Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa

Background: Control of blood pressure (BP) remains a challenge among patients in the public health system in South Africa. The objective was to assess availability of all prescribed antihypertensive medicines among patients with raised BP on the day they attended rural primary healthcare facilities (PHCs) and determine the association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data from an operational study from rural PHCs in South Africa including patients’ demographics and BP, as well as data on medicine availability. Data analysis included descriptive and inferential statistics. Results: 55 black African patients were assessed, with 89.1% being female. Some data were not available for all 55 patients. The mean age was 61.3 years, and 54.6% did not have formal education. Two thirds (67.2%) of patients received all their antihypertensive medications whilst 25.5% received some of their medicines during the three months study period with no record in 7.3% of the patients. There was no significant relationship between receiving all antihypertensive medicines and BP control. The majority of patients on one antihypertensive had better BP control; however, this did not reach significance (p=0.069). Concerns with the lack of BP recording on all occasions in some patients (20%). Conclusion: One third of patients went home without all their antihypertensive medicines from the PHC facilities. Other concerns included the lack of routine BP monitoring and the number of prescribed medicines. Studies are ongoing to explore key issues with medicines availability and concerns with adherence and BP control

Empowering hypertensive patients on chronic medicines at primary health care facilities in South Africa with knowledge to improve disease management

Objectives: Uncontrolled hypertension negatively impacts on mortality. This study aimed to evaluate the impact of a pharmacist-driven patient counselling and education model to empower hypertensive patients on chronic medication. Methods: An operational research project with a quasi-experimental design including an intervention group (55 patients) and a control group (31 patients) of chronic hypertensive patients. Data were collected with interview-administered questionnaires and analysed using SAS® version 9.4. Pharmacist interventions included an educational diary on hypertension management and patient counselling. Findings: There was a 34.7% improvement in patients’ understanding of what normal blood pressure (BP) is in the intervention group compared to the control group (p90%). Conclusions: A pharmacist driven patient counselling and education model can help improve patients’ hypertension knowledge and BP control. These should increasingly become routine, aiming to improve chronic disease management

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa : implications for the future

BACKGROUND: Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. METHODOLOGY: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. RESULTS: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. CONCLUSION: There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored

Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa : findings and implications

Objective: Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary healthcare (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data that included patients’ demographics, BP and data on medicines availability of the intervention group from a three months operational study conducted in rural PHC facilities in South Africa was analysed. The association between medicines availability, the number of antihypertensive medicines and BP control was determined. Findings: 55 black African patients (89.1% females) with a mean age of 61.3 years were included. Two thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3% there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (p=0.017; OR: 5.75; 95% CI: 1.46, 22.61). Conclusion: It is concerning that a third of patients went home without all of their antihypertensive medicines from PHC facilities in South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients

Knowledge of hypertension and its management among hypertensive patients on chronic medicines at primary health care public sector facilities in South Africa; findings and implications.

BackgroundThere are high growing prevalence rates of hypertension in South Africa. Consequently, there is a need to assess knowledge and management among hypertensive patients receiving chronic medication from primary health care (PHC) facilities in South Africa as a basis for improving future management. This is important as South Africa seeks to improve its management of chronic diseases.MethodsDescriptive, quantitative study amongst chronic hypertensive patients in the chronic disease programme. Patients were interviewed face-to-face by trained pharmacists using a structured questionnaire. Data analysis included descriptive and inferential statistics.ResultsHalf (53.7%) of the patients had uncontrolled blood pressure (BP). Less than a third of patients (27.7%) knew what hypertension is, the meaning of recorded BP numbers (4.5%), and what normal BP should be (19.9%). All patients who knew the meaning of BP numbers had formal education (p = 0.047). Only 15.6% of the 56.0% patients, who received hypertension information, received it on antihypertensive medicines specifically.ConclusionsThe majority of the patients lacked hypertension specific knowledge and only half had controlled BP. Interventions to improve the control of high BP should be targeted at closing knowledge gaps as part of the current chronic treatment initiatives in South Africa to ensure the benefits of increased access to care are realized

Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa

Introduction and aim: To evaluate adherence to antihypertensive treatment in rural South Africa and identify potential determinants given concerns with adherence and its impact in this priority disease area. Method: Face-to-face interviews with hypertensive patients and rating their adherence to treatment using defined categorised responses. Associations between adherence and patient characteristics assessed and sensitivity analyses performed. Results: 54.6% of patients were adherent to treatment. Controlled blood pressure (OR = :=2.1; 95% CI [:1.1, -3.8]; p = 0.019), comorbidity (OR = :=2.0; 95% CI [: 1.1, -3.6]; p = 0.032) and smoking (OR = :=0.3; 95% CI [:0.1, -0.8]; p = 0.018) were associated with adherence. Conclusion: Adherence and BP control were suboptimal, only smoking was an independent risk factor for adherence. Adherent patients were twice as likely to have controlled BP, although results were sensitive to the definition of adherence. Initiatives are in place to improve adherence, which will be monitored

Covid-19, healthcare and self-medication issues in resource limited-settings : findings and implications based on experiences in Ghana

Introduction and objectives: There have been concerns with the level of misinformation regarding COVID-19 and its treatment, drug shortages, as well as increased use and prices of antimalarials, antibiotics and hygiene products during the recent pandemic. Community pharmacists can play a significant role in disease prevention and treatment in the fight against COVID-19 including providing hygiene information and medicine availability across Africa and generally. Consequently, there is a need to review the role of community pharmacists in preventing unintended consequences during any pandemic as well as the impact of COVID-19 on the demand, availability and prices of suggested medicines for its management. Method: Multiple approach involving a qualitative review of the management of COVID-19 across countries coupled with a pilot study in Ghana among six purposely selected community pharmacists during the early stages of the pandemic assessing patterns of demand, availability and prices of medicines suggested for the management of COVID-19. Alongside this, pharmacists’ future role enhancing appropriate medicine use in Ghana and wider combined with the help of senior level co-authors. Results: The majority (five out of six) of pharmacists in Ghana reported increased demand for hydroxychloroquine, antibiotics and vitamins as immune boosters resulting in shortages with price increases particularly for antimalarials. Conclusion: The global lockdown had impacted on the supply and prices of medicines in Ghana similar to other countries. Community pharmacists can play a key role with encouraging safe medicine use, reducing self-purchasing of medicines and planning workflows during future pandemics including vaccinations. They can also help address potential misinformation and its consequences as well as the unintended consequences of pandemics including better management of non-communicable diseases

Response to the novel corona virus (COVID-19) pandemic across Africa : successes, challenges, and implication for the future

BACKGROUND: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.http://frontiersin.org/Pharmacologypm2021Family MedicineSchool of Health Systems and Public Health (SHSPH

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Background: There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective: Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach: Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities: A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities, Conclusion: There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care