scholarly journals Economic implications of polypharmacy in Nepal: Multicenter community-based study

Author(s):  
Binaya Sapkota ◽  
Suraj Shakya ◽  
Saroj Sah ◽  
Narendra Chaudhary ◽  
Bijendra Tamang ◽  
...  

Objective:Improper management of polypharmacy in community and hospital pharmacies may lead to adverse effects and drug interactions in patients of all age groups, especially children and the elderly. This study aimed to determine the scenario of polypharmacy in multiple communities in Nepal and the costs associated with them. Design: Cross-sectional study Setting:Local communities of nine districts in Nepal Participants:Total 400 patients of all age groups, who were consuming medicines and who fulfilled inclusion criteria from May 2017 to August 2018 Primary and secondary outcome measures:A semi-structured questionnaire, based on the prescription optimization method, was used for data collection. Multinomial logistic regression was performed to analyze the statistical significance of polypharmacy with the predictor variables (e.g., age, education level, occupation, diagnosis, total cost of medicines). The p-value <0.05 was considered statistically significant at 95% confidence interval. Polypharmacy cases and their economic implications were reported. Results:Eighty-one patients (20.3%) with an age group of 22-31 years with female patients (219, 54.8%) reported more polypharmacy events. There were 216 patients (54%) with prescriptions of five medicines i.e., moderate polypharmacy. Total number of medicines consumed by all 400 patients was 2269, with a mean, SD 5.67, 1.08. Total expenditure by all 400 patients was USD 3409.54 during the study period, with a mean, SD 8.66, 6.04. Both moderate and severe polypharmacy cases were non-significantly related with age, gender and total cost of medications. They had significant relationship in almost all levels of education and occupation and showed mixed type of significance and non-significance with the diagnosis of the respondents. Conclusion: Polypharmacy cases can be minimized, considering adverse drug reactions and drug interactions. Further studies are warranted in medication utilization and avoidable polypharmacy along with detailed pharmacoeconomic evaluation.

2014 ◽  
Vol 6 (3) ◽  
pp. 49-57 ◽  
Author(s):  
Fiekumo Igbida Buseri ◽  
Charity Ngozi Okonkwo

Background: This study aims at investigating the seroprevalence of HIV infection among status naive pregnant women and probable vertical transmission in Sokoto, Nigeria.Materials and Methods: This cross-sectional study examined 13,026 apparently healthy pregnant women aged between 14 and 45 years and 312 mother-baby pairs in 4 different hospital settings in Sokoto State, North West, Nigeria between March, 2011 and February, 2013. The babies were aged between 8 and 16 months. HIV screening was performed using qualitative rapid tests and ELISA and HIV-DNA polymerase chain reaction (PCR) techniques. Measurement of CD4+ T-lymphocytes was carried out by the BD FACScount System. All seropositive pregnant women were immediately placed on triple antiretroviral therapy (ART) throughout the duration of the pregnancy and beyond.Results: An overall 2.4% prevalence of HIV-1 infection among the pregnant women and 20.5% incident of mother-to-child transmission were found. Of the seropositive pregnant women, 75.0% were full-time house wives, 13.8% and 11.2% were traders and civil servants respectively; of which, 70.2% were within the ages of 14 and 27 years (youthful predominance). Pearson’s χ2analysis did not show any statistically significant difference in the Mean values in the 4 health facilities (χ2 =2.084, df=3, P-value=0.555). Similarly, no significant difference in HIV seropositivity in the demographic data of the pregnant women were observed (P>0.05). Infection was recorded in all age groups but there was no statistical significance between age groups and infection (P = 0.833). Of the 64 seropositive babies, 62 (92.5%) contracted HIV from antiretroviral therapy non-adherence mothers (χ2 =271.457, df=1, P<0.01), OR=1506.6 (95%CI=285.5-7950.4). Conclusion: This study found high prevalence of vertical transmission due to ART non-adherence. Intervention initiatives should, therefore, focus seriously on ART non-adherence. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11530Asian Journal of Medical Sciences Vol.6(3) 2015 49-57  


2019 ◽  
Vol 7 (11) ◽  
pp. 1879-1883
Author(s):  
Amin Alinezhad ◽  
Molouk Haji Babaei ◽  
Kheirollah Gholami ◽  
Seyed Hamid Khoei

BACKGROUND: Drug interaction is a term used to refer to unfavourable side effects caused by mixing or taking two or more drugs simultaneously. Although it is not possible to identify all drug interactions, awareness of therapeutic team of potential drug interactions, risk factors that enhance the possibility of these interactions and familiarity with mechanisms of drug interactions can help reduce real drug interactions. AIM: The present research seeks to study the frequency and intensity of possible interactions among various age groups and their correlation with doctor’s speciality, time of drug prescription, patient’s gender, etc.MATERIAL AND METHOD: This is observational, cross-sectional research conducted in spring and winter to study the prevalence of drug interactions among 6000 recipes belonging to 2 private and 2 public drug stores. The information associated with recipes was recorded, and drug interactions were studied based upon quick index of interactions using Up to Date software. Quick index of medical interactions is a response to data dealing with how drugs interact with one another. The risk factor is divided into groups A, B, C, D, and X according to this index with each one having its own definition. The data analysis was studied in terms of prevalence type of drug interactions and the possible correlation with other parameters. SPSS v.16 was used for statistical analysis. RESULTS: The average age of the patients was 42.07 ± 21.56 years. The frequency of male patients was 41.7%. An average number of 4.82 ± 1.91 drugs were prescribed for each patient and an average number of 1.95 ± 2.40 drugs had interaction with one another with levels C, D, and X having the following drug interaction levels: 1.60 ± 2.05, 0.275 ± 0.69, and 0.072 ± 0.31. No such interactions were observed in 31.1% (1846 cases) of recipes. The presence of drug interaction was statistically significant in terms of age, season, drug store and speciality of doctor (P-value < 0.05). The average number of interactions in the recipes issued by psychologists, cardiologists, rheumatologist, neurologists, and general practitioners was more, and this result was statistically significant (P-value < 0.05). CONCLUSION: Considering the results achieved in this research, we may conclude that the drug interactions in recipes exhibit a noticeable frequency with the highest frequency observed in level C influenced by factors such as age, season, class of drugs, and expertise of the doctor.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257082
Author(s):  
Binaya Sapkota ◽  
Suraj Chaudhary ◽  
Prakash Gurung ◽  
Anisha Humagain ◽  
Sujan Sapkota

Background The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to explore the need of individualization and optimization of the dose of anti-gout medications among gout patients. Methods Cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and who were taking antigout medications. Patients not taking anti-gout medications and not showing willingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and verified with the BNF 80. Data were analyzed via R 4.0.3 by applying the multinomial logistic regression to analyze statistical significance of risk with various predictors, and considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and medicines were coded according to the WHO Guidelines for ATC classification and DDD assignment 2020. Results The high risk of progression to CKD increased in the age range 54–63 and ≥84 years by 17.77 and 43.02 times, respectively. Also, high risk increased by 29.83 and 20.2 times for the overweight and the obese respectively. Aceclofenac 100mg was prescribed for maximum patients (30.5%). Need of dose individualization was realized in 30 patients, with maximum (7) in case of etoricoxib 90mg. Various glucocorticoids were prescribed for 36.9% patients, out of whom 3.8%required dose individualization and 15.9% patients with xanthine oxidase inhibitors, out of whom 1.3% required dose individualization. Conclusion Thirty cases required dose individualization, which was although minimal but could have meaningful impact on the clinical success of the individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups.


2020 ◽  
Author(s):  
Binaya Sapkota ◽  
Suraj Chaudhary ◽  
Prakash Gurung ◽  
Anisha Humagain ◽  
Sujan Sapkota

AbstractBackgroundThe conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to individualize and optimize the dose of anti-gout medications among gout patients.Methods and findingsBicentric cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and taking antigout medications. Patients not taking anti-gout medications and not showing unwillingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and BNF 80. Data were analyzed via R 4.0.3. Multinomial logistic regression analysis was performed to analyze statistical significance of risk with various predictors, considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and ATC classification of medicines as per the WHO Guidelines for ATC classification and DDD assignment 2020. High risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. High risk of gout increased by 29.83 and 20.2 times for overweight and obese patients respectively. Aceclofenac 100 mg was prescribed for maximum patients (117, 30.5%). Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible). There were 260 (67.7%) cases without associated comorbidities, followed by 37 (9.6%) patients with hyperthyroidism. Various glucocorticoids were prescribed for 141 (36.9%) patients, out of whom 14 (3.8%) required dose individualization. Altogether 61 (15.9%) patients were prescribed with xanthine oxidase inhibitors, out of whom 5 (1.3%) required dose individualization.ConclusionsThirty (8%) cases required dose individualization, which was although minimal but could have meaningful impact on clinical success of individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups. Also, future randomized controlled trials may be based on these to derive a more conclusive evidence base for gout management.Author summaryWhy was this study done?Dosage individualization helps optimize drug selection and dosing based on pathogenesis, mechanism of action of drugs, and their dose exposure-response relationships.Very limited researches have been undertaken in Nepal to individualize medications for chronic medication users including gout patients. The present study was probably the first of its kind in Nepal aiming to individualize the dose of anti-gout medications among gout patients.What did the researchers do and find?Bicentric cross-sectional study was carried out among 384 new gout patients visiting two gout treatment centers in Nepal and taking antigout medications.Doses to be individualized were decided based on standard references of the Renal Drug Handbook and the British National Formulary 80. Dose to be individualized was later discussed with the prescribing physicians.Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible).What do these findings mean?The present simple effort of individualization of antigout medications might help the physicians optimize the therapeutic success for the patients, once they implement it and patients adhere to it.Since the study was limited to only two gout and rheumatic diseases treatment centers, it might not represent the whole gout patients in the nation but it might provide the evidence base for future large controlled clinical trials.


2020 ◽  
Vol 35 (3) ◽  
pp. 287-293
Author(s):  
Daniele dos Santos e Santos ◽  
Vera Ferreira Andrade de Almeida ◽  
Luana de Oliveira Leite ◽  
Edilene Maria Queiroz Araújo ◽  
Fernando Luís de Queiroz Carvalho ◽  
...  

Introduction: Hydrochlorothiazide is one of the drugs used to treat systemic arterial hypertension, a component of metabolic syndrome. The use of this medication is related to nutrient losses such as magnesium, a fact that favors nutritional deficiency for those with inadequate food consumption of this mineral. Thus, this study aimed to assess food intake of magnesium in patients with metabolic syndrome, who use hydrochlorothiazide. Methods: This is a cross-sectional, analytical-descriptive, retrospective study, carried out in a nutrition school clinic in Salvador–BA, in which the evaluation of the magnesium food consumption of 35 patients was made, according to the values established by the Dietary Reference Intake, and according to sex, age group, education, family income and polypharmacy therapy. Data analysis was performed considering statistical significance when p-value ≤0.05. Results: The average magnesium food consumption found was 188.02 ± 93.9 mg and the percentage of inadequacy according to Estimated Average Requirement and Recommended Dietary Allowances was 80% and 85.7%, respectively. The average food consumption revealed higher results for: men (197.22 ± 27.7 mg) compared to women (186.83 ± 99.5 mg) (p=0.652); adults aged 20 to 39 years (195.69 ± 139.6 mg) compared to other age groups (p=0.935); those who attended high school (205.95 ± 102.5 mg) compared to other schooling (p=0.490); those who had a family income of up to 1 minimum wage (207.06 ± 107.2 mg) compared to other family incomes (p=0.640); and those who used polypharmacy (204.08 ± 104.4 mg) compared to those who did not use it (174.50 ± 84.5 mg) (p=0.371). However, these findings were not statistically significative and all were below the established reference values. Conclusions: The results found revealed an inadequate food intake of magnesium. There is a need to adopt nutritional strategies to encourage the consumption of foods containing magnesium for patients with metabolic syndromic.


2019 ◽  
Author(s):  
Bashayer Hassan Shuaib ◽  
Rahaf Hisham Niazi ◽  
Ahmed Haitham Abduljabbar ◽  
Mohammed Abdulraheem Wazzan

BACKGROUND Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. OBJECTIVE This study aimed to discover and compare the awareness level of radiation doses, protection issues, and risks among radiology staff in Jeddah hospitals. METHODS A cross-sectional survey containing 25 questions on personal information and various aspects of radiation exposure doses and risks was designed using an online survey tool and the link was emailed to all radiology staff in eight tertiary hospitals in Jeddah. The authors were excluded from the study. A P-value of < .05 was used to identify statistical significance. All analyses were performed using SPSS, version 21. RESULTS Out of 156 participants the majority 151 (96.8%) had poor knowledge score, where the mean scores were 2.4±1.3 for doses knowledge, 2.1±1.1for cancer risks knowledge, 2.3±0.6 for general information, and 6.7±1.9 for the total score. Only 34.6% of the participants were aware of the dosage of a single-view chest x-ray, and 9.0% chose the right answer for the approximate effective dose received by a patient in a two-view. 42.9% were able to know the correct dose of CT abdomen single phase. There is a significant underestimation of cancer risk of CT studies especially for CT abdomen where only 23.7% knew the right risk. A p-value of <0.05 was used to identify statistical significance. No significant difference of knowledge score was detected regarding gender (P =.2) or work position (P=.66). CONCLUSIONS Our survey results show considerable inadequate knowledge in all groups without exception. We recommended a conscientious effort to deliver more solid education and obtain more knowledge in these matters and providing periodic training courses to teach how to minimize the dose of radiation and to avoid risk related. CLINICALTRIAL not applicable


2019 ◽  
Author(s):  
Chanda Chalela

BACKGROUND ABSTRACT Introduction a study on prevalence of ITN use was carried out in Buchi community Kitwe Zambia from August to October 2019 OBJECTIVE Prevalence of ITN in BUchi METHODS Methodology: This was a cross sectional study design. A structured questionnaire was used to ascertain ownership and utilization and oral interviews, 200 households were targeted 844 individual covered across the 200 households. Data was analyzed with SPSS version 23. RESULTS ABSTRACT Introduction a study on prevalence of ITN use was carried out in Buchi community Kitwe Zambia from August to October 2019 Methodology: This was a cross sectional study design. A structured questionnaire was used to ascertain ownership and utilization and oral interviews, 200 households were targeted 844 individual covered across the 200 households. Data was analyzed with SPSS version 23. Findings: household ownership of at least an ITN was 52% and individual utilization at 37.6%, with 0.825 ITN/households and 0.195ITN /individual. Malaria prevalence of 52.4% /household and a 12.4% of the population. With 47.6% malaria patient coming from households with ITN and 60% of households with ITN have insufficient coverage.61% of malaria patient were female and 31 % male. however there was no significant relation between Gender and malaria prevalence in study area (p value was >0.05). Malaria cases distribution with age groups, 0-15yrs old represented 49.5%, 16-30 yrs., was at 27.6% and the over 30 yrs. case were at 22.9% .use of other preventive measures 23% used mosquito repellent ,others methods 1% with those not using any other methods 76%. CONCLUSIONS Conclusion The study showed clearly that malaria still poses a problem .the prevalence rate of malaria was still high 12.4% of the population and 52.4% of households. With high prevalence of malaria of 49.5% for 0-15yrs.the difference between ownership 52% and Utilization 37.6% showed that even household with ITN, the ITN were not sufficient.60% of households with ITN, the ITN were not sufficient for all occupants


2021 ◽  
pp. 026010602098234
Author(s):  
Gizachew Worku Dagnew ◽  
Melash Belachew Asresie

Background: Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas. Aim: This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia. Methods: For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance. Results: The prevalence of overweight/obesity among urban reproductive-age women was statistically higher ( p = 21.5%; 95% confidence interval (CI): 18.2–25.1) than the rural women ( p = 3.5%; 95% CI: 2.9%–4.2%). Women who attend secondary or above education, women in the age groups 25–34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women. Conclusions: Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women’s overweight/obesity.


BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e043365
Author(s):  
Subhasish Das ◽  
Md. Golam Rasul ◽  
Md Shabab Hossain ◽  
Ar-Rafi Khan ◽  
Md Ashraful Alam ◽  
...  

IntroductionWe conducted a cross-sectional survey to assess the extent and to identify the determinants of food insecurity and coping strategies in urban and rural households of Bangladesh during the month-long, COVID-19 lockdown period.SettingSelected urban and rural areas of Bangladesh.Participants106 urban and 106 rural households.Outcome variables and methodHousehold food insecurity status and the types of coping strategies were the outcome variables for the analyses. Multinomial logistic regression analyses were done to identify the determinants.ResultsWe found that around 90% of the households were suffering from different grades of food insecurity. Severe food insecurity was higher in urban (42%) than rural (15%) households. The rural households with mild/moderate food insecurity adopted either financial (27%) or both financial and food compromised (32%) coping strategies, but 61% of urban mild/moderate food insecure households applied both forms of coping strategies. Similarly, nearly 90% of severely food insecure households implemented both types of coping strategies. Living in poorest households was significantly associated (p value <0.05) with mild/moderate (regression coefficient, β: 15.13, 95% CI 14.43 to 15.82), and severe food insecurity (β: 16.28, 95% CI 15.58 to 16.97). The statistically significant (p <0.05) determinants of both food compromised and financial coping strategies were living in urban areas (β: 1.8, 95% CI 0.44 to 3.09), living in poorest (β: 2.7, 95% CI 1 to 4.45), poorer (β: 2.6, 95% CI 0.75 to 4.4) and even in the richer (β: 1.6, 95% CI 0.2 to 2.9) households and age of the respondent (β: 0.1, 95% CI 0.02 to 0.21).ConclusionBoth urban and rural households suffered from moderate to severe food insecurity during the month-long lockdown period in Bangladesh. But, poorest, poorer and even the richer households adopted different coping strategies that might result in long-term economic and nutritional consequences.


2020 ◽  
Vol 7 (1) ◽  
pp. 23-36
Author(s):  
Bhuwan Kumari Dangol ◽  
Narbada Thapa

Management is a process of planning, decision making, organizing, leading, motivating and controlling, and an effective utilization of the resources to reach the organizational goals efficiently and effectively. Management has a crucial role in quality of work and production in any institutions. Although a rapid increase of Nursing Education Institutions in Nepal since last decade which had been trained thousands of nursing cadres, the management aspects of these institutions are not studied adequately. Thus current study intended to explore the current status of Nursing Education Institution Management as experienced and perceived by the bachelors nursing students. A descriptive cross-sectional study was conducted among the nursing institutions in Kathmandu valley. Of the total 28 in the valley, 14 were selected purposively. From the selected institutions, all 377 eligible students currently in final year of study were selected. Among them, 208were from BSN and 169 were from B Sc program.  The data was collected through the self administered structured questioners after taking informed consent. Data entry and analysis was done in SPSS version 16 software. The findings of the study show that 70% students were satisfied in institutional management (mean59.62, SD ± 3.66). In academic management (78%), (mean139.82, SD ± 6.22), followed by human resources 67%, (mean43.54, SD ± 2.79) and were in physical resources management 75% students were satisfied (mean45.02, SD ± 3.08). Analysis of variations between group (administrators, faculties, students) found statistical significance (p value <0.05). So it is concluded the perception of students, faculties and administrator were different on managing the nursing education.


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