Evaluating the availability of essential drugs for hypertension, diabetes and asthma in rural Rwanda, 2018

SETTING: Hypertension, diabetes mellitus and asthma are on the rise in developing countries, including Rwanda; there is thus a need to ensure uninterrupted drug availability.OBJECTIVES: To assess 1) the frequency and duration of drug stock-outs; 2) lead time duration 3) monthly stock levels; and 4) drug quantities requested vs. quantity delivered for captopril, metformin and inhaled salbutamol between January and December 2018 Kirehe District, Rwanda.DESIGN: This was a cross-sectional study using secondary programme data.RESULTS: The median annual stock-outs for captopril, metformin and inhaled salbutamol were respectively 4 (IQR 3–4), 3 (IQR 2–3) and 4 (IQR 4–5) at rural health facilities (RHCs); no stock-outs occurred at the district hospital. For all three drugs, the median lead time was 7.5 days (IQR 5.5–11.5) at the hospital vs. 5 days (IQR 3–6) in RHCs. Stock status for captopril was below the 4-week minimum stock level for 2/12 months at the hospital vs. 7/12 months at the RHCs, while metformin and inhaled salbutamol were below the 4-week minimum stock levels for respectively 1/12 and 4/12 months at both hospital and RHCs. Total drug quantities delivered were less than the combined total quantities requested in respectively 8/12, 5/12 and 8/12 months for captopril, metformin and inhaled salbutamol.CONCLUSION: There is a need to regularly and effectively monitor drug stock levels and ensure timely and sufficient stock replenishment to avert stock-outs.

Recognising and managing an acute asthma attack

Asthma is a potentially life-threatening condition, characterised by a reversible narrowing of the airways. It affects 1 in 10 children in the UK. During exacerbations, it is difficult for the child to breathe and get enough oxygen into their blood. There is a huge variance in the severity of an attack. Some can be managed in the community while others are potentially fatal and need urgent transfer to hospital. For that reason, criteria have been created to categorise attacks as mild, moderate, severe or life threatening. Initially, an asthma attack should be treated using inhaled salbutamol; however, if the patient does not respond or has severe or life-threatening asthma, they need urgent transfer to hospital.

Efficacy of Inhaled Salbutamol in the Management of Transient Tachypnoea of Newborn

Objective: To compare the outcome of salbutamol nebulization with controls (normal saline) in transient tachypnea of newborn. Methods: In this randomized controlled trial 284 (142 in each group) neonates were included with gestational age above 35 weeks of any gender. Study was conducted in Department of Pediatrics Holy Family Hospital Rawalpindi. Sampling technique was consecutive non probability sampling. Duration of study was 6 months. Sample size had been calculated using WHO calculator; Significance level 5%, Power of test 80%, Population mean 5.4, Test value of population mean 4.8, Standard Deviation 1.8. At admission complete blood picture, C-reactive protein and chest x-ray were done. Group-1 received salbutamol nebulization at a dose of 0.15mg / kg / dose for 10 minutes in 2ml normal saline QID while Group-2 received only normal saline nebulization 2ml QID in 24 hours. Double blinding was ensured and in case of any side effects of salbutamol (tachycardia, arrhythmias and hypoglycemia) treatment was stopped immediately and managed accordingly. Results: In this study, comparison of outcome of inhaled salbutamol with controls in transient tachypnea of newborn shows that respiratory rate per minute was 50.15+2.34 in Group-1 and 64.92+2.70 in Group-2, p value was 0.0001, heart rate per minute in Group-1 was recorded as 120.08+2.36 and 134.79+3.27 in Group- 2, p value was 0.0001, oxygen saturation(%) was 97.27+0.92 in Group-1 and 83.28+1.81 in Group-2, p value was 0.0001, duration of oxygen therapy(hours) was recorded as 15.49+1.84 in Group-1 and 27.78+5.57 in Group-2, value of p was 0.0001, duration of hospitalization(days) was recorded as 2.03+0.45 in Group-1 and 5.07+0.72 in Group-2 while value of P was 0.0001 Conclusion: Salbutamol Nebulization is more effective than normal saline in TTN. Key Words: Transient Tachypnea of newborn, management, inhaled salbutamol, outcome.