Knowledge among Drug Dispensers and Antimalarial Drug Prescribing Practices in Public Health Facilities in Dar es Salaam.

Irrational prescribing and dispensing of antimalarials has been identified as a contributing factor in the emergence of malaria parasites resistant to existing antimalarial drugs. Factors that contribute to such irrational prescribing and dispensing should therefore be identified to address this problem. The aim of this study was to assess irrational antimalarial drug dispensing and prescribing practices in public health facilities. A descriptive-retrospective cross-sectional study was conducted between January and June 2011 in order to assess prescribing and dispensing practices for antimalarial drugs in three public hospitals and nine health centers in Dar es Salaam, Tanzania. Thirty-two drug dispensers were interviewed using a structured questionnaire. A total of 4,320 prescriptions for the period January to December 2010 were collected and assessed for antimalarial drug prescribing patterns. The majority (84.6%) of drug dispensers had poor knowledge regarding the basic information required from patients before dispensing artemether-lumefantrine. Seventeen of 32 drug dispensers did not know the basic information that should be given to patients in order to increase absorption of artemether-lumefantrine after oral intake. Most drug dispensers also showed limited knowledge about the dosage and contraindications for artemether-lumefantrine. Eighty-seven percent of all prescriptions contained artemether-lumefantrine as the only antimalarial drug, 77.1% contained at least one analgesic, and 26.9% contained at least one antibiotic, indicating unnecessary use of analgesics and antibiotics with antimalarial drugs. A substantial number of prescriptions contained antimalarial drugs that have already been declared ineffective for the treatment of malaria in Tanzania, providing additional evidence of inadequate knowledge among health care workers concerning treatment policy. Despite the government's efforts to increase public awareness regarding use of artemether-lumefantrine as first-line treatment for uncomplicated malaria, there is still irrational prescribing, dispensing, and use of this combination. Based on the results of this study, it is proposed that regular on-the-job training and continuing education be provided to drug dispensers and prescribers in public health facilities

Pharmaceutical Management and Prescribing Pattern of Antimalarial Drugs in the Public Health Facilities in Dar-es-salaam, Tanzania

Despite the efforts of minimizing utilization of limited financial resources in Tanzania, there are still some factors that affect the whole system of supply chain of antimalarial medicines. The goals of Integrated Logistic System (ILS) have not been realized since still there is drug shortage and poor stock recording system in the health facilities. Inadequate knowledge of the pharmaceutical management and inappropriate use of antimalarial drugs always contribute to the poor quality and availability of the drugs in the health facilities and irrational use of the antimalarial drugs. The main objective of the study was to assess the knowledge in practice of pharmaceutical management and prescribing pattern of antimalarial drugs in the public health facilities in Dar-es-salaam. Descriptive retrospective cross-sectional study design was used to survey nine (9) public health facilities in Dar-es-salaam region. The health facilities included 4 hospitals and 5 Health Centers. A total of 32 pharmaceutical health workers (drug store managers and drug dispensers) were interviewed using structured questionnaires. Two different structured questionnaires were used to interview drug store managers and drug dispensers separately. Average stock-out time of antimalarial drugs from January to December 2010 was assessed using a designed form. A total of 4320 prescriptions were examined and recorded from all the selected public health facilities. Adequate storage conditions and handling of medicines procedures were also assessed. Since Medical Stores Department (MSD) is the main supplying source of the antimalarial drugs to these facilities, it was also included in this study as the special site for assessing availability of antimalarial medicines from the source. Among all nine (9) drug store managers, six (6) had poor knowledge on quantification concept, and seven (7) did not apply Integrated Logistic System indicating 2 that it is still confusing to be applied. All of drug store managers had inadequate knowledge on the concept of procurement, and there were no effective and efficient procurement systems in all the health facilities. In most of the facilities, BIN Cards and Stock ledger books were the most commonly used stock recording systems. . There are no Electronic Drug Recording systems in these facilities. A tedious and bureaurocratic process of expired drug disposal was cited as a reason for pilling up of expired drugs in the health facilities. Percentage time out of stock for the antimalarial drugs were 25% for Artemether-Lumefantrine (ALU) and 25.7% for Quinine tablets and 6.4% for injections All drug stores in the health facilities scored satisfactory marks in adequacy storage conditions and handling of antimalarial medicines. However, all facilities had no cold storage facilities with temperature charts; and medicines were kept directly on the floor in seven (7) out of 9 main drug stores and six (6) out of 15 dispensing rooms. Regarding rational dispensing of medicines, only 22 and 12 of all (32) interviewed drug dispensers had good knowledge on recommended doses and dosage regimen of ALU respectively. Regarding dispensing of ALU in pregnancy as special group, 19 drug dispensers were not able to provide correct information for use of ALU during pregnancy. The average number of drugs prescribed per prescriptions was 2.4±0.014, and 98 % of prescriptions contained only one antimalarial drug, among them 88.9 % was ALU. About 96.9 % of the prescriptions showed wrong prescribing pattern for ALU in terms of its dosage. Despite the government efforts in increasing public awareness of ALU and ensuring constant availability of such drugs at MSD, there is a significant stock-out period due to poor pharmaceutical management of antimalarial medicines in the public health facilities. Although adherence to the national malaria treatment guidelines is satisfactory, there is significant irrational prescribing of antimalarials among the prescribers. Based on these findings, it is proposed that regular on-job training and continuing education should be provided to drug dispensers and prescribers in the public health facilities

Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone

Introduction Disease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results. Methods A qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach. Results 51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation. Conclusion Health systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible

E-learning Technology And Its Impact On Pupils’ Academic Performance In Zambian Rural Schools: A Case Of Zedupad Computer Tablet

A paper presentation at the 3rd East African Multidisciplinary Research Conference (EAMARC III) held at the United States International University- Africa, 15th -17th November, 2016.FOCUS OF THE STUDY ICTs and E-learning in rural schools Effectiveness of specific emerging technologies used in e-learning Availability, impact and sustainability of ZEDUPAD computer tablets on the teaching of Mathematics in rural schools According to Ministry of Labour (2016) Zambia’s population is estimated at 14.98 million 49.1% are males 50.9% being females Population growth rate stands at 2.88%. The majority (66.2%) being those aged less than 24 years while those aged between 25 and 54 are represented by 28.5%. These statistics gives a fast population growth thereby mounting pressure on the provision of quality social amenities such as education and health. Other notable challenges facing Zambia today includes: Early marriages and pregnancies high poverty levels High unemployment rates especially among the youths disease burden such as HIV/AIDS Increased load shading by ZESCO lack of access to clean drinking water, quality education and health Despite such challenges, the Zambian government in partnership with private sector has identified education as one of the sustainable tools that can be used to significantly fight against the above stated problems

Estimation of malaria parasite reservoir coverage using reactive case detection and active community fever screening from census data with rapid diagnostic tests in southern Zambia: a re-sampling approach

In areas where malaria transmission has been suppressed by vector control interventions many malaria control and elimination programmes are actively seeking new interventions to further reduce malaria prevalence, incidence and transmission. Malaria infection prevalence and incidence has been shown to cluster geographically, especially at lower transmission levels, and as such a reactive strategy is frequently used, by which index cases presenting to a passive surveillance system are used to target small areas for testing and treatment, reactive case detection (RCD), or focal drug administration (fDA). This study utilizes geo-located data from a census with parasitological testing with rapid diagnostic tests (RDTs) and treatment-seeking data collection conducted in southern Zambia to estimate the coverage of RCD or fDA in terms of the population and parasite reservoir as well as the operational requirements of such strategies, using a re-sampling algorithm developed exclusively for this purpose. This re-sampling algorithm allows for the specification of several parameters, such that different operational variants of these reactive strategies can be examined, including varying the search radius, screening for fever, or presumptive treatment (fDA).; Results indicate that RCD, fDA and active fever screening followed by RCD, even with search radii over several hundered meters will only yield limited coverage of the RDT positive parasite reservoir during a short period. Long-term use of these strategies may increase this proportion. Reactive strategies detect a higher proportion of the reservoir of infections than random searches, but this effect appears to be greater in areas of low, but not moderate malaria prevalence in southern Zambia.; Increases in the sensitivity of RDTs could also affect these results. The number of individuals and households that need to be searched increase rapidly, but approximately linearly with search radius.; Reactive strategies in southern Zambia yield improved identification of the parasite reservoir when targeted to areas with prevalence less than 10%. The operational requirements of delivering reactive strategies routinely are likely to prevent their uptake until prevalence falls far below this level

Additional file 1: of Assessing the effectiveness of household-level focal mass drug administration and community-wide mass drug administration for reducing malaria parasite infection prevalence and incidence in Southern Province, Zambia: study protocol for a community randomized controlled trial

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