Evaluation of antimalarial drug use practices of health extension workers and patient adherence in southern Ethiopia/Wolyta zone

Early diagnosis and prompt treatment is one of the malaria control strategies used to minimize malaria morbidity and mortality. One of the mechanisms to implement early diagnosis and prompt treatment is community access to diagnostic services and effective antimalarial drugs. However, in Ethiopia the health system is underdeveloped and much of the rural population has limited access to modern health services. Therefore, the Ethiopian government introduced the Health Extension Programme(HEP) which is a community-based health care delivery system aimed at accessing essential health services through its health extension workers (HEWs). Involvement of the HEWs in prescribing and dispensing antimalarial drugs is shown to have improved community access to antimalarial drugs. However, there is insufficient knowledge of HEWs compliance to malaria treatment guidelines and patient adherence of patients treated by HEWs. The objectives of this study has been to describe the HEWs practice in malaria treatment, to evaluate adherence of patients to antimalarial drugs, to explore the factors influencing the HEWs malaria treatment practice and patient adherence, and to develop the guidelines to support the HEWs in malaria treatment practice. A qualitative study design was used to study the HEWs practice in malaria treatment along with patient adherence. Data were collected using in-depth face-to-face interviews, focus group discussion and patient medical record review and were analysed according to Tesch’s steps. The study revealed that the HEWs adequately comply with malaria treatment guidelines during diagnosis of malaria, as well as during the prescribing and dispensing of antimalarial drugs. However, there are some factors influencing the performance of HEWs. These are: shortage of diagnostic kit/RDT, shortage of antimalarial drugs, patient pressure to obtain coartem, work load, and community beliefs with regard to antimalarial drugs effectiveness. This study also revealed that the HEWs follow up after treatment of patients and good community support systems improved patient adherence to antimalarial drug use. Factors negatively influencing patient adherence were identified to include: forgetfulness, fear of shortage of drugs, adverse drug effects, duration of treatment, rapid relief of malaria symptoms and inadequate awareness of the consequence of incomplete dosage. Guidelines were developed to support the HEWs in malaria treatment practice with the aim to improve patient adherence to antimalarial drugsHealth StudiesD. Litt. et Phil. (Health Studies

Evaluation of malaria treatment practice of health extension workers (community health workers): a qualitative study conducted in Damot Gale district, Southern Ethiopia

Background: The Ethiopian government introduced the Health Extension Program which is a community-based health care delivery system aimed at accessing essential health services such as malaria diagnosis and treatment through health extension workers (HEWs). Involvement of HEWs in prescribing and dispensing antimalarial drugs improved community access to antimalarial drugs. However, the HEWs compliance to malaria treatment guidelines was not evaluated. Aims and Objectives: This study was conducted to evaluate the HEWs malaria treatment practice based on malaria treatment guidelines. Material and Methods: In-depth interview to 20 HEWs, seven focus discussion with malaria treated patients, and 400 malaria patients medical records review were conducted. Results: The majority of HEWs correctly responded how to diagnose malaria patients using signs and symptoms, and rapid diagnostic test (RDT). Most of malaria-treated patients indicated that they prefer HEWs to other health workers for malaria treatment. Patient record data from patient registration books indicated that about 92%(368) of patients received appropriate drugs in appropriate dose and duration. But some patients (8%, 32) were prescribed with drugs not in line with the guideline. The two main reasons indicated by the HEWs for inappropriate prescription are: the shortage of chloroquine, and patient pressure to take coartem. About 8% (32) and 11% (44) of patients do not know the consequences of not completing antimalarial drugs and what to do after vomiting respectively. Conclusion:The most of HEWs adequately treat malaria patients and the communication with patients is adequate. Improving resource availability, patient education and in-service training are needed to improve malaria treatment practice of the HEWs

Drug use pattern in private drug retail outlets

Abstract: This is the first preliminary appraisal report on drug use pattern in private drug retail outlets in Southern Nations, Nationalities and Peoples Region. Community pharmacies and other retail outlets have always been the major reservouir of drugs in the health care system worldwide. Pharmacy employees are consulted for health advice on problems of all kinds, and remedies are sold or dispensed with almost every transaction. Some of the remedies are safe and effective when used correctly but otherwise can be dangerous. The results of the baseline study revealed that 94% of the retailers dispense drugs under dose; 74% dispense drugs obtained from illegal sources; 68% handled drugs beyond their level of competence; 20% dispense expired drugs, and 63% of the retailers provide medical services against regulations. Irrational use of drugs in the private retail outlets in the region, is obvious as depicted by the results of this study. It is recommended that formulation and implementation of a new drug legislation and regulation in addition to the educational intervention will help in promoting rational practice. [Ethiop. J. Health Dev. 1998;12(3):261-264

Therapeutic Efficacy and Safety of Artemether-Lumefantrine (Coartem®) in Uncomplicated P. Falciparum Malaria in Wolaita Zone, Southern Ethiopia.

Malaria is an important cause of death and illness in children and adults, especially in tropical countries. The emerging resistance to ACTs by p. falciparum malaria threatens the health of the hundreds of millions of people routinely exposed to the risk of infection with this organism. One-arm prospective evaluation of clinical and parasitological responses of directly observed Artemether-Lumefantrine (Coartem®) treatment of uncomplicated Plasmodium falciparum malaria as per WHO  protocol 2009 was conducted  at Baddessa Health Center in Wolaita Zone, Southern Ethiopia from Feb to March, 2015. A total of 88 study participants were enrolled and followed for 42 days and 86 participants were completed follow up. There was 100%% an adequate clinical and parasitological response among participants who completed 42 days of follow-up. Two participants were excluded from study: one participant at day 7 due to self withdrawal and one participant at day 28 due to loss to follow up. However, relatively high proportion of patients (5.7%) still positive on day 3 in this study would indicate possible threat of artemisinin resistance development in the area and regular surveillance should to be continued as WHO recommendation. Keywords: plasmodium palfarum, artemether-lumefantrine, therapeutic efficacy, safety, Ethiopia

Evaluation of malaria treatment practice of health extension workers (community health workers): a qualitative study conducted in Damot Gale district, Southern Ethiopia

Background: The Ethiopian government introduced the Health Extension Program which is a community-based health care delivery system aimed at accessing essential health services such as malaria diagnosis and treatment through health extension workers (HEWs). Involvement of HEWs in prescribing and dispensing antimalarial drugs improved community access to antimalarial drugs. However, the HEWs compliance to malaria treatment guidelines was not evaluated. Aims and Objectives: This study was conducted to evaluate the HEWs malaria treatment practice based on malaria treatment guidelines. Material and Methods: In-depth interview to 20 HEWs, seven focus discussion with malaria treated patients, and 400 malaria patients medical records review were conducted. Results: The majority of HEWs correctly responded how to diagnose malaria patients using signs and symptoms, and rapid diagnostic test (RDT). Most of malaria-treated patients indicated that they prefer HEWs to other health workers for malaria treatment. Patient record data from patient registration books indicated that about 92%(368) of patients received appropriate drugs in appropriate dose and duration. But some patients (8%, 32) were prescribed with drugs not in line with the guideline. The two main reasons indicated by the HEWs for inappropriate prescription are: the shortage of chloroquine, and patient pressure to take coartem. About 8% (32) and 11% (44) of patients do not know the consequences of not completing antimalarial drugs and what to do after vomiting respectively. Conclusion:The most of HEWs adequately treat malaria patients and the communication with patients is adequate. Improving resource availability, patient education and in-service training are needed to improve malaria treatment practice of the HEWs

Anemia and its associated factors among adult people living with human immunodeficiency virus at Wolaita Sodo University teaching referral hospital.

BackgroundIn Sub-Saharan Africa, both HIV/AIDS and anemia have considerable public health problems. Anemia has an adverse effect on treatment outcome and it decreases the quality of life among adult HIV patients. This study was aimed to assess the prevalence of anemia and its associated factors among adult HIV positive patients in Wolaita Sodo University Teaching Referral Hospital.MethodInstitution based cross-sectional study was conducted at Wolaita Sodo University Teaching Referral Hospital from 01 October to December 30, 2016. A randomly selected 411 adult people living with the human immunodeficiency virus were included in the study. A pre-tested questionnaire was used to collect data. Variables with P-value ≤0.25 in the bivariable logistic regression model were taken into multivariable logistic regression analysis along with 95% confidence interval and Odds Ratio was used to examine the association between anemia and independent variables. P-value ≤ 0.05 was taken as statistically significant.ResultPrevalence of anemia in this study was 36.5% with 95% CI (32%-41%). Factors associated with anemia among adult people living with HIV/AIDS were individuals who lived with HIV ≥9years (AOR = 2.6, 95% CI:-1.03-6.59),years lived with HIV 5-8 years (AOR = 2.59, 95% CI:-1.02-6.57),CD4 count ConclusionPrevalence of anemia among this study participant was high. This may affect the treatment outcome, increases morbidity and mortality of the participants. So periodic screening of anemia, a routine checkup of nutritional status, CD4 count and examination for intestinal parasite are essential

Assessment of drug use patterns in terms of the WHO patient-care and facility indicators at four hospitals in Southern Ethiopia: a cross-sectional study

Abstract Background Patient-centered care is now the goal for virtually all healthcare systems. The aim of this research was to evaluate the patient care quality in regard to drug dispensing in four hospitals in southern Ethiopia namely Wolaita Sodo University teaching and referral hospital (WSUTRH), Tercha zonal hospital (TZH), Sodo Christian hospital (SCH) and Dubo St. Mary’s Catholic primary hospital (DSMCPH). Methods A cross sectional study was conducted by using the WHO patient care and facility indicators between September 10 and October 20, 2014. Patients who visited the outpatient departments of the four hospitals were selected by systematic random sampling method and interviewed. In total 384 patients were selected based on a rough estimate of proportion of patients visiting to the four hospitals. Facility indicators including the availability of essential drugs list (EDL), national drug formulary, standard treatment guideline (STG) and key drugs were evaluated. Descriptive statistical calculations were performed using SPSS® version 20.0 software. Result The mean number of drugs was in the range between 1.9 ± 0.9 to 2.2 ± 2.0. The mean consultation time range was found to be 4.2 ± 1.6 to 4.9 ± 5.0 min whereas the mean dispensing time was ranged from 96.1 ± 52.0 to 152.3 ± 47.6 s. The overall mean number of drug prescribed for the four hospitals was 2.0 ± 1.2 and the mean percentage of medications actually dispensed in the hospitals was thus calculated to be 86.3. The mean percentage of medications clearly labeled was 45.4. Patients who knew their dosage forms accurately were 78.8. Among the four hospitals evaluated only one hospital (25 %) had at least a copy of the Ethiopian essential drug list (EDL), standard treatment guideline for hospitals and drug formulary. The mean availability of key drugs in the hospitals was found to be 65.7 %. Conclusion The result of the present study indicates that the patient consulting time, medications labeling and availability of key drugs in the hospitals are inadequate. The medication labeling practice in the four hospitals is unacceptably low. These patient care indicators need a special attention for improvement