BackgroundAlthough over the counter (OTC) drugs are believed to be relatively safe, their inappropriate use could have serious implications. The aim of the study was to assess the practice of self-medication, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea.MethodsA descriptive cross-sectional study was conducted among 609 customers in 20 pharmacy outlets in Asmara between August and September, 2017. Two-stage cluster sampling was employed and data were collected using a structured questionnaire through face to face exit interviews. Descriptive statistics and multivariate logistic regression were performed using SPSS (version 22).ResultsOf the 609 customers, 93.7% had practiced self-medication with OTC drugs; of which 81.8% were at risky practice. On average, each participant was using OTC drugs at least once a month (Median = 1, IQR = 3.67). Educational level (p < 0.0001), religion (p = 0.047), occupation (p = 0.027) and knowledge regarding OTC drugs (p = 0.019) were significantly associated with risky practice. Respondents with elementary and below educational level were fifteen times (AOR = 15.49, CI: 1.97, 121.80) at higher risk compared to those with higher education, and students were almost three times (AOR = 2.96, CI: 1.13, 7.73) at higher risk than governmental employees. Furthermore, respondents with below average score in knowledge were more likely to be engaged in risky practice (AOR = 1.83, CI: 1.11, 3.04) compared to those with above average score. The most frequently preferred OTC drug group was analgesics (34.3%) followed by antipyretics (15.7%) and cough and cold preparations (14.2%). About 14% of the respondents admitted that they had taken more than the recommended dose and 6.9% had experienced drug related problems following the consumption of OTC drugs. Always, 35% of the respondents read package insert(s) and 73.9% check expiry dates while purchasing OTC drugs. Refrigerating OTC drugs, where it is not recommended, was also one of the prominent risky practices.ConclusionsThis study revealed that inappropriate self-medication practice with OTC drugs was prevalent requiring early intervention to minimize the risks.Electronic supplementary materialThe online version of this article (10.1186/s12889-019-6470-5) contains supplementary material, which is available to authorized users.

Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.

ObjectiveAntimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at deeply understanding, qualitatively, the pharmacy professionals’ perspective on the factors that trigger DAWP and how this practice could be mitigated.DesignA qualitative exploratory study design was employed.SettingDrug retail outlets of Asmara, capital of Eritrea, and pharmaceutical services of Eritrea.ParticipantsThirty pharmacy professionals who were owners and employees of the drug retail outlets stationed in Asmara and six key informants from the pharmaceutical services of all administrative regions of Eritrea, selected purposively, were the study participants.Data collection and analysisThe data were collected using focus group discussions and key informant interviews between March and September 2020. The collected data were transcribed verbatim, translated to English and finally thematically analysed using an inductive approach.ResultsThe main triggering factors were related to the drug retail outlet owners, dispensers, healthcare system and patients. Knowledge and attitude-based motivation, economic interest, inadequate services in health facilities, weak regulatory enforcement, inadequate training, trust and satisfaction of patients, previous successful experience, seriousness of a condition and saving time and money were reported among others as determinants of DAWP.ConclusionsThe triggering factors to DAWP were found to be very complex and some of them were important that might require immediate attention from policymakers. Ensuring readily available and accessible healthcare services, empowering medicines regulation and continuing sensitisation of dispensers are highly recommended to minimise DAWP.

Purpose In Eritrea, a 6-month isoniazid preventive therapy (IPT) was introduced in Eritrea in 2014 to prevent/reduce risk of incident tuberculosis in people living with HIV (PLHIV). The global and local uptake of IPT in newly enrolled PLHIV was reported to be low. Anecdotal reports showed that there was resistance from clinicians against its implementation. This study was therefore conducted to explore the factors that affect implementation of IPT in Eritrea from the perspectives of healthcare professionals. Materials and Methods An exploratory qualitative study that used a framework content analysis using inductive approach was employed. Data were collected from a sample of HIV care clinic prescribers from regional and national referral hospitals through in-depth interviews. Senior program officers were also interviewed as key informants. A conceptual framework model was developed using a root cause analysis. Results Overall, five themes and 13 sub-themes emerged from the in-depth interviews with healthcare professionals and key informants. Several multi-level causes/factors related to the healthcare system, HIV control program, healthcare professionals, patients and the product were identified as barriers to the implementation of IPT. Information gap on IPT and fear of isoniazid-induced liver injury were identified as the main reasons for the reluctance in administering IPT. It was observed that healthcare professionals had significant information gap that resulted in rumors and doubts on the benefits and risks of IPT, which ultimately caused reluctance on its implementation. Inadequate planning and operationalization during the introduction of IPT and inadequate laboratory setups were found to be the possible root causes for the aforementioned central problems. Conclusion The root causes/factors for the limited implementation of IPT in Eritrea were mainly related to the HIV control program and the healthcare system. Adequate planning, operationalization and capacitation of the existing laboratory setups are recommended for a successful implementation of IPT.

Background Despite the growing conventional healthcare coverage in Eritrea, traditional medicine (TM) remains an essential source of healthcare service to the population. This study, therefore, aims at exploring the attitude, societal dependence, and pattern of TM use of the Gash-Barka community. Methods A cross-sectional study was conducted between December 2018 and January 2019 in Gash-Barka region, one of the six regions of Eritrea. Two-stage stratified cluster sampling design was used to provide representative sample of households. The data collected through face-to-face interview using a structured questionnaire was entered twice and analyzed using CSPro7.2 and SPSS 23, respectively. Both descriptive and analytical analyses were performed to test statistical significance. Results Of the total 210 participants, 202 completed the interview with a response rate of 96.2%. Almost 97% of the respondents were aware of the general existence of TM. About half of the respondents (47.4%) had visited traditional health practitioners (THPs) at least once in their lifetime. The majority of the respondents claimed their medical condition had been improved (63.2%), were satisfied with the outcome (76.8%), and had not encountered complications (95.2%) due to TM use. Around 40% of the respondents admitted they do not disclose previous TM use to conventional health practitioners. Females are more likely to have had ever visited THPs (AOR = 1.85, CI: 1.01, 3.38) and use TM in the future (AOR = 2.26, CI: 0.92, 5.14) than males. Moreover, those who had visited THPs before (COR = 8.30, CI: 3.25, 21.20) are more likely to use TM as a primary treatment choice and prefer to use TM in the future (AOR = 4.40, CI: 1.97, 9.83) than those who had never visited THPs. About 61% of the total families claimed they had circumcised at least one female child, and 96.8% disclosed they had circumcised at least one male child. Out of which, 89.2% of the circumcisions were done by THPs. Conclusion TM is popular and widely relayed upon by Gash-Barka residents with exposure of children to harmful TM practices. Since the reliance of the community on TM is expected to continue, further representative studies are recommended to inform regulatory interventions and integrate TM into the health system.

Background: The use of skin lightening agents (SLAs) is common among African females with black skin color. Although they usually contain harmful ingredients and can cause complications, their use remains to be a common practice. This study was conducted to assess the awareness, perception, and utilization of SLAs among females residing in Asmara, Eritrea. Methods: A cross-sectional analytical study using a quantitative approach was conducted in representative samples of all beauty salons available in Asmara from May to July, 2021. The study participants were selected using two-stage stratified cluster sampling and data were collected through a face-to-face interview using a structured questionnaire. Descriptive analysis and logistic regression, at bivariate and multivariate level, were performed. Results:The study enrolled 721 females and 684 completed the study. The majority of the respondents had the perception that SLAs can make someone light colored (84.4%), look beautiful (67.8%), trendy and fashionable (55.0%), and white skin is more attractive than dark skin (58.8%). About two-thirds (64.2%) reported they had previously used SLAs, mainly influenced by friends (60.5%). Approximately 46% were current users, while 53.6% stopped it mainly due to adverse effects, fear of adverse effects and ineffectiveness. A total of 150 products including natural ingredients were mentioned being used to lighten the skin, and Aneeza, Natural face, and Betamethasone containing brands were among the top used products. The occurrence of at least one adverse effect due to the use of SLAs was 43.7%, while 66.5% were satisfied with the use of SLAs. Additionally, employment status and perception of SLAs were found to be determinants of being a current user. Conclusion: Utilization of SLAs, including products containing harmful or medicinal ingredients, was prevalent among the females of Asmara city. Thus, coordinated regulatory interventions are recommended to tackle unsafe practices and raise public awareness to promote the safe use of cosmetics.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) drugs have never been associated with erythrocytosis. In Eritrea, however, several cases of incident erythrocytosis had been observed in the MDR-TB hospital. This study was aimed at exploring the association between MDR-TB drugs and secondary erythrocytosis, characterising the cases, and identifying other possible risk factors.MethodsA retrospective cohort study was conducted in Merhano National Referral MDR-TB hospital. Data were extracted from physically available clinical cards and laboratory results collected longitudinally between 23 June 2011 and 17 January 2021. Initially, univariate descriptive statistics (frequency, mean (SD), median (IQR) and range) were used as appropriate. Then, χ2 or Fisher χ2 test, and bivariate and/or multivariate Cox proportional hazard model were used to identify the predictors of incident erythrocytosis. All statistical analyses were conducted using R, and a two-sided alpha 0.05 was used to determine the statistical significance.ResultsA total of 257 patients’ medical cards were screened, and 219 were eligible for further analysis. The median age of the patients was 38 years (range: 13–90 years) and 54.8% were males. During the follow-up time, 31 (14.2%) patients developed secondary erythrocytosis yielding an incidence rate of 7.8 cases per 1000 person-months. On average, the median time to onset of the event was found to be 5-months (range: 1–24 months). Males were more likely to develop the event than females (adjusted HR=7.13, 95% CI=1.66 to 30.53), and as body weight increases by 1 kg, the likelihood of developing secondary erythrocytosis was found to increase by 7% (adjusted HR=1.07, 95% CI=1.03 to 1.10). Moreover, all cases of secondary erythrocytosis were found to be possibly associated with the MDR-TB drugs.ConclusionThe authors hypothesised that the incident erythrocytosis is possibly be associated with MDR-TB drugs, and further studies are required to substantiate this finding.

Purpose Understanding the integration of pharmacovigilance activities in the healthcare system and identifying existing hindering factors systematically through the eyes of stakeholders has paramount importance to realize a successful integration. Thus, this study aimed to assess the perspectives of the stakeholders of the Eritrean Pharmacovigilance Center (EPC) on the integration of pharmacovigilance activities into the Eritrean healthcare system. Methods An exploratory qualitative assessment of the integration of pharmacovigilance activities into the healthcare system was conducted. Key informant interviews were conducted among the major stakeholders of the EPC via face-to-face and telephone interviews. Data were collected between October 2020 and February 2021, and analyzed through thematic framework analysis. Results A total of 11 interviews were completed. The integration of the EPC in the healthcare system was rated as good and encouraging except in the National Blood Bank, and Health Promotion. The relationship between the EPC and Public health programs was described as mutual with an eminent impact. Several facilitating factors for integration were identified namely: the unique work culture of the EPC; provision of basic and advanced training; motivating and recognizing healthcare professionals in vigilance activities; and the financial and technical support provided to the EPC from national and international stakeholders. On the other hand, the absence of concrete communication systems, inconsistencies in training and communication, the absence of data-sharing mechanisms and policies, and the absence of designated pharmacovigilance focal persons were identified as barriers to successful integration. Conclusion Integration of the EPC in the healthcare system was found to be commendable except in some areas of the healthcare system. Therefore, the EPC should work towards identifying further areas of integration, mitigate the identified limitations and at the same time sustain the integration already initiated.