Improving rational drug use in Africa: the example of Sudan

Awad, Abdelmoneim; Ball, Douglas E.; Eltayeb, I. B.

doi:10.26719/2007.13.5.1202

Cited by 31 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this category of patients, we also observed tendency towards higher use of oral AS+SP in children while use of injectable artemether was more common for older children and adults, the finding reflecting previous report from Khartoum where irrational injectable therapy under the chloroquine policy was common and indeed prevailing in adults [26]. Injectable antimalarials have a long history in Sudan [26,34] and may be due to a combination of factors including the lack of appropriate training of health workers, lack of public education and patients' demands and beliefs. Future educational and supervisory interventions targeting health workers, as well as those targeting the broader public, should urgently address the problem of inappropriate use of injectable artemether.…”

Section: Discussionsupporting

confidence: 84%

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

et al. 2012

View full text Add to dashboard Cite

BackgroundEffective malaria case-management based on artemisinin-based combination therapy (ACT) and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy.MethodsA cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result.ResultsWe evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 < 5 years and 1,218 ≥ 5 years). Health facility and health worker readiness was variable: chloroquine was available at only 5% of facilities, 73% stocked recommended artesunate and sulfadoxine/pyrimethamine (AS+SP), 51% had the capacity to perform parasitological diagnosis, 53% of health workers had received in-service training on ACTs, 24% were trained in the use of malaria Rapid Diagnostic Tests, and 19% had received a supervisory visit including malaria case-management. At all health facilities 46% of febrile patients were parasitologically tested and 35% of patients were both, tested and treated according to test result. At facilities where AS+SP and malaria diagnostics were available 66% of febrile patients were tested and 51% were both, tested and treated according to test result. Among test positive patients 64% were treated with AS+SP but 24% were treated with artemether monotherapy. Among test negative patients only 17% of patients were treated for malaria. The majority of ACT dispensing and counseling practices were suboptimal.ConclusionsFive years following change of the policy from chloroquine to ACTs and 3 years before the end of the new malaria strategic plan chloroquine was successfully phased out from public facilities in Sudan, however, an important gap remained in the availability of ACTs, diagnostic capacities and coverage with malaria case-management activities. The national scale-up of diagnostics, using the findings of this survey as well as future qualitative research, should present an opportunity not only to expand existing testing capacities but also to implement effective support interventions to bridge the health systems gaps and support corrective case-management measures, including the discontinuation of artemether monotherapy treatment.

show abstract

Section: Discussionsupporting

confidence: 84%

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

et al. 2012

View full text Add to dashboard Cite

show abstract

“…This is consistent with the evidence of inappropriate prescribing and dispensing practices, as well as inadequate patient knowledge, reported in hospitals and health centers in the country [3].…”

Section: Introductionsupporting

confidence: 90%

User satisfaction with services provided by a drug information center in Sudan

Fathelrahman

Awang

Bashir³

et al. 2008

Pharm World Sci

View full text Add to dashboard Cite

show abstract

“…In the performed studies, education, drug policies and practical guidelines and therapeutic protocols were estimated to be effective in improving the status of rational prescription (20). In the present study, both groups criticized the incompetent inspectoral system with regard to unclear policies and criteria for rational prescription, poor compilation and notification of national therapeutic guidelines, lack of active supervision of drug prescription and use of persuasive/punitive methods.…”

Section: Resultsmentioning

confidence: 99%

Reasons for physicians' tendency to irrational prescription of corticosteroids

Yousefi¹,

Majdzadeh²,

Valadkhani³

et al. 2012

Iran Red Crescent Med J

View full text Add to dashboard Cite

BackgroundAccording to World Health Organization (WHO) estimation, more than half of all pharmaceutical products are inappropriately prescribed, distributed, and sold and more than half of all patients use the medicines prescribed for them incorrectly. As more than 40% of therapeutic costs are pharmaceutical costs, this implies a significant waste of health resources in the world.ObjectivesTo find effective factors in irrational prescription of corticosteroids in Iran and design suitable interventions to decrease prescription rates of corticosteroids.Materials and MethodsA qualitative study was performed in 2009 on fifteen general practitioners in two groups identified by high and low corticosteroid prescription rates. Data analysis was performed by thematic analysis and the study's validity was based on training interviewers, use of interview guide, avoidance of imposing opinions, coding by two independent persons and use of all opinions obtained in the analysis.ResultsThe effective factors in irrational prescription of corticosteroids can be divided into four categories: lack of knowledge, patient-physician relationship in terms of monetary cost, poor availability of proper alternative medicines and weak supervision of regulatory bodies. As the same results were found in both groups regarding the role of regulatory organizations and availability of alternative medicines, it seems that interventions in knowledge and the patient-physician relationship which were different in the two groups can be more effective for reduction of prescription in high rate prescribers although intervention in regulatory supervision and medicine availability could have a moderate effect in both groups. In addition the common feature in all the above categories was the gap between knowledge and actual practice which is significant on three regulatory levels, supervisors, physicians and patients, and should be noted for intervention design.ConclusionsThe interventions applied in other countries can also be effective in decreasing irrational prescription of corticosteroids in Iran. These interventions include: standard clinical guidelines, essential medicines list, practical workshops, purposeful training based on problem-solving, training of all parties including pharmacists and patients, improved regulatory mechanisms, availability of assured quality medicines, availability of suitable alternatives to painkillers and realistic rational prescription policy.

show abstract

Improving rational drug use in Africa: the example of Sudan

Cited by 31 publications

References 0 publications

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

User satisfaction with services provided by a drug information center in Sudan

Reasons for physicians' tendency to irrational prescription of corticosteroids

Contact Info

Product

Resources

About