Adverse Drug Reactions in Selected Wards of the Yangon General Hospital and Yangon Specialty Hospital During the First Quarter of 2019 : An Active Pharmacovigilance Study in Myanmar

Previous studies in Europe and the USA have reported a high prevalence of adverse drug reactions (ADRs), but data on local ADRs in Myanmar are sparse. Our objective was to study ADRs in patients admitted to selected wards of Yangon General Hospital (YGH) and Yangon Specialty Hospital (YSH), Myanmar. This was a prospective observational study in three hospital wards during the first quarter of 2019. Suspected ADRs were carefully investigated in a face-to-face interview with each patient and via review of clinical records. Patients transferred to other wards or discharged were followed-up by the researchers until day 28 after admission. ADRs were divided into those that (1) led to the admission and (2) occurred during the hospital stay or after discharge (up to day 28 after admission). A total of 65 ADRs were identified, with 47 (29.4%) of 160 patients experiencing at least one ADR. Among these, 16 (24.6%) had led to hospital admission and 49 (75.4%) occurred in 31 patients during their hospital stay. Of 160 patients, 21 had taken at least one herbal remedy and six of these developed an ADR. Five ADR-drug associations (hypokalaemia with methylprednisolone, increased transaminase levels with standard antituberculosis drugs, upper gastrointestinal bleeding with nonsteroidal anti-inflammatory drugs, constipation with tramadol, and increased transaminase levels with herbal remedies) represented 18 (27.7%) of the 65 ADRs in this study. According to the Schumock and Thornton preventability scale, more than half of these ADRs (35 [53.9%]) were preventable. The present study highlights the existence of ADRs among patients attending these hospitals. The implementation of active pharmacovigilance in hospitals could be a helpful first step to improving the awareness of unwanted effects of medicines and patient safety, as well as a way to strengthen the national pharmacovigilance system in countries such as Myanmar. The online version of this article (10.1007/s40801-020-00180-0) contains supplementary material, which is available to authorized users

Traumatic Brain Injury in Myanmar: Preliminary Results and Development of an Adjunct Electronic Medical Record

BACKGROUND: The treatment of traumatic brain injury (TBI) in Myanmar is a major health issue. Comprehensive appreciation of the pathology is limited given the lack of granular metadata available. In this proof-of-concept study, we analyzed demographic data on TBI generated from a novel prospective, online database in a low-to-middle income country (LMIC). METHODS: Neurosurgery residents were given an electronic tablet for data entry onto an online database. Metadata-driven data capture was carried prospectively by the trained residents and the information was reviewed weekly by the supervising team in the United States. RESULTS: Complete data was available on 242/253 (96%) patients. Age at admission was 37 years (range 16-85) and length of stay was 3.53 days (1-21). Etiologies included motorcycle accidents, falls, assaults, pedestrian vehicular injuries and industrial accidents. Dispositions were primarily to home (211). Average Glasgow Coma Score (GCS) at admission was 12.97. There was a 68% mortality rate of patients directly admitted to NOGH with GCS75% for patients transferred in from other facilities. Surgery was performed on 30 patients (12.4%). CONCLUSIONS: Despite a lack of formal training in electronic medical records or research, the resident team was able to capture the majority of admissions with granular-level data. This helped shed light on the etiology and severity of TBI in Myanmar. As a result, more effective transport systems and access to trauma care must be achieved. Accessible regional trauma centers with investment in intensive care units, operative care, anesthesia, and imaging resources is necessary