Background: Medicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. Methods: A qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants’ idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data. Results: Almost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier’s issuing of medicines without health facilities’ needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision. Conclusion: Medicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities.

Background: Tuberculosis remains the major public health problem besides tremendous efforts to combat it. Most tuberculosis patients are treated with a standard dose of first-line anti-TB drugs. The cure rate, however, varies from patient to patient. Various factors have been related to anti-TB treatment failure. In recent years, studies associating lower plasma concentrations of anti-TB drugs with poor treatment outcomes are emerging although the results are inconclusive. Objective: Investigate the impact of first-line anti-tubercular drugs pharmacokinetics on treatment outcome. Methods: A systematic search of Pubmed, EMBASE, Web of Science, and the Cochrane Library for articles published in the English language between January 2010 to June 2020 was conducted to identify eligible studies describing associations of first-line anti-tubercular drug pharmacokinetics with treatment outcomes. The primary outcomes considered were pharmacokinetics parameter results and its association with treatment outcome. Results: The search identified 1754 articles of which twelve articles; ten prospective observational studies and two controlled clinical trials fulfilled the eligibility criteria. The majority of the studies showed target concentrations for the first-line anti-tubercular drugs below the current standard range. Among the twelve studies, eleven studies assessed rifampicin pharmacokinetics of which eight reported association of drug concentration and treatment outcomes. Similarly, four out of eight and three out of seven reported drug concentration and treatment outcome association for isoniazid and pyrazinamide, respectively. Despite the low plasma concentration, a favorable treatment outcome was achieved for the bulk of the patients. Irrespective of the inconsistency, an increase in exposure to rifampicin improved the outcome, and lower rifampicin, isoniazid, and pyrazinamide concentration are associated with poor outcome. No data are available for ethambutol associating its pharmacokinetics with treatment outcomes. Conclusion: The pharmacokinetics of first-line antitubercular drugs can influence treatment outcomes. Further controlled clinical studies are, however, required to establish these relationships.

Background: Breast cancer is the most common cancer among women and it affects quality of life of those women. So far, the two most frequently used tools for assessing health related quality of life in breast cancer patients, EORTC QLQ-C30 and EORTC QLQ-BR23 modules, were not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tools among Ethiopian breast cancer patients. Methods: Institutional based longitudinal study was conducted from January 1 to May 1, 2017 GC at only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. A total of 146 patients who visited the facility during that period, with no missing quality of life data, were selected for analysis. The psychometric properties of the EORTC QLQ-C30 and EORTC QLQ-BR23 were evaluated in terms of reliability, convergent, divergent, construct and clinical validity using SPSS version 22. Results: Satisfactory internal consistency reliability (Cronbach’s α coefficients > 0.7) was confirmed, except for cognitive function (α = 0.516) of EORTC QLQ-C30 and body image (α = 0.510) of EORTC QLQ-BR23. Multiple-trait scaling analysis demonstrated a good convergent and divergent validity. No scaling errors were observed. Most items in EORTC QLQ-BR23 possessed a weak or no correlation with its own dimension in EORTC QLQ-C30 (r < 0.4) except with some of symptom scales. A statistically significant chemotherapy induced quality of life scores changes (P ≤ 0.05) were observed in all dimensions of both instruments between baseline and the end of first cycle chemotherapy, except for body image (P = 0.985) and sexual enjoyment (P = 0.817) of EORTC QLQ-BR23, indicating clinical validity. Conclusion: Amharic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 modules are valid and adequately reliable tool and can be used for clinical and epidemiological cancer researches to study the health related quality of life (HRQoL) of women with breast cancer in Ethiopia.

Background: Stroke is becoming a leading cause of death and adult disability in the developing world. Objective: The objective of the study was to assess the clinical characteristics, treatment outcomes, and its predictors among stroke patients admitted to Ambo University Referral Hospital (AURH), West Ethiopia. Methods: All 111 stroke patients hospitalized from April 2016 to May 2019 were included using a hospital-based retrospective study. Socio-demographic profile, past medication history, clinical presentation, drugs prescribed for comorbid condition and stroke treatment, and outcomes data were collected using data abstraction formats and results were summarized using both descriptive and inferential statistics. Key Findings: According to WHO clinical criteria, 89 (80.2%) were diagnosed with ischemic stroke, and 20 (18.0%) were diagnosed with hemorrhagic stroke. The majority of the patients 94 (84.7%) had at least one antecedent risk factor in which hypertension accounted for 44.1%. More than half, 69 (62.2%), of hospitalized stroke patients had good treatment outcomes while 42 (37.8%) had a poor outcome. The overall case-fatality rate was 18 (16.2%), 12 (13.5%) from ischemic stroke, and 6 (30.0%) from hemorrhagic stroke. Acetyl salicylic acid (ASA) with atorvastatin/simvastatin, 67 (73.5%) in ischemic stroke and 12 (60.0%) in hemorrhagic stroke, was the most frequent medications prescribed for stroke during admission while it was frequently prescribed for 48 (53.6%) of ischemic stroke and 10 (50.0%) of the hemorrhagic stroke on discharge. Overall, ceftriaxone + metronidazole 32 (28.8%) was frequently prescribed concomitant medications during admission. The major predictors identified for poor stroke outcomes were substance abuse (AOR=2.839, P=0.024) and have had not received any medication for stroke treatment during admission (AOR=12.503, P≤ 0.001). Conclusion: A significant number of the admitted stroke patients had poor treatment outcome in which the case-fatality rate was relatively high. Substance abuse and having not received medication for stroke were the significant predictors for poor treatment outcome. Hence, a well-established stroke unit setup at AURH is required for accurate diagnosis and management of stroke to overcome stroke-related mortality and/or poor treatment outcome.

Background: The irrational use of medicines is a worldwide problem increasing morbidity, mortality and costs through increasing adverse medicine reactions and hence patients are not achieving their desired outcomes. In Ethiopia, although there are studies that show the presence of irrational use of medicines in the country, there is limited objective evidence on evaluating medicine use from prescriber, patient and health facility perspectives. Therefore, the objective of this study was to evaluate rational medicine of the improved asphalt were contrasted together with each other as well as with the perspicuous asphalt. Conclusions Methods: Retrospective and prospective cross sectional study were employed to collect data from prescriptions dispensed through main pharmacies and Information for patients respectively. A structured questionnaire was employed to collect information from prescription papers and respondents after obtaining a verbal consent. Data was entered, cleaned, edited and analyzed using SPSS Version 23.0 statistical software package. Results: The average number of medicines prescribed per encounter was 1.74. The% of encounters in which an antibiotic and injection was prescribed was 48.9% and 12.6% respectively. The mean consultation time spent between the prescriber and patient was 5.12 minutes and the mean pharmacy dispensing time was 1.28 minutes. The availability of selected tracer medicines in the health facilities was 79.6%. Conclusion: The study identified that the pattern of prescribing was appreciable and nearly similar with WHO standard reference. However, the patient care factors needs to be improved.

Background: Deprescribing is essential for reducing inappropriate medication use and polypharmacy. For a holistic approach, it is essential to know how older adult patients and their caregivers perceive deprescribing. Objective: To assess the attitude of older adult patients and caregivers towards deprescribing medication at Ambo University Referral Hospital. Methodology: Institutional-based cross-sectional study was conducted using the revised Patients’ Attitude Towards Deprescribing tool (rPATD). The data was analyzed using the SPSS-25 software. Backward linear regression and logistic regression were used to measure association between outcome and determinant variables. The two-sided P-value ≤ 0.05 with 95% confidence interval was utilized for reporting significant factors. Results: One hundred fifty-six (81.3%) of the respondents (ie, 85.0% of older adult and 77.2% of caregivers) agreed to stop one or more of their regular medications if the physician said it was possible despite 98 (51.0%) of them (ie, 49.0% of older adult and 53.3% of caregivers) being satisfied with their/their care recipient’s medications. On the overall aggregate mean score, the respondents had a neutral position (2.6– 3.59) regarding the burden and concerns of stopping medications whereas the majority of them disagree (1.0– 2.59) with the inappropriateness of the medication they were taking and agreed (3.6– 5.0) with the need for their involvement in treatment decision making. Concerns about stopping medicine scores (AOR = 0.440, 95% CI = 0.262– 0.741, P = 0.035) and perceived levels of medication inappropriateness (AOR = 0.653, 95% CI = 0.456– 0.936, P = 0.020) was significantly associated with the willingness to discontinue and overall satisfaction with their medicine regimen respectively. Conclusion: The majority of older adult patients and caregivers would like to deprescribe if the physicians recommended it. The perceived concerns of stopping and inappropriateness of the medicines were associated with the willingness to deprescribe and overall satisfaction with their medicine respectively. Healthcare providers should prompt the deprescribing process with older adult patients and caregivers by addressing their concerns about stopping medications.