Quality of drug prescription in primary health care facilities in Mwanza, north-western Tanzania

Background: Drug therapy can improve a patient’s quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of Mwanza, Tanzania.Methods: This descriptive cross-sectional study was carried out in Ilemela and Nyamagana districts in Mwanza, Tanzania. The study included 20 randomly selected public and private health care facilities. A random sample of the patient records in each facility was included. From each patient record, the latest prescription was assessed. Information assessed and recorded included prescribing indicators, frequency of prescription error, various formulations and groups of drugs prescribed. Prescribers were interviewed on factors affecting prescribing practices.Results: A total of 570 prescriptions were studied. The average number of drugs prescribed per encounter was 2.8. The percentage of encounters with an antibacterial agent prescribed was 33.8% and injections constituted 7.9% of cases. Prescriptions by generic name were 85.8% while 90.6% of drugs prescribed were from the national essential drug list. Antibacterial agents, analgesics and antimalarial agents accounted for 75.3% of all drugs prescribed. Of all prescriptions, 485 (85.1%) had at least an error. A total of 1,177 errors were made. Errors of omissions accounted for the majority (99.3%) of all errors. The most commonly observed missing prescription particulars were the drug strength (23.2%) and patient weight (22.2%).  The average number of drugs per encounter was higher in private facilities (3.2) than in public facilities (2.4) (P <0.0001). The range of drugs per prescription was also higher in private (1-7) than in public facilities (1-5) (P<0.0001). There were statistically significant differences in the distribution of various drug groups prescribed between public and private facilities and between health centres and dispensaries (P <0.001 and 0.027, respectively).Conclusion: Prescribing of higher number of drugs than the WHO recommendations and overuse of antibiotics is still a problem at health care facilities in Mwanza Tanzania. The frequency of occurrence of prescription errors found during the study was considerably high

Common Preventable Health and Social Problems Encountered by Elderly in Shinyanga Region in the Northern Part of Tanzania

In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance; at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used; the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility; subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465); Arthritis 52% (241/465); Dental problems 27% (124/465); Hypertension 23% (107/465); Backache 22% (105/465); Malaria 28% (132/465); Hearing problems 26% (121/645); Urinary tract Infection 35% (165/465); Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis; some of the geriatrics had more than two diseases. The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable

Microbial contamination of traditional liquid herbal medicinal products marketed in Mwanza city: magnitude and risk factors

Introduction: The use of the traditional herbal medicinal products (THMPs) has been increasing worldwide due to the readily availability of raw materials and low cost compared to the synthetic industrial preparations. With this trend in mind, the safety and quality of THMPs need to be addressed so as to protect the community. The present study evaluated the magnitude and risk factors associated with microbial contamination of liquid THMPs marketed in Mwanza. Methods: A cross-sectional study was conducted in Mwanza city involving 59 participants from whom 109 liquid THMPs were collected and processed following the standard operating procedures. The data were analyzed using STATA software version 11. Results: The median age (interquartile range) of participants was 35 (27-43) years, with males accounting for 36 (61%). Of 109 liquid THMPs collected, 89 (81.7%) were found to be contaminated; with predominant fecal coliforms being Klebsiella spp and Enterobacter spp. fortunately, no pathogenic bacteria likeSalmonella spp and Shigella spp were isolated. There was a significant association of liquid THMPs contamination with low education level (p< 0.001), lack of formal training on THMPs (p=0.023), lack of registration with the Ministry of Health (p=0.001), lack of packaging of products (p<0.001) and use of unboiled solvents during preparation of THMPs (p<0.001). Conclusion: There is high contamination rate of liquid THMPs in Mwanza City which is attributable to individuals and system-centered factors. Urgent measures to provide education to individuals involved in THMPs as well as setting up policies and regulations to reinforce THMPs safety is needed.Pan African Medical Journal 2016; 2

Medicines dispensers' knowledge on the implementation of an artemisinin-based combination therapy policy for the treatment of uncomplicated malaria in Tanzania

Objectives In 2005, Tanzania changed its policy for uncomplicated malaria treatment from sulphadoxine–pyrimethamine (SP) to artemisinin-based combination therapy (ACT), specifically artemether–lumefantrine (ALU). SP remains the medicine of choice for intermittent preventive treatment in pregnancy (IPTp). There is a need to assess dispensers' knowledge regarding the treatment of uncomplicated malaria and IPTp in Tanzania given appreciable self-purchasing to improve future care. Methods Descriptive cross-sectional design with structured questionnaires to capture quantitative data, with qualitative data captured using focus groups. The study was performed at 32 private pharmacies and 33 Accredited Drug Dispensing Outlets in the Nyamagana and Sengerema Districts in Tanzania, with 20 dispensers included in the qualitative discussions. Key findings The knowledge level of dispensers in the private medicine outlets was variable. Most dispensers knew ALU was first-line treatment in uncomplicated malaria, however variable knowledge about taking ALU with fatty meals. Generally, dispensers had poor knowledge about dosing intervals for SP in IPTp and variable knowledge regarding treatments in the first trimester. Overall, 49% had good knowledge and 48% had moderate knowledge of ACT in uncomplicated malaria. There was a significant relationship between dispenser type and knowledge of ACT but no statistical relationship between the level of knowledge on IPTp and the dispenser. Conclusions The majority of dispensers in private medicines outlets have good knowledge on ACT policy in the treatment of uncomplicated malaria; however, few dispensers had good knowledge on IPTp, which may contribute to irrational dispensing of SP. This needs addressing given the extent of self-purchasing in Tanzania

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Influence of Cytochrome P450 Polymorphisms on Pharmacokinetic Profiles and Treatment Outcomes Among Malaria Patients in Sub-Saharan Africa : A Systematic Review

Background: Sub-Saharan Africa (SSA) population is genetically diverse and heterogenous thus variability in drug response among individuals is predicted to be high. Cytochrome P450 (CYP450) polymorphisms is a major source of variability in drug response. This systematic review presents the influence of CYP450 single nucleotide polymorphisms (SNPs), particularly CYP3A4*1B, CYP2B6*6 and CYP3A5*3 on antimalarial drug plasma concentrations, efficacy and safety in SSA populations. Methods: Searching for relevant studies was done through Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. Two independent reviewers extracted data from the studies. Results: Thirteen studies reporting the influence of CYP450 SNPs on plasma concentrations, efficacy and safety were included in the final data synthesis. CYP3A4*1B, CYP3A5*5, CYP2B6*6 and CYP2C8*2 did not affect antimalarial drug plasma concentration significantly. There was no difference in treatment outcomes between malaria patients with variant alleles and those with wild type alleles. Conclusion: This review reports lack of influence of CYP3A4*1B, CYP3A5*3, CYP2C8*3 and CYP2B6*6 SNPs on PK profiles, efficacy and safety in SSA among P. falciparum malaria patients

Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: a challenge to health systems

Abstract Background Self-medication is a universal challenge that requires attention because of the potential threat not only to the pregnant women but also to unborn child. Data on self-medication practice and predictors among pregnant women is lacking in Tanzania. Information on the effects of this practice to the pregnant woman and the foetus globally is also scanty. Methods This was a cross sectional study which was conducted using face to face interview with 372 pregnant women at Makongoro health centre. Semi-structured questionnaires were used. Data were analysed using STATA 13 (Statistical Corporation, College Station, Texas, US). Results A total of 372 pregnant women participated in the study. The prevalence of self-medication among pregnant women was 172 (46.24%). There was a significant statistical association between self-medication and occupation (P value =0.01), gestation age (P < 0.01) and education (P < 0.01). Age, marital status and gravidity were not associated with self-medication (P = 0.809, P = 0.243 and P = 0.922) respectively. When bivariate logistic regression was performed, occupation and education were the only determining factors for self-medication. Pregnant women who were unemployed, doing business and house wife were most likely to practice self-medication than employed pregnant women (P = 0.03; OR = 2.33; 95% CI, 1.06–5.31, P = 0.01; OR = 2.31; CI 1.21–4.41, P = <0.01, OR = 2.73, 95% CI 0.52–2.43) respectively. Pregnant women with no formal education, incomplete primary education, primary education and secondary education were most likely to practice self-medication than pregnant women with college or university education (P < 0.01, OR = 6.37 95% CI 2.37–19.03, P < 0.01, OR = 6.58, 95% CI 2.36–18.25, P < 0.01, OR = 3.78, 95% CI 1.89–7.56, P < 0.01, OR = 2.59 95% CI = 1.30–5.17). The leading illness/symptoms which led to self-medication among pregnant women attending clinic were malaria 56 (32.56%, morning sickness 44 (25.55%) and headache 33(19.19%). Drugs commonly used in self-medication among pregnant women were ant malarial 42 (24.42%), antiemetics 59 (34.30%) and analgesics 33 (19.19%). Conclusion Prevalence of self-medication among pregnant women is high in Tanzania. This is a threat to the safety of the developing foetus and the pregnant woman. Therefore there is a need of interventions to minimize the practice among pregnant women

Neighborhood Social Environment and Health Communication at Prepregnancy and Maternal Stages among Caucasian and Asian Women: Findings from the Los Angeles Mommy and Baby Survey

Introduction. We study whether the relationship between neighborhood social environment and maternal communication with healthcare providers differs between Asians and Caucasians. Method and Materials. Using the 2007 Los Angeles Mommy and Baby (LAMB) survey, we measure new mother’s neighborhood social environment by four key variables: (1) instrumental/emotional support during pregnancy, (2) neighborhood social cohesion, (3) neighborhood social exchange, and (4) neighborhood services. Logistic regressions were applied for data analysis. Neighborhood social exchange predicts less chance of lacking communication about sensitive issues in preconception visits among Caucasians (logged odds: −0.045; P<0.01) and Asians (L.O.: −0.081; P<0.001) and predicts less chance of lacking communication during preconception visits among Asians (L.O.: −0.092; P<0.05). Neighborhood social cohesion predicts more chance for lacking communication about preparation for pregnancy only among Asians (L.O.: 0.065; P<0.05). Neighborhood services predict less chance of lacking communication about stigmatized issues in the prenatal visit among Asians (L.O.: −0.036; P<0.05). Discussion. Caucasians and Asians with more neighborhood social exchange are more likely to discuss sensitive issues during preconception visits. Neighborhood service significantly predicts maternal discussion of stigmatized issues with health care providers, but only among Asians

Disposal practices of expired and unused medications among households in Mwanza, Tanzania.

BackgroundThe community practice towards disposal of expired and unused medications in spite of its adverse impact have been widely neglected in many developing countries. The available guidelines in Tanzania focus on the disposal of expired medications and cosmetics in hospitals and community pharmacies only.AimThe aim of this study was to assess the disposal practice of expired and unused medications at household level in Mwanza city, north-western Tanzania.MethodologyThe household based cross-sectional study was conducted among 359 randomly selected household members. Semi-structured questionnaires were used for interview during data collection and while STATA® version 13 was used for analysis.ResultsOut 359 households visited, 252 (70.19%) had medications kept in their houses at the time of data collection. Among them, 10 (4.0%) households had kept medications at their houses because they were still continuing with treatment while 242 (96.0%) kept unused medications which were supposed to be discarded. The main reason for keeping unused or expired medications at home was uncompleted course of treatment (199 (82.20%) after feeling that they had recovered from illness. The main reason for discarding medications were recovering from illness (141(48.7%) and expiry (136 (46.9%). The major discarding practices for medications were disposing into domestic trashes (219 (75.5%) and pit latrines (45 (15.5%). Majority of respondents (273 (76%) were aware that improper disposal of expired medications are detrimental to human health and environment in general.ConclusionImproper disposal of unused and expired medications at household level was a common practice in the study area. Tailor-made interventions by the Food and Drugs Authority (FDA) and other national as well as local stake holders are urgently needed to address the situation

Plasmodium falciparum Merozoite Surface Proteins Polymorphisms and Treatment Outcomes among Patients with Uncomplicated Malaria in Mwanza, Tanzania

Background. The severity of malaria infection depends on the host, parasite and environmental factors. Merozoite surface protein (msp) diversity determines transmission dynamics, P. falciparum immunity evasion, and pathogenesis or virulence. There is limited updated information on P. falciparum msp polymorphisms and their impact on artemether-lumefantrine treatment outcomes in Tanzania. Therefore, this study is aimed at examining msp genetic diversity and multiplicity of infection (MOI) among P. falciparum malaria patients. The influence of MOI on peripheral parasite clearance and adequate clinical and parasitological response (ACPR) was also assessed. Methods. Parasite DNA was extracted from dried blood spots according to the manufacture’s protocol. Primary and nested PCR were performed. The PCR products for both the block 2 region of msp1 and the block 3 regions of msp2 genes and their specific allelic families were visualized on a 2.5% agarose gel. Results. The majority of the isolates, 58/102 (58.8%) for msp1 and 69/115 (60.1%) for msp2, harboured more than one parasite genotypes. For the msp1 gene, K1 was the predominant allele observed (75.64%), whereas RO33 occurred at the lowest frequency (43.6%). For the msp2 gene, the 3D7 allele was observed at a higher frequency (81.7%) than the FC27 allele (76.9%). The MOIs were 2.44 for msp1 and 2.27 for msp2 (p=0.669). A significant correlation between age and multiplicity of infection (MOI) for msp1 or MOI for msp2 was not established in this study (rho = 0.074, p=0.521 and rho = −0.129, p=0.261, respectively). Similarly, there was no positive correlation between parasite density at day 1 and MOI for both msp1 (rho = 0.113, p=0.244) and msp2 (rho = 0.043, p=0.712). The association between MOI and ACPR was not observed for either msp1 or mps2 (p=0.776 and 0.296, respectively). Conclusions. This study reports high polyclonal infections, MOI and allelic frequencies for both msp1 and msp2. There was a lack of correlation between MOI and ACPR. However, a borderline significant correlation was observed between day 2 parasitaemia and MOI