A Study Evaluating Rational Drug Use In Malaria Management Among Public And Private Healthcare Facilities At Two Pakistan Cities

Malaria continues to be a major public health issue in Pakistan, due to socioeconomic and epidemiological reasons. The thesis aimed to assess current scenario related to rational drug use, knowledge, perceptions and adherence of prescribers with standard treatment guidelines for malaria in public and private healthcare facilities in two cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). A combination of quantitative and qualitative research methods were used for data collection. The perceptions’ of malaria control program officials, prescribers and hospital pharmacists regarding factors affecting rational treatment practices for malaria were explored by conducting semi-structured interviews. Simple random sampling technique was used to draw the sample of public and private tertiary (n = 20), secondary (n = 10), primary (n = 20) healthcare facilities and community pharmacies from Islamabad (n = 118) and Rawalpindi (n=120) respectively. Besides that, a sample of 360 prescribers was selected randomly from the two cities (n = 180 each city). Prescribing practices were evaluated by assessing prescriptions for malaria using WHO prescribing indicator form while a structured questionnaire was used to assess the perceptions and knowledge of prescribers regarding standard treatment guidelines. United State Agency for International Development (USAID) stock out form and questionnaire were use to review drug availability and process of drug management respectively. Simulated visits were also performed to observe disease case management of malaria at community pharmacies

ROLE OF COMMUNITY PHARMACIST AND NUTRITIONISTS IN OBESITY MANAGEMENT: A LITERATURE REVIEW

The idea of engaging community pharmacists and nutritionists in weight management services has been well accepted by the community, as both can help to improve behavior and knowledge regarding obesity among obese patients. The aim of this study is to summarize research findings from developed and developing countries as well as from Pakistan regarding role of community pharmacists and nutritionists in obesity management. A total of 38 studies were reviewed regarding trends in obesity management. The review concluded that the role of community pharmacists and nutritionists in obesity management is not well acknowledged in most of the developing countries including Pakistan. Limited data are available on a number of nutritionists and type of services provided by them for weight management in these countries. There is urgent need to identify the barriers and gaps to further enhance the effectiveness of obesity management. Beside this intervention studies involving multi-disciplinary health- care professionals must be designed to control current obesity crisis worldwide.Keywords: Community pharmacists, Counseling, Nutritionists, Obesity, Weight management program

EVOLVING TRENDS AND FUTURE PROSPECTS OF ADR MONITORING AND REPORTING: A LITERATURE REVIEW

Objective: Owing to the importance of safe use of medicines, adverse drug reaction (ADR) monitoring has become a fundamental component tobe performed along with other health-care services. Pharmacist being drug experts are in good position to provide professional assistance for ADRmanagement. The aim of this study is to summarize research findings from developed and developing countries as well as from Pakistan regardingevolving trends and future prospects of ADR monitoring and reporting by pharmacists. Methods: A total of 49 studies were reviewed regarding trends ofADR monitoring using different search engines including google scholar, pubmed and science direct. Results: The review highlighted that there is needto identify the barriers and gaps to further enhance the effectiveness of current ADR monitoring practices. Conclusion: Strong legislation is required inPakistan to develop and implement an effective ADR monitoring program to reinforce the conception of effective pharmacovigilance system in Pakistan.Keywords: Adverse drug reactions, Reporting, Pharmacist, Pharmacovigilance, Pakistan

HEALTH-RELATED QUALITY OF LIFE AND DEPRESSION AMONG PATIENTS OF LIVER CIRRHOSIS IN PAKISTAN

Objective: The present study was designed to assess HRQoL and depression among patients of liver cirrhosis in Pakistan. Methods: A descriptive cross-sectional study design was used to assess health-related quality of life and depression among liver cirrhosis patients in Pakistan. Two pre-validated questionnaires i.e. SF 36 and HADS were self-administered to a sample of 382 cirrhotic patient’s selected using convenience sampling technique for measuring HRQoL and depression, respectively. After data collection, data was cleaned, coded and analyzed using in SPSS version 21. Results: The results highlighted that lowest scores for HRQoL were observed in the domain of role physical (40.02,±24.01) followed by role emotional (41.93,±26.99) whereas the highest scores were observed in the domain of physical functioning (51.87,±15.22). Conclusion: The results of the present study concluded that liver cirrhosis patients in Pakistan had poor HRQoL across all domains along with mild to moderate depression. While all domains were affected, the greatest impact was on role limitation due to physical as well as emotional problems. The most affected group among patients were females and patients having age greater than 60 y. Besides this severity and advanced stage of cirrhosis had a negative effect on all domains of HRQoL. Presence of complications further reduced HRQoL and increased depressive symptoms among liver cirrhosis patients

POSTPARTUM HEALTH RELATED QUALITY OF LIFE AFTER DIFFERENT MODES OF DELIVERY AMONG WOMEN IN PAKISTAN: THE NEGLECTED LINK FOR BETTER MATERNAL and CHILD HEALTH

Objective: The present study was designed to evaluate women postpartum quality of life after different modes of delivery in Pakistan.Methods: A descriptive cross-sectional study design was used. A pre-validated tool SF-36 was self-administered to a sample of 382 women in the postpartum period (6-8 w, 10-12 w, 14-16 w,>9 mo,>15 mo) undergone through elective/emergency cesarean sections or normal vaginal delivery and had delivered a single live child. After data collection, data was cleaned coded and entered in SPSS version 21.0. Descriptive statistics comprising of frequency and percentages was calculated. The non-parametric tests including Mann-Whitney and Kruskal-Walis (p ≥ 0.05) were performed to find out the difference among different variables.Results: Comparison of HRQOL domains by mode of delivery using Mann-Whitney test demonstrated a significant difference (p=0.01) between normal delivery and cesarean section. Women undergoing normal delivery had significantly higher scores as compared to women having cesarean section. Also, a significant difference (p=0.027) among HRQOL scores was observed between working women and house wives and as well who had better socioeconomic status (p=0.018).Conclusion: The results of the present study concluded that postpartum quality of life of most of the women undergoing normal vaginal delivery was better as compared to women undergoing cesarean sections in twin cities of Pakistan. Surgical intervention during cesarean section might lead to consistent postpartum pain, inability to cope with needs of newborn and family which in turn can reduce postpartum quality of life among women

Health Related Quality of Life among TB Patients: Question Mark on Performance of TB DOTS in Pakistan

Due to long duration of treatment and use of several agents, tuberculosis can lead to poor health related quality of life among patients. Objective. The present study was designed to assess health related quality of life among pulmonary tuberculosis patients in Pakistan. Methodology. A descriptive cross-sectional study design was used. SF-36 was self-administered to a sample of 382 pulmonary tuberculosis patients receiving self-administered or directly observed types of treatment, in baseline, initial, or continuous phase of treatment. After data collection, data was cleaned, coded, and statistically analyzed using SPSS version 21.0. Results. The results of the current study highlighted a significant impact on several domains of HRQoL of pulmonary TB patients. Highest HRQoL scores had been observed for the domain of physical functioning (60.03, ±25.779) whereas lowest HRQoL scores were observed for the domain of general health (34.97, ±14.286) perceptions of TB patients followed by bodily pain (43.40, ±24.594). Conclusion. The results of the present study concluded that TB patients had poor HRQoL in spite of the new therapeutic strategies and free availability of medicines. The disease had a negative impact on HRQoL of TB patients across all domains

A qualitative study exploring perspectives towards rational use of medicines in Pakistan's Malaria Control Program (MCP)

A malária é um dos mais importantes problemas sanitários globais, que ameaça a saúde população devido às condições socioeconômicas e por razões epidemiológicas no Paquistão. Este estudo qualitativo focou-se nas perspectivas no sentido do uso racional da intervenção médica entre os funcionários do programa de controle da malária. Oito entrevistas semiestruturas com todos os funcionários que trabalham no programa de controle da malária foram conduzidas em Islamabad. As entrevistas, que eram gravadas e transcritas, foram avaliadas por análise temática do conteúdo e por todos os autores. Todos os respondentes concordaram com o êxito da implementação do programa de controle da malária no Paquistão por meio do aprimoramento do diagnóstico e de facilidades do tratamento, promovendo a gestão racional por meio do treinamento dos prescritores. Entretanto, o financiamento é, ainda, o principal desafio enfrentado para a implementação futura do programa.Malaria is one of the most important global public health problems threatening the health of the population owing to prevailing socio-economic conditions and epidemiological reasons in Pakistan. This qualitative study has focused on the perspectives held towards the rational use of medicine intervention among malaria control program officials. Eight semi-structured interviews with all officials working for the malaria control program in Islamabad were conducted. The interviews, which were audio-taped and transcribed verbatim, were evaluated by thematic content analysis and by all authors. All respondents agreed on successful implementation of the malaria control program in Pakistan for controlling malaria by improving diagnostic and treatment facilities and promoting rational case management through training of prescribers. However, funding is still the major challenge faced by the program for its future implementation

Clinical Pharmacy Curriculum around the Globe

Abstract Pharmacy education in developing countries in the past, have mainly focused on industrial and product development roles of pharmacist. But these, major changes have been seen in pharmacy practice and other practice fields for pharmacists. The introduction of clinical pharmacy as a major discipline has necessitated a change in the current curriculum of pharmacy education in developing countries. The aim of this literature review is to summarize the research findings related to different clinical pharmacy curriculum being followed for training students in patient care areas among developed and developing countries including Pakistan. A total of 50 published articles were reviewed regarding current clinical pharmacy curriculum and clinical clerkship models which are followed worldwide. This review concluded that there is a need to upgrade the clinical pharmacy curriculum in the country so the pharmacist can be involved effectively in provision of direct patient care. The stakeholders should take strict actions to design an integrated clinical pharmacy model to be implemented in clinical clerkship for students. Therefore policy makers should accelerate legislative and regulatory changes to expand scope of clinical pharmacy practice in Pakistan

Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan

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Juicio sobre la adherencia a las directrices de tratamiento de la malaria. Un estudio transversal comparativo en Pakistán

A comparative, cross-sectional study was designed to assess the adherence of prescribers with national standard treatment guidelines for malaria in all the twenty public and private tertiary healthcare facilities in the two cities of Pakistan. A total of 600 patient encounters were assessed with the national standard treatment regimen for malaria. No significant difference at (p ≤ 0.05) was observed among adherence of prescribers having different designations and levels of experience with standard treatment regimen for malaria in the two cities. The results of the present study showed low adherence of prescribers with standard treatment regimen for malaria in Pakistan.Se diseñó un estudio transversal comparativo para evaluar la adherencia de los  prescriptores a las pautas estándar nacionales de tratamiento de la malaria, en veinte instalaciones sanitarias terciarias,  públicas y privadas, de dos ciudades de Pakistán. Se evaluaron un total de 600 encuestas a pacientes sometidos al régimen estándar nacional de tratamiento contra la malaria. No se observó diferencia significativa alguna (a nivel de p ≤ 0.05)  sobre la adherencia de prescriptores con diferentes niveles de experiencia con el régimen de tratamiento estándar para la malaria en las dos ciudades. Los resultados del presente estudio mostraron baja adhesión de los prescriptores al régimen de tratamiento estándar para la malaria en Pakistán.