The IUPHAR sub-committee on clinical pharmacology in developing countries and the medicines utilization research in Africa (MURIA) group co-organized the third training workshop on drug utilization research in Africa

The IUPHAR Sub-Committee on Clinical Pharmacology in developing countries continues to partner with The Medicines Utilization Research In Africa (MURIA) Group to advance Drug Utilization research (DUR) in Africa and promote sustainable rational uses of medicines (RUM) through training, workshops, networking and cross national research.1-6 The Third Annual MURIA Training Workshop and Symposium took place between 26 and 28 June, 2017 at The University of Windhoek, Namibia, with the theme ‘Medicines Utilization Research in Africa influencing patient care and policy.

Comparative Study of Microwave-assisted and Conventional Synthesis of 3-[1-(s-phenylimino) Ethyl]-2H-chromen-2-ones and Selected Hydrazone Derivatives

In this study, 3-acetylcoumarin 1, used as the essential precursor was synthesized by the reaction of salicyaldehyde with ethyl acetoacetate in the presence of a catalytic amount of piperidine in solvent-free medium. Schiff bases 2-9 were obtained by the condensation reaction of 3-acetylcoumarin, 1 with various aniline derivatives while reaction of 3-hydrazinoquinoxalin-2-one with four different 6-susbtituted 3-acetylcoumarins afforded the corresponding hydrazones 10-13. Both Schiff bases and hydrazone products were synthesized under microwave irradiation method and conventional synthetic strategy for comparative study. The microwave assisted reaction was remarkably successful and gave both Schiff bases and hydrazones in higher yields at shorter reaction time compared to conventional heating method. The characterization of the synthesized compounds were structurally confirmed by analytical data as well as spectroscopic means which involved 1H-and 13C-nmr, ir, UV-visible and mass spectra

The prescribing of generic medicines in Nigeria : knowledge, perceptions and attitudes of physicians

Generic medicines have the same efficacy and safety as originators at lower prices. However, there are concerns with their utilization in Nigeria. Evaluate physicians’ understanding and perception of generics. Questionnaire among physicians working in tertiary healthcare facilities in four geo-political regions of Nigeria. Response was 74.3% (191/257) among mainly males (85.9%). The mean knowledge score regarding generics was 5.3 (maximum of 9) with 36.6%, 36.1% and 27.2% having poor, average and good knowledge respectively. Cross-tabulation showed statistical significance (P = 0.047) with the duration of practice but not with position, subspecialty or sex. The majority did not agree that generic medicines are of lower quality than branded medicines. Therapeutic failure was a major concern in 82.7%, potentially discouraging prescribing of generics. Majority (63.9%) did not support generic substitution by pharmacists. Knowledge gaps were identified especially with the perception of generics. These need to be addressed

Reported needs of information resources, research tools, connectivity and infrastructure among African Pharmacological Scientists to improve future patient care and health.

INTRODUCTION:The potentials of Africa for growth and economic transformation through science remains challenging because of existing gaps in knowledge and infrastructure. The Africa Pharmacological Science Gateway project and the Medicines Utilization Research in Africa Group seeks to meet the research needs of African pharmacologists. This study aimed at identifying priority needs that might be met by access to information and tools through e-infrastructure. METHODS:A web-based cross-sectional study among 472 members of pharmacological societies in Africa to obtain information on their research interests and skills, available resources, needs and knowledge gaps. Descriptive analyses were done. RESULTS:A total of 118 responses from 13 countries were received, mostly from Nigeria (48.3%) and South Africa (21.3%). Respondents had wide ranges of research interests predominantly in drug utilization research.The desired resources included drug utilization research training and tools, pharmacokinetics and pharmacometrics modelling training and tools, drug-drug interaction and medicine prices resources, statistical analysis resources, access to journals, training in specific laboratory techniques, equipment and funding for research-related activities. CONCLUSIONS:Key areas of needs not currently provided by the African Pharmacological Science Gateway e-infrastructure were identified to guide further provision of resources on the e-infrastructure and potentially enhance research capacity within the continent

Availability and use of long-acting insulin analogues across Africa including biosimilars; current situation and implications

Background: Prevalence rates of diabetes mellitus are growing, and likely reach 34.2 million people in sub-Saharan Africa by 2040. This has significant implications on morbidity, mortality, and costs exacerbated by complications. Complications in patients requiring insulins enhanced by hypoglycaemia. Long-acting insulin analogues can reduce hypoglycaemia and improve patient compliance. However, typically appreciably more expensive than other insulins, limiting their listing on national essential medicine lists (EMLs). Biosimilars may help reduce prices and enhance listing. Objectives: Assess current listing and funding for insulins including long-acting insulin analogues across Africa. Methods: Mixed methods approach including documentation of utilisation patterns and prices nationally as well as from hospitals, ambulatory care, wholesalers and pharmacies among a range of African countries. Input from senior level government, academic, and healthcare professionals on the current situation with long-acting insulin analogues and potential changes needed to enhance future funding of biosimilar long-acting insulins. Results: Variable listing of long-acting insulin analogues on national EMLs across Africa due to high prices and issues of affordability. Even when listed in EMLs, utilisation in public healthcare systems is limited due to similar issues including affordability. Appreciably lowering the prices of long-acting insulin analogues via biosimilars should enhance future listing on EMLs and use accompanied by educational and other initiatives. However to date, limited price reductions for biosimilars versus originators across Europe and Asia. Conclusion: There are concerns with funding long-acting insulin analogues across Africa including biosimilars. A number of activities have been identified to improve future listing on EMLs and subsequent us

Knowledge, attitude, and acceptance of COVID-19 vaccines among secondary school pupils in Zambia : implications for future educational and sensitisation programmes

The coronavirus disease 2019 (COVID-19) pandemic resulted in the closure of schools to slow the spread of the virus across populations, and vaccines administered to protect people from severe disease, including school children and adolescents. In Zambia, there is currently little information on the acceptance of COVID-19 vaccines among school-going children and adolescents despite their inclusion in the vaccination programme. This study assessed the knowledge, attitude, and acceptance of COVID-19 vaccines among secondary school pupils in Lusaka, Zambia. A cross-sectional study was conducted from August 2022 to October 2022. Of the 998 participants, 646 (64.7%) were female, and 127 (12.7%) would accept to be vaccinated. Those who were willing to be vaccinated had better knowledge (68.5% vs 56.3%) and a positive attitude (79.1% vs 33.7%) compared to those who were hesitant. Overall, the odds of vaccine acceptance were higher among pupils who had higher knowledge scores (AOR=11.75, 95% CI: 6.51-21.2), positive attitude scores (AOR=9.85, 95% CI: 4.35-22.2), and those who knew a friend or relative who had died from COVID-19 (AOR=3.27, 95% CI: 2.14-5.09). The low vaccine acceptance among pupils is of public health concern, emphasizing the need for heightened sensitisation programmes that promote vaccine acceptance among pupils in Zambia

Introduction and utilization of high priced HCV medicines across Europe; implications for the future

Background: Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens. de Bruijn et al. HCV Medicines Objective: Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines. Methods: Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement). Results: Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries. Conclusion: There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance

Ongoing efforts to improve antimicrobial utilisation in hospitals among African countries and implications for the future

There are serious concerns with rising antimicrobial resistance (AMR) across countries 67 increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives 68 globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no excep-69 tion especially with the highest rates of AMR globally. Key activities in NAPs include gaining a 70 greater understanding of current antimicrobial utilisation patterns through point prevalence sur-71 veys (PPS) and subsequently instigating antimicrobial stewardship programmes (ASPs). Conse-72 quently, there is a need to comprehensively document current utilisation patterns among hospitals 73 across Africa coupled with ASP studies. 33 PPS studies ranging from single up to 18 hospitals were 74 documented from a narrative review with typically over 50% of in-patients prescribed antimicrobi-75 als, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole were the most prescribed 76 antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively 77 was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated 78 across Africa in recent years to improve future prescribing utilising a range of prescribing indicators. 79 The various findings resulted in a range of suggested activities that key stakeholders, including 80 governments and healthcare professionals, should undertake in the short, medium and long term 81 to improve future antimicrobial prescribing and reduce AMR

Challenges and issues in drug utilization research identified from the Latin American and African regions

Background: Despite advancements in drug utilization research (DUR), these have not been universal. Some regions such as the Latin America (LatAm) and African regions are facing challenges that are impeding the development of DUR. Objectives: To identify the main challenges and issues for DUR in the LatAm and African regions Methods: A collaborative initiative by the International Society of Pharmacoepidemiology Global Development Committee in partnership with the Latin America Drug Utilization Group and the Medicines Utilization Research in Africa Group was undertaken. A comprehensive literature review was conducted to identify local and international DUR publications. A core group of investigators and experts in DUR reviewed the publications and identified the main methodological challenges and issues. Subsequently, the group exchanged materials, participated in WebEx discussions, and reviewed the draft document. Results: Main issues: 1) Socioeconomic: high unemployment rate with poor standard of living, socioeconomic inequalities, low literacy levels, urban segregation, high migration rates, high rates of violent crime including drug trafficking and possession. 2) Healthcare-related: Disparities of social determinants of health, differences in the quality of public and private health sectors; and epidemiologic transition from communicable diseases to non-communicable diseases. Most health care systems are fragmented with variable access to medical care and medicines, and substandard record keeping. 3) Drug utilization-related: Inappropriate use of medicines including the elderly; limited infrastructure to reliably collect DU data; over-prescription of antimicrobials; polypharmacy; high rates of self-medication; and poor patient adherence (e.g. HIV/AIDS, diabetes mellitus and hypertension). Planning for DUR is affected by the multiplicity of drug distribution channels; trading in sub-standard, counterfeit medicines and insufficient quality control centers. Some publications are generated by local investigators, often suffering of methodological issues such as lack of representativeness of the population, limited data validity, and small sample sizes. Conclusions: There are common challenges for DUR when working within the LatAm and African regions. Based on our findings, the group is developing Guidance on Good Practices of Drug Utilization Research in those regions to assist researchers with issues pertaining to the planning, conduct, and evaluation of DUR