Overuse of medications in low- and middle-income countries: a scoping review

OBJECTIVE: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. METHODS: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. FINDINGS: We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. CONCLUSION: Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications

COVID-19 among Indonesian ENT specialist and resident after second dose of Sinovac vaccination

Background: The purpose of this study was to obtain data on the prevalence of specialist doctors and Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) residents in Indonesia who suffered from Coronavirus disease 2019 (COVID-19) after receiving the second dose of COVID-19 vaccination using the Sinovac vaccine (CoronaVac) and the length of time infected with COVID-19 after the second Sinovac vaccination. Methods: We performed a descriptive observational study, using a cross-sectional design. Data collection took place between August 2021 and October 2021. The respondents in this study included specialist doctors and ORL-HNS residents who worked in various hospitals in Indonesia who had received the second dose of the Sinovac vaccination. Data collection was performed by means of Self-reporting Online Survey Platform (Google Form). Results: This study included 1,530 respondents, and 54.2% of respondents were women. Respondents consisted of 68.6% ORL-HNS doctors and the rest were residents with an average age of 41.46 years old. The distance between the first and second doses of Sinovac was mostly under one month, which was 71.3% of the respondents. A total of 76.3% of respondents did not have co-morbid diseases. Based on this study, 16.9% of respondents suffered from COVID-19 after the second dose of Sinovac vaccination. The length of time suffering from COVID-19 after the second Sinovac vaccination was 3-6 months (9.7%). Conclusions: Based on this study, 16.9% of respondents suffered from COVID-19 after receiving the second Sinovac vaccination and 9.7% suffered from COVID-19 after 3-6 months of Sinovac vaccinatio