A systematic approach to improve rational medicine use in Eswatini

Philosophiae Doctor - PhDStudies on rational medicine use (RMU) have mainly focused on identifying, quantifying, and addressing irrational use without exploring reasons behind this irrational use. In addition, minimal work has been conducted on irrational use of medicines in the context of the growing burden of non-communicable diseases (NCDs). This PhD research examined medicine use in Eswatini, (previously Swaziland) between April 2017 and March 2019, with a focus on prescribing practices linked to specific diagnoses. It further explored factors influencing RMU, which included testing the effects of a short intervention - prescription audit and feedback coupled with small group education - on prescribing practices in health facilities

Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis

Background: Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis. Objective: To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis. Methods: The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed. Results: Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams. Conclusions: Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics.IS

Health system actors' perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study

Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. Methods A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. Results Participants were aged between 21-57years, had been practicing for 1-30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: Poor use of treatment guidelines, lack of RMU policies, poorly-functioning pharmaceutical and therapeutics committees, stock-outs of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: Knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers

Knowledge and attitudes of non-occupational HIV post-exposure prophylaxis amongst first- and second-year medical students at Stellenbosch University in South Africa

Background: Human immunodeficiency virus (HIV) infection is a worldwide problem, with 68% of infected people residing in sub-Saharan Africa. Antiretroviral therapy is used as post-exposure prophylaxis (PEP) to prevent infection in cases of occupational exposure, and use has recently been expanded to nonoccupational exposure. Studies have demonstrated a lack of awareness of non-occupational PEP (NOPEP) in the general population. Aim: The aim of this study was to evaluate knowledge and attitudes towards availability of, access to and use of NO-PEP amongst first- and second-year medical students. Setting: Participants were medical undergraduates of Stellenbosch University in the Western Cape of South Africa who were registered in 2013. Methods: A descriptive cross-sectional study of 169 students was performed. Data were collected using self-administered questionnaires handed out in a classroom in August 2013. Self-reported knowledge and attitudes towards NO-PEP and barriers to access to and use of NO-PEP were analysed using frequency tables. Associations between self-reported and objective knowledge of NO-PEP were analysed by odds ratios. Results: Over 90% of students had good knowledge on HIV transmission, and about 75% knew how it can be prevented. Twenty eight per cent (n = 47) of students reported knowledge of NO-PEP; 67% reported hearing about it from lecturers, whilst 1% reported hearing about it from their partner. Students who knew the correct procedure to take when a dose is forgotten were 2.4 times more likely to report knowledge of NO-PEP than those who did not know what to do when a dose is forgotten (p = 0.029). No other associations were statistically signifiant. Conclusion: Students had positive attitudes towards the use of NO-PEP and also identifid barriers to its use. Despite good knowledge of HIV prevention and transmission, knowledge on NO-PEP was poor

Knowledge and attitudes of non-occupational HIV post-exposure prophylaxis amongst first- and second year medical students at Stellenbosch University in South Africa

CITATION: Ncube, N. B. Q., Meintjes, W. A. J. & Chola, L. 2014. Knowledge and attitudes of non-occupational HIV post-exposure prophylaxis amongst first- and second year medical students at Stellenbosch University in South Africa. African Journal of Primary Health Care & Family Medicine, 6(1): 1-9, doi: 10.4102/phcfm.v6i1.665.The original publication is available at http://www.phcfm.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Human immunodeficiency virus (HIV) infection is a worldwide problem, with 68% of infected people residing in sub-Saharan Africa. Antiretroviral therapy is used as post-exposure prophylaxis (PEP) to prevent infection in cases of occupational exposure, and use has recently been expanded to nonoccupational exposure. Studies have demonstrated a lack of awareness of non-occupational PEP (NOPEP) in the general population. Aim: The aim of this study was to evaluate knowledge and attitudes towards availability of, access to and use of NO-PEP amongst first- and second-year medical students. Setting: Participants were medical undergraduates of Stellenbosch University in the Western Cape of South Africa who were registered in 2013. Methods: A descriptive cross-sectional study of 169 students was performed. Data were collected using self-administered questionnaires handed out in a classroom in August 2013. Self-reported knowledge and attitudes towards NO-PEP and barriers to access to and use of NO-PEP were analysed using frequency tables. Associations between self-reported and objective knowledge of NO-PEP were analysed by odds ratios. Results: Over 90% of students had good knowledge on HIV transmission, and about 75% knew how it can be prevented. Twenty eight per cent (n = 47) of students reported knowledge of NO-PEP; 67% reported hearing about it from lecturers, whilst 1% reported hearing about it from their partner. Students who knew the correct procedure to take when a dose is forgotten were 2.4 times more likely to report knowledge of NO-PEP than those who did not know what to do when a dose is forgotten (p = 0.029). No other associations were statistically significant. Conclusion: Students had positive attitudes towards the use of NO-PEP and also identified barriers to its use. Despite good knowledge of HIV prevention and transmission, knowledge on NO-PEP was poor.http://www.phcfm.org/index.php/phcfm/article/view/665Publishers versio

Tackling antimicrobial resistance across sub-Saharan Africa; current challenges and implications for the future

Introduction: Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. Areas covered: Consequently, there is an urgent need to document current NAP, other activities, and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. Expert Commentary: All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though, there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programmes. Key challenges remain across Africa. These include available personnel, expertise, capacity and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AM