Background:Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved.Aims:The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia.Patients and Method:The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic.Result:Oral hypoglycemic agent were prescribed for 351(91.4) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%). About 312 (88.9%) patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3%) and metformine 80(25.7%). Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1%) followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied.Conclusion:Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.

AIM: Adverse drug reaction is noxious and unwanted reaction to drugs at dose used in humans for diagnosis, treatment or prophylaxis. Adverse drug reaction monitoring is an area of drug information that has been given little attention yet. Spontaneous reporting is currently the major back bone for the detection of adverse drug reactions. The objective of this study was to assess the knowledge, attitude and practices of adverse drug reaction reporting among health professionals in selected health facilities in southwest Ethiopia. METHOD: A cross-sectional study design was used among health professionals in selected health facilities in January 2010. Prescribers other than physicians, junior pharmacy technicians and also health assistants were excluded. Data was collected using self administered questionnaires from volunteered physicians (Medical interns and above), nurses (Diploma and above) and Pharmacy professionals (Diploma and above) and analyzed using SPSS version 16.0. RESULTS: A total of 82 health professionals were participated in the study. From those 82 participants, only 19 (23.17%) and 21 (25.61%) knew the existence of national reporting system and a yellow card of adverse drug reaction reporting form. Thirteen (15.85%) participants encountered adverse drug reaction in the past 12 months in their clinical activities, but none of them reported to responsible body. Even though the participants’ knowledge and practice were inadequate, most of the respondents 47 (57.31%) agreed that adverse drug reaction reporting is part of duty of them and important to the public in general and to the patient in particular. CONCLUSION: There was no documentation and reporting of adverse drug reaction, which might partly be explained by lack of knowledge and misconceptions about spontaneous reporting. Our study strongly suggests that there is a great need to create awareness and to promote the reporting of adverse drug reaction amongst health professionals, which will lay a solid foundation for healthcare professionals to be diligently involved in quality pharmacovigilance and spontaneous reporting in their future practices. [TAF Prev Med Bull 2012; 11(4.000): 397-406

Background:To benefit from therapy and to avoid contracting treatment resistant strains, the individuals must adhere to medications.Aim:The study was designed to assess the degree of drug adherence and its determinants in patients living with HIV/AIDS and TB comorbidity.Materials and Methods:A cross-sectional study was conducted to assess the degree of drug adherence and its determinants with the help of self-administered questionnaires in Tercha District Hospital in South Ethiopia.Result:A total of 24 patients were included in the study. The majority were females (54.2%) and the mean age was 32.4 (SD±9.6) years. Adherence level was 95.8% for Antiretroviral (ARV) medications and 79.2% for anti TB medications. Educational status was associated with anti TB (P=0.021) medication adherence. The reason for the missed doses were mostly lack of money for transport (23.7% for antiretroviral therapy (ART), 26.0% for TB treatment) and forgetting to take medications (18.4% for ART, 17.4% for TB treatment.Conclusion:The adherence level obtained for both ARV and anti-TB where high. Transportation costs for patients could be reduced by bringing the services close to where they live.

IntroductionTreat-to-target (T2T) strategies using a protocol of pre-defined adjustments of disease-modifying anti-rheumatic drugs (DMARDs) according to disease activity improve outcomes for patients with rheumatoid arthritis (RA). However, successful implementation may be limited by deviations from the protocol. The aim of this study was to determine the prevalence of protocol deviation, explore the reasons and identify subsets of patients in whom treatment protocols are more difficult to follow.MethodsIn this retrospective cohort study, treatment-naïve patients with RA of less than one year’s duration, attending a dedicated early arthritis clinic between 2001 and 2013, were followed for three years from initiation of combination therapy with conventional DMARDs which was subsequently modified according to a T2T protocol. At each clinic visit, whether deviation from the protocol occurred, the type of deviation and the reasons for deviation were assessed. The relationship between protocol deviations and baseline variables was determined using linear regression analysis.ResultsIn total, 198 patients contributed 3,654 clinic visits. The prevalence of protocol deviations was 24.5% and deviation in at least at one clinic visit was experienced by 90.4% of patients. The median time to first deviation was 30 weeks. Continuing existing treatment rather than intensifying therapy was the most common type of deviation (59.9%). Patient and physician related factors were the most common reasons for deviation, each accounting for 24.7% of deviations, followed by toxicities (23.3%) and comorbidities (20.0%). The prevalence of protocol deviations was lower among patients who achieved remission after three years (13.1%; 162 deviations out of 1,228 visits) compared with those who were not in remission (30.9%; 523/1692) (P <0.0001). On multivariate analysis, only body mass index (P = 0.003) and helplessness score (P = 0.04) were independent predictors of protocol deviations although the predictive power of the model was not strong (R2 = 0.17).ConclusionsDeviation from a T2T protocol occurred in one quarter of visits, indicating that applying the T2T approach is feasible in clinical practice. Failure to escalate dose when indicated was commonly encountered, and just under half of the observed deviations were related to either toxicities or comorbidities and were therefore justifiable on clinical grounds.

Catha edulis (khat) is a plant grown commonly in the horn of Africa. The leaves of khat are chewed by the people for its stimulant action. Khat is an evergreen shrub, which is cultivated as a bush or small tree. The leaves have an aromatic odour. The taste is astringent and slightly sweet. The plant is seedless and hardy, growing in a variety of climates and soils. Khat contains more than 40 alkaloids, glycosides, tannins, amino acids, vitamins and minerals. Many different compounds are found in khat including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins and minerals. The phenylalkylamines and the cathedulins are the major alkaloids which are structurally related to amphetamine. The major effects of khat include those on the gastro-intestinal system and on the nervous system. Constipation, urine retention and acute cardiovascular effects may be regarded as autonomic (peripheral) nervous system effects; increased alertness, dependence, tolerance and psychiatric symptoms as effects on the central nervous system. The main toxic effects include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men. The purpose of this review is to summarize the chemistry, pharmacology, toxicology of khat (Catha edulis Forsk).