Methods used to assess drug prescribing and dispensing behaviours in the public and private sectors by non-professional health providers

In most developing countries, self-medication is common. Pharmacies, drug stores and drug shops are important providers of health advice and provision of inexpensive medicines. In assessing drug sellers performance, various methods have been used to collect data from drug sellers and other non professional providers. Some of these methods include exit interviews for patients after purchase of drugs, observations to assess drug sellers/dispensers roles and consumers behaviour, interviews with the drug sellers and nonprofessional providers themselves, use of simulated client approach and use of the patients care indicators such as generic prescribing/dispensing, number of drugs selected from the essential drug list or national drug formulary of the particular country. The above mentioned methods or approaches have been widely applied in most developing countries to assess dispensing and prescribing practices related to diseases like malaria, respiratory infections (pneumonia), diarrhoea and other childhood conditions. Here, the assessment can be done in 3 problem areas, drug sellers (untrained/unlicensed or nonprofessionals), pharmacists or clinicians and other trained health workers) and patients. In most cases it has been found that non-professional providers sell drugs to customers with or without prescriptions. Furthermore, the majority of drug sellers/dispensers prescribe or dispense drugs using brand names. In addition, the most commonly prescribed and dispensed drugs, antimalarials and antibiotics mostly in syrup forms for under-five children or analgesics such as paracetamol and multivitamins. Rarely do non-professional providers and drug sellers advocate oral rehydration salts (ORS), probably because of the low profit margin compared to antibiotic syrups for diarrhoea.Keywords: Self medication, drug sellers, prescribing behaviour, dispensing, nonprofessional heath providersEast and Central African Journal of Pharmaceutical Sciences Vol.14 (2011) 57-6

How sulfadoxine-pyrimethamine (SP) was perceived in some rural communities after phasing out chloroquine (CQ) as a first-line drug for uncomplicated malaria in Tanzania: lessons to learn towards moving from monotherapy to fixed combination therapy

Malaria is a leading cause of death in Sub-Saharan Africa. Tanzania changed its malaria treatment policy from chloroquine (CQ) to Sulphadoxine-Pyrimethamine (SP) as first line drug in August 2001. We wanted to assess the perception and behaviour about SP after phasing out chloroquine which was very popular, cheap, available, and was preferred by many people for self-medication in homes as it was considered to have minimal side effects. Focus Group Discussions (FGDs) were carried out after one year of the anti-malarial drug treatment policy change in the country. The FGD themes were on malaria for under-five children and other age groups, anti-malarial drug use through self-medications, specific experiences people had about SP drug for both mothers/guardians, men in the communities and health workers. A total of twelve FGDs were performed with mothers/guardians, men and health workers in the selected public health care facilities in the district. In the FGDs people feared adverse reactions from SP; its slow ability of reducing fever and self-treatment in this case was less reported from the mothers/guardians groups. However, SP was reported by health workers to be administered using the direct observation approach under supervision in their health care facilities. This was done in order to increase compliance as there were worries that some mothers were throwing away the drug if they were instructed by health workers to go and administer SP to their sick children at home. Based on this information, it is obvious that fear and negative perceptions about SP drug was common in the study setting. As evidence of this, there was less reported home-stocking and self-medication in the discussions for this particular recommended new first-line anti-malarial. The public has demonstrated a lack of confidence in SP. Furthermore, some health workers expressed obvious fear and negative perceptions towards the drug despite the fact that some FGDs with health workers considered the drug to be good and effective against malaria. Such negative perception towards SP highlights the need to start earlier sensitization and educational campaigns to the rural communities for a new drug program to ensure its success. Messages should clearly state what should be expected from the new drug (Coartem), before its introduction. This is important especially as Tanzania is expected to move towards the expensive but efficacious and effective fixed-combination (Coartem) anti-malarial therapy early next year (2006)

キノアおよびアマランサス種子からの抗酸化物質の検索と評価およびコラゲナーゼ阻害効果

博士(学術)大阪市立大

Saleability of Anti-malarials in Private Drug Shops in Muheza, Tanzania: A Baseline study in an era of assumed Artemisinin Ccombination Therapy (ACT).

Artemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance. The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidized ALu. All drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume. All surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for 74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%). In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for IPTp, as stipulated in the national anti-malarial policy. It is a major reason for concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy. Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to train private drug dispensers

A conceptual framework for creating brand management strategies

Branding has become a business priority over the past few decades due to the growing awareness that brands are one of the companies' most valuable intangible assets. Academics and practitioners have proposed models of components to simplify brands into a small number of parts, or dimensions. Nonetheless, there is a lack of specific approaches to brand management models that fit specific business scenarios. The objective of this study was to propose a general framework to create custom brand management strategies that fit specific business scenarios through a set of independent brand dimensions. The framework was applied to the specific case of SME alliance in a B2B export environment as an example of use. This study reviews the most cited brand management models in literature and classified them into 12 independent brand dimensions. The results suggest that regardless of the brand management model, all of them converge on the fact that creating a highquality brand relationship with the customer is crucial for the branding process. Findings suggest non-evident relationships between dimensions. The findings also suggest that brand dimensions' and brand dimension relationships' importance in specific business scenarios shape brand management models in unique ways

Cyanide and cyanide complexes in the goldmine polluted land in the East and Central Rand Goldfields, South Africa

The use of cyanide in gold extraction is of concern when it is not properly managed from the extraction process to the management of wastes. The distribution and fate of cyanide in the environment upon release from the tailings dumps depends on its physical-chemical speciation. This study presents results of distribution, speciation and fate of cyanide in selected compartments, namely: tailings, sediments and water systems in gold mine polluted land. Sampling of tailings in a facility that is being rehabilitated was done in 2006 and 2007 to assess the impact of AMD on cyanide release over that period. Deposition of materials in the tailings dams stopped in 2004. The results revealed that the pH of the tailings decreased between 2006 and 2007. Elevated concentrations of CNfree, SCN- and CNO- were observed for 2007 compared to 2006. Most cyanide species had degraded as a result, primarily, of decrease in pH due to generation of AMD, also the oxidation of CNfree and the reaction with active sulphur species such as S2O3. The decrease of cyanide total (CNT) with time is a consequence of natural attenuation of cyanides in tailings which may be attributed to physicalchemical and microbiological mechanisms. Cyanide and its metal complexes were found to be unstable following generation of AMD in the dump over a period of one year. The dissociation of metal-cyanide complexes when the pH drops, releases CNfree which is either volatilised as HCN(g) or transported in solution with the contamination plume or converted to SCN- ,CNO- and NH4 +. However, in most of cases high concentrations of metal-cyanide complexes were found even at low pH values of the tailings suggesting that these complexes are very stable. This was substantiated by the geochemical modelling which predicted the predominance of iron-cyanide complexes in tailings at low pH. iii Cyanide released from cyanide complexes flows into the central pond of the tailings facility and partly leaches into the groundwater. Salt crusts were observed along the capillary fringe of the central pond as well as around other water bodies considered in the study. These crusts were found to contain elevated concentrations of heavy metals (e.g. 12940 mg kg-1 Fe and 186.1 mg kg-1 Co) and cyanide (e.g. 118.4 mg kg-1 CNT, 14.36 mg kg-1 CNWAD and 100.2 mg kg-1 CNSAD). This obviously has implications of secondary pollution as these crusts tend to be very soluble in water thus leading to the release of heavy metals and cyanide into water systems during rainfall. Characterization of cyanide was also done in drainage water from an active slimes dam where deposition from a reprocessing plant takes place. The slimes dam had drainage pipes and a solution trench around it that drained away excess water. Low concentration of CNT was obtained in pipe water from the pipe with low pH values (2 - 4) whilst this concentration was high in water from the trench with high pH values (5 -7). Copper and iron complexes were the most abundant. High concentrations of SCN- and CNO- were obtained as result of conversion of CNfree as explained previously. Salt crusts collected around the dam presented low pH (3) and high conductivity, the evidence of high metals content. High concentrations (198.4 mg kg-1) of CNT were obtained in the crusts with predominance of CNSAD (Fe and Co). The bluish-green colour of the crusts and the elevated concentrations of CNSAD as well as those for iron could suggest the presence of Prussian blue. Analysis of the wetland sediments showed the transport of cyanide from the tailings dumps to the wetland through the streams. An enrichment of cyanide was observed in the sediment with the enrichment factor of 3 for CNT with predominance of strong complexes (Fe and Co). The sediment is rich in organic matter and cyanide is known to bind strongly with organic matter. Although other possible sources (e.g. bacterial or microbial sources) could have contributed to the enrichment of cyanide in sediment, this was not investigated. Cyanide can be transported from the tailings dams to natural streams and other surface water bodies through groundwater. A natural stream within a reprocessing area was considered as a water system and cyanide in it was characterised. Three clusters were observed: water collected upstream with high pH, water from downstream with low pH (4) and the groundwater with low pH (3). Low concentrations of CNfree were obtained downstream. This could be due by the lost of CNfree by volatilization due acidic pH conditions. CNT was found to be lower downstream than upstream with the predominance of CNWAD. CNT concentrations were high at the seepage point, where the groundwater discharges to the surface. These concentrations were similar to those obtained in the groundwater. Copper and iron complexes were dominant in the surface and groundwater and this was substantiated by modelling results as well. SCN- was not detected in surface water as it is highly soluble in water and then leaches in the groundwater. The concentrations of CNO- were the same up and downstream. The results obtained from the study revealed that concentration of CNfree in most water bodies exceeded stipulated limits by bodies such as WHO, USEPA and UE. For instance, concentrations of up to 0.304 mg l-1 of CNfree were obtained in some instances to compare with limits of 0.07 mg l-1 by WHO, 0.02 mg l-1 by DWAF/South Africa. Additional studies should be done to find out the impact of organic matter (e.g. humic and fulvic acids) on the fate of cyanide. Various natural attenuation mechanisms of cyanide in tailings dams should be investigated. An assessment of the phytoremediation program vis-à-vis cyanide cyclisation is recommended and a monitoring of groundwater (borehole water) quality is required

Tanzanian men’s gender attitudes, HIV knowledge, and risk behaviours

This study uses data from the 2004-05 Tanzanian Demographic and Health Survey to examine whether men’s traditional gender role attitudes contribute to their sexual risk behaviours for HIV.   Logistic regression with random effects were used to analyze effects on risk behaviours at last sex (partners being drunk and condom use) with the three most recent sexual relationships.  Men’s traditional gender attitudes increased risky sexual behaviours (e.g., not using a condom) even when they had accurate knowledge regarding HIV risks.  The impact of men’s gender attitudes and HIV knowledge on risky sexual behaviours did not vary by relationship type.  Unexpectedly, condom use was more likely when either partner was drunk compared to neither being drunk, though the protective impact of HIV knowledge remained.  Overall, these findings suggest that traditional gender attitudes present barriers to preventing HIV/AIDS that even increased knowledge about HIV risks may not overcome. 

Development of a biophysical system based on bentonite, zeolite and micro-organisms for remediating gold mine wastewaters and tailings ponds

A thesis submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg 2012Wastes from mining operations usually contain a suite of pollutants, among them cyanide and its complexes; heavy metals; metalloids and radionuclides. The pollution plume can affect public health through contamination of drinking water supplies, aquatic ecosystems and agricultural soils. As such, waste management and remediation has become an important integral component of mining. Conventional chemical and physical methods are often expensive and ineffective when the pollutant concentrations are very high, so the challenge of developing cost-effective materials with high adsorption efficiencies for pollutants still remains. This research was dedicated to the development of biosorbents with high metal loading capacity for the remediation of mine wastewater, namely: zeolite/bentonite functionalised with microbial components such as histidine, cysteine, sorbitol and mannitol; zeolite/bentonite functionalised with Penicillium-simplicissimum and zeolite-alginate complex generated by impregnating natural zeolite into alginate gel beads. The ability of the fresh water algae, Oedogonium sp. to remove heavy metals from aqueous solutions in batch systems was also assessed. Optimum biosorption conditions for the removal of Co, Cu, Cr, Fe, Hg, Ni, Zn and U (in a single-ion and multi-ion systems) were determined as a function of pH, initial concentration, contact time, temperature, and mass of biosorbent. An increase of adsorption capacity was observed following modification of natural zeolite/bentonite by microbial components with a maximum adsorption capacity obtained at low pH. The FTIR results of the developed biosorbents showed that the biomass has different functional groups that are able to react with metal ions in aqueous solution. Immobilisation of fungi (Penicillium-simplicissimum) on zeolite/bentonite yielded biomass of 600 mg g-1 (10-fold higher than the non-immobilised one) at a pH 4, showing the potential of this sorbent towards remediation of AMD-polluted mine sites. The maximum uptake of metals ions (in a multi-ion system) was higher and constant (40-50 mg g-1) in the inactive fungal biomass (heat-killed) from pH 2 to 7. The uptake of U and Hg increased significantly in the zeolite/bentonite-P.simplicissimum compared to their natural forms due to the presence of the N-H, S-H and COO- groups. iii The pseudo second-order adsorption model was found to be more suitable in describing the adsorption kinetics of metal ions onto biomasses in single- and multi-ion systems with the sorption of nickel being controlled by film diffusion processes (with the coefficient values of 10-7 cm2 s-1). The thermodynamic parameters showed that the adsorption onto developed biosorbents was feasible and spontaneous under the studied conditions. The calculated values of the loading capacities in column adsorption for the natural zeolite/bentonite as well as zeolite/bentonite-P.simplicissimum were close to those obtained in the batch tests, mainly for U and Ni. The bed depth service time model (BDST) was used successfully to fit the experimental data for Ni and U adsorbed on the natural zeolite. This suggested a linear relationship between bed depth and service time, which could be used for scale-up purpose. The developed biosorbents could be regenerated using 1 mol L-1 HNO3 solution for potential re-use. The total decrease in biosorption efficiency of zeolite-Penicillium simplicissimum after five cycles of adsorption-desorption was ≤ 5% which showed that zeolite/bentonite-Penicillium simplicissimum had good potential to adsorb metal ions repeatedly from aqueous solution. On applying it to real wastewater samples, the zeolite-P. simplicissimum biosorbent removed 97% of the metals. Penicillium sp. immobilisation enhanced the potential and makes it an attractive bioremediation agent. The zeolite-alginate sorbent exhibited elevated adsorption capacities for metals. This showed potential for use of such a system for remediation purposes. It also provides a platform to explore the possibility of using zeolite in conjunction with other polysaccharide-containing materials for heavy metal removal from wastewaters. The results obtained in this study have shown that zeolite and bentonite are good supports for biomass. The biofunctionalised zeolite/bentonite systems have potential in removal of heavy metals from wastewaters