Health-Care Providers' Preparedness for H1N1/09 Influenza Prevention and Treatment in Dar es Salaam, Tanzania.

\ud In Tanzania, the first case of H1N1/09 influenza was reported in September 2009. By March 2010, the reported number of cases was 770 with one death. Due to shortage of qualified human resources, essential medicines and laboratory supplies in health facilities, it was not known how well health-care providers in the country were prepared to deal with the pandemic. The study was conducted from December 2009 to May 2010 in public hospitals and private community pharmacies in Dar es Salaam, Tanzania. Fifty-three prescribers and 200 dispensers were interviewed to assess their knowledge on the prevention and treatment of H1N1/09 influenza, and dissemination of correct information to the public regarding the pandemic. Most participants had inadequate knowledge on the transmission, prevention and management of H1N1/09 influenza. The majority of prescribers knew neither the antiviral drugs recommended for the treatment of H1N1 influenza (64%) nor their adverse effects (92.5%). The drug dispensers' knowledge was also inadequate regarding the transmission, prevention and treatment of H1N1/09 influenza. Forty-one (20.5%) salespersons without formal training in pharmaceutical or medical sciences were found dispensing and supervising the pharmacies. Most participants had misconceptions on how H1N1/09 virus was transmitted. The results of the study revealed gaps in the knowledge of the health-care providers on the prevention and treatment of H1N1/09 influenza infection. This indicates the need for strengthening of health-care systems and provision of continuing education and professional development for health-care providers on new and re-emerging diseases in the community.\u

Knowledge among Drug Dispensers and Antimalarial Drug Prescribing Practices in Public Health Facilities in Dar es Salaam.

Irrational prescribing and dispensing of antimalarials has been identified as a contributing factor in the emergence of malaria parasites resistant to existing antimalarial drugs. Factors that contribute to such irrational prescribing and dispensing should therefore be identified to address this problem. The aim of this study was to assess irrational antimalarial drug dispensing and prescribing practices in public health facilities. A descriptive-retrospective cross-sectional study was conducted between January and June 2011 in order to assess prescribing and dispensing practices for antimalarial drugs in three public hospitals and nine health centers in Dar es Salaam, Tanzania. Thirty-two drug dispensers were interviewed using a structured questionnaire. A total of 4,320 prescriptions for the period January to December 2010 were collected and assessed for antimalarial drug prescribing patterns. The majority (84.6%) of drug dispensers had poor knowledge regarding the basic information required from patients before dispensing artemether-lumefantrine. Seventeen of 32 drug dispensers did not know the basic information that should be given to patients in order to increase absorption of artemether-lumefantrine after oral intake. Most drug dispensers also showed limited knowledge about the dosage and contraindications for artemether-lumefantrine. Eighty-seven percent of all prescriptions contained artemether-lumefantrine as the only antimalarial drug, 77.1% contained at least one analgesic, and 26.9% contained at least one antibiotic, indicating unnecessary use of analgesics and antibiotics with antimalarial drugs. A substantial number of prescriptions contained antimalarial drugs that have already been declared ineffective for the treatment of malaria in Tanzania, providing additional evidence of inadequate knowledge among health care workers concerning treatment policy. Despite the government's efforts to increase public awareness regarding use of artemether-lumefantrine as first-line treatment for uncomplicated malaria, there is still irrational prescribing, dispensing, and use of this combination. Based on the results of this study, it is proposed that regular on-the-job training and continuing education be provided to drug dispensers and prescribers in public health facilities

Diarrhoea Among Under-Five Children and Household Water Treatment and Safe Storage Factors in Mkuranga District, Tanzania

In Mkuranga district diarrhoea was among the top ten causes of morbidity and mortality among children under the age of five. Household water treatment and safe storage also known as point of use water treatment (POU) has been shown to be an effective means of reducing diarrhoea and other diseases associated with unsafe drinking water. The purpose of this study was to determine factors associated with diarrhoea with focus on Household water treatment and safe storage and microbial contamination of drinking water. A Cross sectional analytical study was conducted in Mkuranga semi-urban area in Mkuranga district Coast region of Tanzania whereby a probability sample of 400 households was obtained using a multistage sampling technique. Semi-structured questionnaires were used to collect information. Moreover drinking water samples were collected from each household for micro-bacterial analysis mainly E.Coli and Total coli forms. WHO drinking water standards were used to categorize drinking water as acceptable or not. The data were entered; cleaned and analysed using Epi Info version 3.6.11 bivariate analysis was done to determine association between variables, while logistic regression was conducted to control for confounding effects, p values are reported at 95% level. The study was approved by Muhimbili University of Health and Allied Sciences Research and Publications Committee. A total of 301 children between the age of 6 months to 59 months were studied with the response rate of 95%. The mean age of study population was 2years±1.3 Standard deviation with a male to female ratio of 0.9:1. The prevalence of under five diarrhoea was 32.7%, the proportion of households that reported treating water with any method was 49.5%. Out of 301 drinking water samples tested about 37.2% were fecally contaminated with the mean E.Coli count of 2.6cfu/100ml of water (SD=±4.8cfu). Also 78% of all drinking water samples tested had total coli forms with the mean total coli form count of 69.9cfu/100ml (SD=±43.2cfu). Drinking water within unacceptable standards (Adjusted OR=20.64, 95%CI 5.84-128, p=0.00), Storing water in container without lid (Adjusted vii OR=5.4 95%CI 2.6-11.3) and lack of formal education to guardians/parents (Adjusted OR=1.9, 95%CI 1.08-3.50) increased the risk of diarrhoea. Also treating water with any method (AOR=0.49, 95% CI 0.28-0.84), treating water by boiling (Adjusted OR=0.39, 95% CI 0.2-0.7), Store water in container with lid (Adjusted OR=0.31, 95%CI 0.17-0.53) and parents washing hands with soap following house activities (AOR=0.41, 95% CI 0.24-0.84) were associated with reduced risk of diarrhoea. Households should be sensitized to treat their drinking water, wash hands with soap, store drinking water in containers with cover in addition adult formal education should be provided in order to reduce the under five diarrhoea in Mkuranga semi urban area

Antimalarial Drugs for Pediatrics - Prescribing and Dispensing Practices in a Tanzanian City

Purpose: To assess dispensing and prescribing practices with regard to antimalarial drugs for pediatrics in private pharmacies and public hospitals in Dar es Salaam, Tanzania.Methods: This was a cross-sectional, descriptive study that assessed the knowledge and practice of 200 drug dispensers in the private community pharmacies in Dar es Salaam. Two hundred (200) parents of children seeking malaria treatment were also interviewed at the public hospitals.Results: A majority of drug dispensers had moderate (63.3 %) to low knowledge (36.7 %) regarding antimalarial drug use in pediatrics. Parents had moderate (67 %) to low (33 %) level of understanding of the instructions given to them by the prescribers regarding administration of antimalarial drugs to pediatrics at home. Most children were not weighed, and there were indications of wrong calculations of doses of antimalarials in pediatrics.Conclusion: Overall, there were irrational dispensing and prescribing of antimalarial drugs to pediatrics. Since malaria is a major killer disease in Tanzania, especially in children under five years of age, there is a need to institute measures to ensure rational prescribing, dispensing and use of antimalarial drugs in pediatrics.Keywords: Antimalarials, Dispensing, Knowledge, Pediatrics, Pharmacies, Prescribin

Rational dispensing and use of artemether-lumefantrine during pregnancy in Dar es Salaam, Tanzania

Artemether–Lumefantrine (ALu) is widely used for uncomplicated malaria during the second and third trimester of pregnancy. Because of the suspected teratogenic effects of artemether during the first trimester, quinine is used in early pregnancy unless the risks outweigh the benefits. The aim of this study was to assess dispensing practice of ALu in private pharmacies and knowledge of pregnant women regarding the use of ALu. This was a prospective-descriptive study involving visits to 200 private retail pharmacies (using a mystery shopper) and interviewing pregnant women at the municipal public hospitals in Dar es Salaam, Tanzania. Among the drug dispensers, 60 (30%) were pharmacists, 71(35.5%) nurse assistants, 34 (17%) pharmaceutical technicians and 35 (17.5%) sales persons with no formal education on drug dispensing. Among the dispensers, 14.5% had high knowledge, 38.0% had medium knowledge and 47.5% had low knowledge on the use of ALu during pregnancy. About thirty three percent of the drug dispensers were willing to dispense ALu during the first trimester of pregnancy.  Sixty two percent of the drug dispensers indicated that ALu is the drug of choice for uncomplicated malaria after the first trimester of pregnancy. However, 36% indicated that ALu could not be used during pregnancy.  A total of 200 pregnant women were interviewed. Among them, 16.5% were aware that ALu should not be taken during the first trimester of pregnancy. Only 17% of pregnant women were given information on the importance of taking food when using ALu, but none of them was given information on the importance of fatty meals when using ALu. In conclusion, the results show that most drug dispensers have inadequate knowledge about good dispensing practice of ALu in pregnancy. There is therefore a need for continuing training of drug dispensers regarding antimalarial drugs use in pregnancy

Factors Influencing Prescribing Practices of Medical Practitioners in Public and Private Health Facilities in Dar es Salaam, Tanzania

Purpose: To determine the factors that influence prescribing practices of medical practitioners in public and private health facilities in Dar es Salaam, TanzaniaMethods: One hundred and ninety two (192) medical practitioners from 11 public and 3 private health facilities of Dar es Salaam, Tanzania were interviewed for the criteria they consider when making prescribing decisions. Systematic sampling was used to obtain the required number of medical practitioners working in the hospitals, while for those working in the health centers convenience sampling was used.Results: Medical information from textbooks (64 %) and internet (63 %) were the main sources of prescribing information among medical practitioners. In comparison, medical practitioners in private health facilities (97 %) were more concerned with proven effectiveness of drugs than those working in public health facilities (74.2 %, p = 0.001). Cost of drug to patients was considered much more by practitioners in public health facilities (48.4 %) than their counterparts in private health facilities (24.3 %, p = 0.010). Availability of drugs in the health facility influenced prescribing decisions by a majority of prescribers from public health facilities (53.5 %) than those working in private health facilities (18.9 %, p = 0.000).Conclusion: There are substantial differences between prescribers working in public and private health facilities with regard to the factors which influence their prescribing decisions. In order to promote rational use of medicines, these factors should be considered by health planners when formulating policies and allocating resources in health facilities.Keywords: Prescribing practice, Medical practitioners, Health facilities, Prescribing information, Drug costs, Rational use, Drug effectivenes

Screening for the P-glycoprotein inhibitory pump activity of plant extracts that are used in Tanzanian traditional medicine

An in vitro screening experiment of 45 methanolic plant extracts was carried out to investigate the inhibition of P-glycoprotein (P-gp) in MCF-7R cells. The investigation was carried out using standard functional assay with rhodamine 6G as the fluorescent probe and reserpine, a known inhibitor of P-glycoprotein pump, was used as a reference drug. The results revealed that out of the 45 plant extracts tested, 3 extracts i.e. Bauhinia thoningii, Clerodendrum myricoides and Rhus natalensis exhibited pronounced activity at the concentration of 100 µg/ml. In comparison to the negative control, B. thoningii, C. myricoides and R. natalensis extracts inhibited the pump by a factor of about 2.5, 4 and 4.3, respectively. The remaining 42 extracts did not show any activity. The reference drug reserpine (20 μM) inhibited the pump by a factor of about 11. These preliminary results indicate that the inhibition of P-gp in MCF-7R cells is through a concerted action of compounds present in the extracts and that if isolated might be effective P-gp pump inhibitors in the treatment of cancer. Keywords: plant extract, P-glycoprotein inhibition; rhodamine 6G; MCF-7R cells East and Central African Journal of Pharmaceutical Sciences Vol. 7 2004: 16-2

Cytotoxic activity of some Tanzanian medicinal plants

Thirty-three aqueous methanolic extracts obtained from thirty plant species, belonging to seventeen families were screened for cytotoxic activity against HeLa (Human cervical carcinoma) cells. The ability of the extracts (10 g/ml and 1 g/ml) to inhibit proliferation of HeLa cells was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) dye reduction assay. Extracts from roots of Agathisanthemum bojeri, Synaptolepis kirkii and Zanha africana and the leaf extract of Physalis peruviana at a concentration of 10 µg/ml inhibited cell proliferation by 58.3 %, 68.1 %, 75.7 % and 91.8 %, respectively. The remaining 29 extracts exhibited no pronounced cytotoxic activity at the tested concentrations. It is worth investigating the four extracts, which showed pronounced cytotoxic activity so as to isolate and identify the compounds responsible for cytotoxic activity. Keywords: cytotoxic plants, Tanzanian medicinal plants, Agathisanthemum bojeri, Synaptolepis kirkii, Zanha africana, Physalis peruviana The East and Central African Journal of Pharmaceutical Sciences Vol. 8(2) 2005: 35-3

Cytotoxic Screening of Some Tanzania Medicinal Plants

East and Central African Journal of Pharmaceutical Sciences Vol.6(3) 2003: 52-5

Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: A Systematic Review

Highlights  Prevalence of DCM varies widely in SSA.Cardiovascular risk factors are important in patients with DCM.The role of genetics in idiopathic DCM is not studied in major part of SSA