Time series analysis of consumption and short term forecasting of female contraceptives in the Kenyan public health sector

Background: Contraceptive security is crucial in ensuring access to family planning services and improving the contraceptive prevalence rate. This requires proper forecasting and procurement of contraceptives. It is therefore important to study consumption patterns and apply forecasting techniques so as to adjust for any changes in the choice of contraceptives over a given time period. Objectives: The objectives of this study were to analyze trends, identify any seasonal or cyclic patterns in consumption of contraceptives, compare service point and consumption data, forecast consumption for six months and determine optimal models for forecasting contraceptives. Methods: Data on consumption of implants, injectables, pills, and Intrauterine Contraceptive Devices (IUCDs) were extracted from the Kenya District Health Information System for the years 2014-2018. An exploratory analysis was done and the data decomposed to evaluate the trends and seasonal components. Service point and consumption data of contraceptives were compared. Short-term forecasting using the Autoregressive Integrated Moving Average (ARIMA) and the Exponential Smoothing (ES) models was done. The optimal model for forecasting was determined and the models validated using actual facility consumption data for 2018. Results: The consumption of pills, injectables, and IUCDs declined while that of implants increased significantly across the 4 years. There were differences in the data reported for consumption and service point data for injectables, implants, and IUCDs. The ES models recorded the least error when forecasting consumption of all contraceptives except for one-rod implants in which the ARIMA model had the least errors. Conclusion: There was a general shift towards the use of long-acting reversible methods especially implants in Kenya. The difference in the reporting of consumption and service point data for injectables, implant, and IUCDs showed gaps in the documentation and reporting of contraceptives. The ETS models were generally superior to the ARIMA models for predicting consumption of contraceptives. Keywords: Contraceptives, consumption, forecasting, time series, trend

Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care

Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of medical expenses are currently allocated to medicines, and this needs to be optimally managed. Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent year. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, Control), VEN (Vital, Essential and Non-essential) and ABC-VEN matrix analysis used to study drug expenditure patterns. Morbidity data extracted from the Medical Records. Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2% to 14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9%-17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items consume the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines were major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries. This is now being implemented

Adverse effects of chemotherapy and their management in Pediatric patients with Non-Hodgkin's Lymphoma in Kenya: A descriptive, situation analysis study.

BACKGROUND:Chemotherapy-related side effects and their management in patients with Non-Hodgkin's Lymphoma (NHL) are not well defined in developing countries, including Kenya. This needs addressing considering the high number of patients with cancer in these countries. Consequently, we sought to determine the common side effects of chemotherapy used to treat NHL in pediatric patients and its implications. METHODS:Observational study conducted at the Kenyatta National Hospital in patients aged ≤15 years. Some data was collected by reviewing patients' records admitted to the pediatric oncology ward, December 2016 to May 2017; and additional data was collected retrospectively (review of patients' records with NHL, January-2014 to May-2017). Data were analyzed descriptively. RESULTS:Overall, out of the identified NHL patients (n = 85), 93% (n = 79) had chemotherapy-related side effects. The majority of patients suffered from side effects were managed; apart from 23% to 24% of the documented anemia and hypersensitivity, respectively. CONCLUSIONS:Whilst the majority of the reported side-effects were being managed, the lack of management of some side effects raises real concerns since this indicates either failure to manage or failure to document their management in patients' records, both of which should be addressed appropriately to improve future care

Clinical and financial implications of medicine consumption patterns in Kenya

Introduction: Medicines can constitute up to 70% of total health care budgets in developing countries and considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH) over 30% of expenditures are for medicines and this needs optimal management. Consequently, we investigated drug consumption patterns, their costs and morbidity patterns at KNH. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, Control), VEN (Vital, Essential and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data extracted from Medical Records. Results: An average of 811 medicine types are procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2% to 14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9%-17% of all medicines procured but accounted for 15% of annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of total expenditure. Vital and Essential medicines consumed the highest proportion of drug expenditure. ABC-VEN categorization showed 31% medicine types consumed an average of 85% of total expenditure. Therapeutic category and morbidity patterns analysis showed a mismatch between expenditure and morbidity which needs investigation. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and also need to be carefully managed. ABC-VEN categorization identified medicines were major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within hospitals within available budgets especially in low and middle income countries. This is now being implemented

Systematic Review, Meta-Analysis and Grading of Evidence on the Effectiveness of Antimicrobial Prophylaxis for Neurosurgical Site Infections

Background: Antimicrobial prophylaxis is crucial for neurosurgical procedures, even though they are clean procedures. Observational studies have shown the effectiveness of different antibiotics in preventing neurosurgical site infections, but there remains paucity of systematic reviews and meta-analyses which have assessed their effectiveness in East Africa. Objectives: To generate and appraise the quality of evidence that would inform antimicrobial prophylaxis in neurosurgery. Methodology: A systematic review and meta-analysis was conducted between October 2014 and December 2015. Studies that involved the administration of systemic antibiotics for prophylaxis, use of antibiotic impregnated shunt catheters among adult patients aged over 18 years were included and subjected to abstract, title and full text screening. A meta-analysis was carried out using RevMan (Review Manager) version 5 software. The quality of evidence was evaluated using the GRADE system. Results: One systematic review of randomized controlled trials (n=17) and 11 randomised controlled trials were included in the study. From the first meta-analysis, use of systemic antibiotics demonstrated an overall protective effect of 52% from development of surgical site infections [OR 0.48 (95% CI 0.30, 0.79)]. In the second meta-analysis, the use of antibiotic impregnated shunt catheters was associated with a higher risk of mortality compared to use of the standard shunt [(OR 1.47(95% CI 0.82, 2.62)]. Following evaluation of quality of evidence, in the antibiotics versus placebo arm, the quality of evidence was moderate, while that for antimicrobial impregnated shunts was very low. Conclusion: Antimicrobial prophylaxis using systemic antibiotics or antimicrobial impregnated shunts is effective in preventing neurosurgical site infections. Antimicrobial impregnated shunts are too expensive for our study population. Key words: systematic review, meta-analysis, antimicrobial prophylaxi

Interventions to reduce pre-treatment loss to follow-up in adults with pulmonary tuberculosis : a scoping review protocol

Abstract Introduction Tuberculosis (TB) is one of the top causes of death worldwide with more than 90% of reported cases occurring in low- and middle-income countries according to the World Health Organization Global Tuberculosis Report 2021. Pre-treatment loss to follow-up is a key contributor to community transmission and deaths due to the disease. Breaking the transmission cycle will require timely diagnosis and prompt initiation of effective treatment. Therefore, in this protocol, we outline a scoping review to systematically map out available evidence on interventions to reduce pre-treatment loss to follow-up in adults with pulmonary TB and identify any existing gaps in knowledge. Thereafter, we will develop a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to provide a base to guide the implementation of the available interventions. Methods and analysis We will use the framework proposed by Arksey and O’Malley to conduct our scoping review. We will search the following electronic databases: Cochrane Library, MEDLINE (OVID), EMBASE (OVID), CINAHL, Science Direct, Web of Science, Global Index Medicus, Health Research and Development Information Network, Turning Research into Practice, Latin American and Caribbean Health Sciences, SCOPUS, and EBSCOhost. We will also search the medRxiv database for pre-prints and review reference lists of included studies. We will perform the search without date restriction. We will utilize filters limiting search results to English studies. We will include any primary study that meets the eligibility criteria as guided by the population, concept, and context framework. To minimize selection bias, two review authors will independently screen and select eligible studies. We will resolve disagreements through discussion and consensus and, if necessary, consult a third review author. We will extract data using a predesigned form. We will analyze data descriptively and present findings in a narrative summary and tables. We will then develop a conceptual framework to map the various interventions and factors to consider for effective implementation. Ethics and dissemination For this scoping review, we will not seek formal ethical approval since we will be using secondary data that is available in the public domain. We will use Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) to guide the reporting of our findings. We will disseminate our findings through peer-reviewed publications, stakeholder meetings, and conference presentations

Topical umbilical cord care

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