the mental health of healthcare workers, associated factors and coping strategies that have been employed in Africa. Methods: This was a systematic review that was conducted through searching databases including; PubMed/Medline and Google Scholar. The study included published literature from January 2020 to May 2022 that met the inclusion criteria. The selection of articles was conducted following the 2020 PRISMA guidelines. Results: A total of 39 articles were retrieved, of which only 18 met the inclusion criteria and were used in this study. Our review revealed that healthcare workers experienced mental health disorders such as anxiety, depression, insomnia, stress and burnout that were associated with the COVID-19 pandemic. Coping strategies such as religious practices, support from family members and colleagues and avoiding listening to social media about COVID-19 were used to minimize mental health problems. Conclusion: The COVID-19 pandemic has caused increased mental health disorders among healthcare workers in Africa. Identification of factors associated with mental health problems is cardinal in developing coping mechanisms against the psychological impact of COVID-19. Therefore, there is a need for governments to develop and implement strategies for protecting the mental health of healthcare workers during crises such as the COVID-19 pandemic

Student’s perspectives, satisfaction and experiences with online and classroom learning during the COVID-19 pandemic : findings and implications on blended learning

Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted classroom-based learning, necessitating the adoption of online learning in most universities. However, there has been a lack of information on university students' perspectives regarding online learning during the COVID-19 pandemic. This study assessed the perspectives, satisfaction, and experiences with online and classroom learning among human health students at the University of Zambia. Methods: This cross-sectional study was conducted among 737 students at the University of Zambia from October 2022 to April 2023. Data were analysed using Stata version 16.1. Results: Of the 737 participants, 51.6% were female and 56.5% agreed that blended learning should continue even after the COVID-19 pandemic. However, 78.4% of the students believed that group discussions were more suitable in the classroom than online learning. Most students (67.1%) disagreed that they preferred online learning to classroom learning. Further, 77.6% of the students disagreed that online learning gave more satisfaction than classroom learning. Conclusions: This study found that most students recommended the continuation of blended learning after the pandemic. However, they believed that follow-up tutorials and assessments were better undertaken in physical classrooms than online learning. These findings are important in sensitising stakeholders in the education sector and governments to consider blended learning as a teaching strategy in the future. There is a need to develop and implement curricula that offer blended learning to students as well as ensure the students have the necessary facilities and equipment to support such learning

Impact of the coronavirus disease on the mental health and physical activity of pharmacy students at the University of Zambia: a cross-sectional study

Background: The novel coronavirus disease (COVID-19) is a serious global health problem that has negatively impacted the mental health of students.Methods: We conducted an online descriptive cross-sectional study among 273 undergraduate pharmacy students at the University of Zambia from August to September 2020. A partial proportional odds regression model was used to determine the predictors of anxiety. All statistical tests were set at 95% confidence level (p<0.05).Results: A response rate of 70% was obtained with the majority of the students being female 51.6%. Of the 273 respondents, 23.8% did not experience anxiety, 34.4% experienced mild anxiety, 24.9% experienced moderate anxiety while 16.9% experienced severe anxiety about COVID-19. It was also found that 61.2% of students reported that their attention to mental health increased during the COVID-19 pandemic whereas 44.3% reported an increased resting time with a significant reduction in relaxation 51.3% and physical activity 45.4% time. Factors that affected mental health included; reduced family care (OR: 2.27; 95% CI: 1.09-4.74), not changing attention to mental health (OR: 0.33; 95% CI: 0.18-0.62), being in the final year of study (OR: 0.33; 95% CI: 0.13-0.84), reduced time of resting (OR: 2.10; 95% CI: 1.26-3.50) and feeling helpless (OR: 0.42; 95% CI:0.23-0.75).Conclusions: COVID-19 negatively impacted the mental health and physical activity of pharmacy students at the University of Zambia. This can have negative health and academic outcomes for students going forward. Higher learning institutions and key stakeholders should implement measures to aid students to recover from the impact of COVID-19 on their mental health and physical activity

The paradigm shift towards online learning during Covid-19 pandemic: an assessment of the attitudes on the learning practices among University of Zambia pharmacy students

Abstract Background The nexus between higher education and digital technology has been extensively studied in the past and recently during the COVID-19 pandemic. This study aims to ascertain pharmacy students' attitudes towards using online learning during COVID-19. Methods This cross-sectional study assessed the University of Zambia’s (UNZA) pharmacy students’ adaptive characteristics, such as attitude, perception, and barriers to online learning during the COVID-19 pandemic. Data from a survey of N = 240 were collected using a self-administered, validated questionnaire along with a standard tool. Findings were statistically analysed using STATA version 15.1. Results Of the 240 respondents, 150 (62%) had a negative attitude towards online learning. Further, 141 (58.3%) of the respondents find online learning less effective than traditional face-to-face learning. Regardless, 142 (58.6%) of the respondents expressed a desire to modify and adapt online learning. The mean scores for the six domains of attitude (perceived usefulness, intention to adapt, ease of use of online learning, technical assistance, learning stressors, and distant use of online learning) were 2.9, 2.8, 2.5, 2.9, 2.9, and 3.5, respectively. After multivariate logistic regression analysis, no factors in this study were significantly associated with attitude towards online learning. The high cost of the internet, unreliable internet connectivity and lack of institutional support were perceived barriers to effective online learning. Conclusion Although most of the students in this study had a negative attitude toward online learning, they are willing to adopt it. Online learning could supplement traditional face-to-face learning in pharmacy programs if it can be made more user-friendly, have fewer technological barriers, and be complemented by programs that help improve practical learning abilities